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Zaver HB, Rajpal N, Shah NL, Argo CK. MELD and MELD 3.0- What it means for your practice. Am J Gastroenterol 2024:00000434-990000000-01066. [PMID: 38477457 DOI: 10.14309/ajg.0000000000002748] [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: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Himesh B Zaver
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Zaver HB, Patel T. Opportunities for the use of large language models in hepatology. Clin Liver Dis (Hoboken) 2023; 22:171-176. [PMID: 38026124 PMCID: PMC10653579 DOI: 10.1097/cld.0000000000000075] [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: 04/12/2023] [Accepted: 06/05/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Himesh B. Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Tushar Patel
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
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Zaver HB, Ghoz H, Malviya B, Bali A, Antwi S, Moyer AM, Bi Y. Pilot Study: Personalized Medicine in Endoscopy, Can Pharmacogenomics Predict Response to Conscious Sedation? J Pers Med 2023; 13:1107. [PMID: 37511720 PMCID: PMC10381361 DOI: 10.3390/jpm13071107] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Adequate response to moderate (conscious) sedation varies significantly between individuals. Polymorphisms in genes encoding drug metabolizing enzymes can lead to inter-individual variability in drug efficacy, potentially influencing sedation requirements during endoscopic procedures. OBJECTIVES The aim of this study was to assess the potential role of inter-individual variation in inherited polymorphisms of drug-metabolizing enzymes, cytochrome P450 (CYP450), specifically CYP3A4 and CYP3A5, in sedation requirements for outpatient endoscopic procedures. METHODS A retrospective analysis of sedation requirements and pharmacogenomics data in 106 unique patients who received outpatient esophagogastroduodenoscopy (EGD), colonoscopy, or both between December 2011 and February 2019 was conducted. Patients were divided into two groups based on their sedation requirements during endoscopy (high vs. normal sedation). RESULTS Patients with reduced a CYP2C19 metabolism (poor + intermediate metabolizers) (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.16-0.91, p = 0.03), poor CYP3A5 metabolism (OR = 0.25, 95% CI: 0.095-0.65, p = 0.0046), and poor UGT1A1 (OR = 2.76, 95% CI: 1.07-7.13, p = 0.08) had higher odds of requiring normal sedation compared to those with CYP2C19 increased metabolism, CYP3A5 intermediate metabolism, and UGT1A1 intermediate metabolism. CONCLUSION Information about inter-individual variation in (CYP450) genes may be useful for determining the sedation requirements for outpatient endoscopic procedures. We found that patients with reduced CYP2C19 metabolism, poor CYP3A5 metabolism, and poor UGT1A1 metabolism were more likely to require normal sedation requirements during outpatient endoscopic procedures.
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Affiliation(s)
- Himesh B. Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Hassan Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA (Y.B.)
| | - Balkishan Malviya
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA (Y.B.)
| | - Aman Bali
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Samuel Antwi
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Ann M. Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA (Y.B.)
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Saleh H, Ho BT, Call JT, Plante MM, Zaver HB, Powers HR, Metcalfe AM, Graham CG, Lewis MD. Severe Mpox Proctitis Complicated by Bowel Obstruction. ACG Case Rep J 2023; 10:e01048. [PMID: 37168504 PMCID: PMC10166331 DOI: 10.14309/crj.0000000000001048] [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: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
Mpox is a rare infection caused by the zoonotic orthopoxvirus. We present the case of a 44-year-old man with HIV and a history of kidney transplant who presented with mpox and developed proctitis-associated bowel obstruction, urinary retention, and eosinophilia. Our case highlights potential gastrointestinal manifestations of severe mpox infection.
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Affiliation(s)
- Hasan Saleh
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Bao T. Ho
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Justin T. Call
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Marie M. Plante
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - Himesh B. Zaver
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Harry R. Powers
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
| | | | | | - Michele D. Lewis
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
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Zaver HB, Mzaik O, Thomas J, Roopkumar J, Adedinsewo D, Keaveny AP, Patel T. Utility of an Artificial Intelligence Enabled Electrocardiogram for Risk Assessment in Liver Transplant Candidates. Dig Dis Sci 2023; 68:2379-2388. [PMID: 37022601 PMCID: PMC10077316 DOI: 10.1007/s10620-023-07928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Post-operative cardiac complications occur infrequently but contribute to mortality after liver transplantation (LT). Artificial intelligence-based algorithms based on electrocardiogram (AI-ECG) are attractive for use during pre-operative evaluation to screen for risk of post-operative cardiac complications, but their use for this purpose is unknown. AIMS The aim of this study was to evaluate the performance of an AI-ECG algorithm in predicting cardiac factors such as asymptomatic left ventricular systolic dysfunction or potential for developing post-operative atrial fibrillation (AF) in cohorts of patients with end-stage liver disease either undergoing evaluation for transplant or receiving a liver transplant. METHODS A retrospective study was performed in two consecutive adult cohorts of patients who were either evaluated for LT or underwent LT at a single center between 2017 and 2019. ECG were analyzed using an AI-ECG trained to recognize patterns from a standard 12-lead ECG which could identify the presence of left ventricular systolic dysfunction (LVEF < 50%) or subsequent atrial fibrillation. RESULTS The performance of AI-ECG in patients undergoing LT evaluation is similar to that in a general population but was lower in the presence of prolonged QTc. AI-ECG analysis on ECG in sinus rhythm had an AUROC of 0.69 for prediction of de novo post-transplant AF. Although post-transplant cardiac dysfunction occurred in only 2.3% of patients in the study cohorts, AI-ECG had an AUROC of 0.69 for prediction of subsequent low left ventricular ejection fraction. CONCLUSIONS A positive screen for low EF or AF on AI-ECG can alert to risk of post-operative cardiac dysfunction or predict new onset atrial fibrillation after LT. The use of an AI-ECG can be a useful adjunct in persons undergoing transplant evaluation that can be readily implemented in clinical practice.
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Affiliation(s)
- Himesh B Zaver
- Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Obaie Mzaik
- Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jonathan Thomas
- Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Joanna Roopkumar
- Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Andrew P Keaveny
- Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Tushar Patel
- Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Daoud ND, Ghoz H, Mzaik O, Zaver HB, McKinney M, Brahmbhatt B, Woodward T. Endoscopic Management of Luminal Strictures: Beyond Dilation. Dig Dis Sci 2022; 67:1480-1499. [PMID: 35212884 DOI: 10.1007/s10620-022-07396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/19/2022]
Abstract
Luminal strictures can occur as part of many different gastrointestinal (GI) disorders anywhere along the GI tract and affect all age groups. The end goal of managing any stricture is to re-establish an adequate and durable luminal patency that is sufficient to resolve the presenting clinical symptoms. Treatment options can be generally categorized into medical, endoscopic, and surgical. However, within each of these categories, multiple different options are available. Therefore, choosing the best treatment modality is often challenging and depends on multiple factors including the type, location, and complexity of the stricture, as well as the preference of the treating physician. In this article, we will review the most current literature regarding foregut strictures, particularly esophageal and gastric, beyond dilation.
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Affiliation(s)
- Nader D Daoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Hassan Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Obaie Mzaik
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Himesh B Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Micah McKinney
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Timothy Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Zaver HB, Koop AH, Aqel BA, Palmer WC. Hereditary hemochromatosis and liver transplantation: A survey of symptoms, lifestyle, and physician counseling pre- and post-transplant. Clin Res Hepatol Gastroenterol 2022; 46:101898. [PMID: 35235879 DOI: 10.1016/j.clinre.2022.101898] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Himesh B Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
| | - Andree H Koop
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Bashar A Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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Zaver HB, Moktan VP, Harper EP, Bali A, Nasir A, Foulks C, Kuhlman J, Green M, Algan GA, Parth HC, Wu-Ballis M, DiCicco S, Smith BT, Owen RN, Mai LS, Spiros SL, Griffis J, Ramsey Walker DT, Hata DJ, Oring JM, Powers HR, Bosch W. Reduction in Health Care Facility-Onset Clostridioides difficile Infection: A Quality Improvement Initiative. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1066-1074. [PMID: 34820598 PMCID: PMC8599925 DOI: 10.1016/j.mayocpiqo.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To reduce health care facility–onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. Patients and Methods A multidisciplinary team conducted a quality improvement initiative from January 1, 2020, through March 31, 2021. Clostridioides difficile infection and inappropriate testing were identified via electronic health records using predefined criteria related to stool quantity/caliber, confounding medications, and laboratory data. An intervention bundle was designed including (1) provider education, (2) implementation of an appropriate testing algorithm, (3) expert review of C difficile orders, and (4) batch testing of assays to facilitate review and cancellation if inappropriate. Results Compared with a baseline period from January to September 2020, implementation of our intervention bundle from December 2020 to March 2021 resulted in an 83.6% reduction in inappropriate orders tested and a 41.7% reduction in HCFO CDI incidence. Conclusion A novel prevention bundle improved C difficile diagnostic stewardship and HCFO CDI incidence by reducing testing of inappropriate orders. Such initiatives targeting HCFO CDI may positively affect patient safety and hospital reimbursement.
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Key Words
- ATA, appropriate testing algorithm
- CDC, Centers for Disease Control and Prevention
- CDI, Clostridioides difficile infection
- CMS, Centers for Medicare & Medicaid Services
- COVID, coronavirus disease
- HAI, health care–associated infection
- HCFO, health care facility–onset
- IDSA, Infectious Diseases Society of America
- IPAC, infection prevention and control
- PCR, polymerase chain reaction
- QI, quality improvement
- SIR, standardized infection ratio
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Affiliation(s)
- Himesh B Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Varun P Moktan
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Eugene P Harper
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Aman Bali
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Ayan Nasir
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Carla Foulks
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Justin Kuhlman
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Max Green
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Gillian A Algan
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Heather C Parth
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | | | - Sandra DiCicco
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Brenda T Smith
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Ronald N Owen
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Lorraine S Mai
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Sarah L Spiros
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - John Griffis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | | | - D Jane Hata
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | - Justin M Oring
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL.,Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
| | - Harry R Powers
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL.,Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
| | - Wendelyn Bosch
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL.,Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
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Zaver HB, Ghoz H, Malviya BJ, Brahmbhatt B, Palmer WC, Lacy BE, DeVault KR, Krishna M, Bi Y. Lymphocytic Esophagitis: Assessing Risk Factors and Clinical Outcomes. Dig Dis Sci 2021; 66:3976-3984. [PMID: 33216240 DOI: 10.1007/s10620-020-06706-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/02/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lymphocytic esophagitis is a rare esophageal condition. Our knowledge of potential risk factors and treatment outcomes of lymphocytic esophagitis is limited. AIM To investigate potential risk factors associated with the development of lymphocytic esophagitis and compare clinical characteristics and treatment outcomes of patients diagnosed with lymphocytic esophagitis to patients diagnosed with eosinophilic esophagitis. METHODS This is a multicenter retrospective study. Lymphocytic esophagitis patients were identified based on pathology results between 1997 and 2019. Control groups consisted of patients with normal esophageal biopsies and patients diagnosed with eosinophilic esophagitis. Thirteen potential risk factors for lymphocytic esophagitis were analyzed using univariate and multivariate models including IBD, achalasia, hyperlipidemia, hypothyroidism, celiac sprue, CVID, H. pylori, thymoma, aspirin, opioids, ACE-I, metformin, and statin use. Comparative statistics were performed. RESULTS Ninety-four adult patients with lymphocytic esophagitis, 344 with eosinophilic esophagitis, and 5202 control patients with normal esophageal biopsies were analyzed. Age older than 60 [adjusted odd ratio (AOR) 1.03, 95% CI 1.02-1.05, p = 0.001], aspirin use (2.7, 95% CI 1.4-4.9, p = 0.001), statin use (2.2, 95% CI 1.2-4.2, p = 0.01), or a diagnosis of achalasia (2.4, 95% 1.08-5.67, p = 0.03) were associated with lymphocytic esophagitis. Compared to eosinophilic esophagitis, lymphocytic esophagitis patients were more likely to respond to medical treatment (95% CI 2.54-12.8, p = 0.0001). CONCLUSIONS Our data suggests that lymphocytic esophagitis is more likely to be found in older female patients and is significantly associated with achalasia, statin, and aspirin use. Compared to eosinophilic esophagitis, lymphocytic esophagitis is more likely to respond to treatment with medical therapy.
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Affiliation(s)
- Himesh B Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Hassan Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Balkishan J Malviya
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Kenneth R DeVault
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Murli Krishna
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Zaver HB, Ghoz H, Stancampiano F, Alnahhal KI, Malviya B, Patel K, Rodriguez AC, Oberoi M, Koralewski A, Crawford MJ, Choudhry A, Mareth K, Werlang ME, Kroner PT, Simons-Linares CR, Lukens F, Bartel MJ, Stark M, Brahmbhatt B. Risk of bleeding following double balloon enteroscopy in patients on continued antiplatelet and/or anticoagulation therapy. Endosc Int Open 2021; 9:E1397-E1403. [PMID: 34466365 PMCID: PMC8382496 DOI: 10.1055/a-1499-6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/25/2021] [Indexed: 11/03/2022] Open
Abstract
Background and study aims Anticoagulation (AC) and antiplatelet (AP) therapy may increase the risk of gastrointestinal bleeding after double balloon enteroscopy (DBE); however, limited data are currently available regarding the incidence. The aim of this study was to assess the incidence and clinical characteristics of post-DBE bleeding in patients on AC and AP therapy. Patients and methods The medical records of patients who underwent DBE between 2009 and 2013 at Mayo Clinic, Florida, were retrospectively reviewed. Patients were divided into three groups: 1) continued AP therapy; 2) AC therapy; and 3) neither AP nor AC at the time of DBE. Follow-up data were collected at 60 days and 1 year. Results A total of 683 patients were identified; 43 on AC, 183 on AP and 457 not on AP or AC therapy. The most common indication for DBE was obscure gastrointestinal bleeding in the groups on and not on AP (85.3 % vs 70.9 %, P < 0.0001). There was no statistical difference in post-DBE bleeding rates in patients on AP vs not on AP at 60 days (11.5 % vs 7.5 %, P = 0.12) or 1 year (19.9 % vs 15.7 %, P = 0.23). Rates of bleeding in patients on AC were 11.6 % within 60 days and 22.5 % within 1 year. Multivariate analysis reflected American Society of Anesthesiologist > 3 and indication for DBE of GI bleeding were independent risk factors for post-DBE bleeding within 1 year. Conclusions Continued antiplatelet use at the time of DBE was not an independent risk factor for bleeding post-DBE at 60 days or 1 year of follow up.
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Affiliation(s)
- Himesh B. Zaver
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Hassan Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Khaled I. Alnahhal
- Division of Vascular Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Balkishan Malviya
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Krupa Patel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Andrea C. Rodriguez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Mansi Oberoi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Andrea Koralewski
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Matthew J. Crawford
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Aruj Choudhry
- Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States
| | - Karl Mareth
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Monia E. Werlang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Paul T. Kroner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Frank Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Michael J. Bartel
- Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States
| | - Mark Stark
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
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Wijarnpreecha K, Ungprasert P, Panjawatanan P, Harnois DM, Zaver HB, Ahmed A, Kim D. COVID-19 and liver injury: a meta-analysis. Eur J Gastroenterol Hepatol 2021; 33:990-995. [PMID: 32639420 PMCID: PMC8162043 DOI: 10.1097/meg.0000000000001817] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 05/10/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS The number of cases with coronavirus disease 2019 (COVID-19) has exceeded seven million worldwide. However, the data describing the global prevalence of liver injury associated with COVID-19 is lacking secondary to the novelty of this ongoing pandemic. Therefore, we conducted a meta-analysis to determine the association between COVID-19 and liver injury. METHODS A systematic literature search of indexed databases including, PubMed, Medline, and Embase databases from inception to 14 April 2020, was used to identify studies that reported data of liver chemistry in patients diagnosed with COVID 19. The overall prevalence of abnormal liver chemistry and relevant 95% confidence interval was used to estimate the pooled results studies. RESULTS Sixty-four studies with 11 245 patients with COVID-19 were included. The pattern of abnormal liver enzymes was notable for higher aspartate aminotransferase (AST) than alanine aminotransferase (ALT) levels. The overall global prevalence of elevated AST, ALT, total bilirubin, gamma-glutamyltransferase (GGT), and alkaline phosphatase was 23.2, 21.2, 9.7, 15.0, and 4.0%, respectively. The prevalence of elevated AST was substantially higher among those with severe cases (45.5%) compared to non-severe cases (15.0%). Co-existing chronic liver disease presented up to 37.6% of patients with COVID-19. CONCLUSION A fourth of COVID-19 patients had elevated liver enzymes and associated with disease severity. Our study may be used as a guide for clinicians and epidemiologists to proactively identify other sources of injury and illness in patients diagnosed with COVID-19. Intensive monitoring for liver injury may be needed in cases with severe COVID-19.
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Affiliation(s)
- Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | | | - Denise M. Harnois
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Himesh B. Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Department of Medicine, Stanford, California, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Department of Medicine, Stanford, California, USA
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Zaver HB, Ghoz HM, Palmer WC. 31-Year-Old Woman With Diarrhea. Mayo Clin Proc 2021; 96:e1-e6. [PMID: 33413840 DOI: 10.1016/j.mayocp.2020.05.050] [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: 03/07/2020] [Revised: 04/23/2020] [Accepted: 05/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Himesh B Zaver
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Hassan M Ghoz
- Fellow in Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - William C Palmer
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL.
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