1
|
Barnes EL, Agrawal M, Syal G, Ananthakrishnan AN, Cohen BL, Haydek JP, Al Kazzi ES, Eisenstein S, Hashash JG, Sultan SS, Raffals LE, Singh S. AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders. Gastroenterology 2024; 166:59-85. [PMID: 38128971 DOI: 10.1053/j.gastro.2023.10.015] [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] [Indexed: 12/23/2023]
Abstract
BACKGROUND & AIMS Pouchitis is the most common complication after restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. This American Gastroenterological Association (AGA) guideline is intended to support practitioners in the management of pouchitis and inflammatory pouch disorders. METHODS A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, conduct an evidence synthesis, and develop recommendations for the prevention and treatment of pouchitis, Crohn's-like disease of the pouch, and cuffitis. RESULTS The AGA guideline panel made 9 conditional recommendations. In patients with ulcerative colitis who have undergone ileal pouch-anal anastomosis and experience intermittent symptoms of pouchitis, the AGA suggests using antibiotics for the treatment of pouchitis. In patients who experience recurrent episodes of pouchitis that respond to antibiotics, the AGA suggests using probiotics for the prevention of recurrent pouchitis. In patients who experience recurrent pouchitis that responds to antibiotics but relapses shortly after stopping antibiotics (also known as "chronic antibiotic-dependent pouchitis"), the AGA suggests using chronic antibiotic therapy to prevent recurrent pouchitis; however, in patients who are intolerant to antibiotics or who are concerned about the risks of long-term antibiotic therapy, the AGA suggests using advanced immunosuppressive therapies (eg, biologics and/or oral small molecule drugs) approved for treatment of inflammatory bowel disease. In patients who experience recurrent pouchitis with inadequate response to antibiotics (also known as "chronic antibiotic-refractory pouchitis"), the AGA suggests using advanced immunosuppressive therapies; corticosteroids can also be considered in these patients. In patients who develop symptoms due to Crohn's-like disease of the pouch, the AGA suggests using corticosteroids and advanced immunosuppressive therapies. In patients who experience symptoms due to cuffitis, the AGA suggests using therapies that have been approved for the treatment of ulcerative colitis, starting with topical mesalamine or topical corticosteroids. The panel also proposed key implementation considerations for optimal management of pouchitis and Crohn's-like disease of the pouch and identified several knowledge gaps and areas for future research. CONCLUSIONS This guideline provides a comprehensive, patient-centered approach to the management of patients with pouchitis and other inflammatory conditions of the pouch.
Collapse
Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Manasi Agrawal
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Gaurav Syal
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio
| | - John P Haydek
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elie S Al Kazzi
- Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio
| | - Samuel Eisenstein
- Division of Colorectal Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Jana G Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Shahnaz S Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| |
Collapse
|
2
|
Haydek JP, Scott FI. Editorial: the impact of COVID on management of IBD flares-different care but similar outcomes. Aliment Pharmacol Ther 2023; 57:154-155. [PMID: 36480717 DOI: 10.1111/apt.17259] [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: 12/13/2022]
Affiliation(s)
- John P Haydek
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
3
|
Haydek JP, Scott FI. Editorial: progress towards more comprehensively understanding the sources of corticosteroids for patients with IBD. Aliment Pharmacol Ther 2022; 56:896-897. [PMID: 35934853 DOI: 10.1111/apt.17137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John P Haydek
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
4
|
Affiliation(s)
- John P Haydek
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
5
|
Lovasik BP, Haydek JP, Rutledge H, Lawson E, Buchter DS, Delman KA, Dressler DD. Clinical Case-Conference Blogs: Integrating Clinical Librarians to Enhance Resident Education and Enforce ACGME Competencies. Med Sci Educ 2021; 31:375-380. [PMID: 34457895 PMCID: PMC8368700 DOI: 10.1007/s40670-021-01229-7] [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] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 06/13/2023]
Abstract
Resident conferences are primary educational endeavors for trainees and faculty alike. We describe the development of collaborative clinician-librarian educational blogs within the Internal Medicine (2009), Pediatrics (2012), and General Surgery (2018) residency programs. Clinical librarians attended resident conferences and generated evidence-based blog posts based on learning topics and clinical questions encountered during the conferences. In the decade since introduction of the blogs, this partnership has resulted in over 2000 blog posts and generated over 1800 individual views per month. The development of a clinical librarian-managed blog serves as a relevant resource for promoting evidence-based practices within a case-based learning curriculum, engages interdisciplinary collaboration through existing resources, and is generalizable across various clinical practice disciplines and trainees.
Collapse
Affiliation(s)
- Brendan P. Lovasik
- Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - John P. Haydek
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Hannah Rutledge
- Biomedical Library, University of Pennsylvania, Philadelphia, PA USA
| | - Emily Lawson
- Woodruff Health Sciences Library, Emory University, Atlanta, GA USA
| | - D. Susie Buchter
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Keith A. Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - Daniel D. Dressler
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| |
Collapse
|
6
|
Binder AK, Haydek JP, Parihar S, Modlin CE, Tannu M, Aldredge A, Sueblinvong V. Slow on the Uptake, Progression to Heartbreak. J Investig Med High Impact Case Rep 2020; 8:2324709620936832. [PMID: 32583694 PMCID: PMC7318803 DOI: 10.1177/2324709620936832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The prevalence of serotonin syndrome increases over the past several years as more serotonergic medications are being used in clinical practice. It is a potentially lethal condition caused by excessive serotonergic activity. Common causes of serotonin syndrome are the use of prescription medications, illicit drugs, or a combination of substances, leading to an increase in the activity of serotonin in the central and peripheral nervous system. The clinical symptoms range from mild to severe. We report a case of a 25-year-old woman with polysubstance abuse, including cocaine, who presented with confusion, rigidity, high-grade fever, and reduced biventricular function on echocardiogram. Based on the combination of substance used history, clinical presentation, and echocardiogram findings, she was diagnosed with serotonin syndrome complicated by takotsubo cardiomyopathy. She improved after being treated in the intensive care unit and was discharged from the hospital. This patient demonstrates the importance of recognizing and promptly initiating management of serotonin syndrome in order to improve morbidity and mortality.
Collapse
|
7
|
Ben-Yakov G, Alao H, Haydek JP, Fryzek N, Cho MH, Hemmati M, Samala V, Shovlin M, Dunleavy K, Wilson W, Jones EC, Rotman Y. Development of Hepatic Steatosis After Chemotherapy for Non-Hodgkin Lymphoma. Hepatol Commun 2019; 3:220-226. [PMID: 30766960 PMCID: PMC6357828 DOI: 10.1002/hep4.1304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/01/2018] [Indexed: 12/17/2022] Open
Abstract
Nonalcoholic fatty liver disease is the most common liver disorder in the developed world. Although typically reflecting caloric overload, it can also be secondary to drug toxicity. We aimed to describe the incidence and risk factors for de novo steatosis during chemotherapy for non‐Hodgkin lymphoma (NHL). In this retrospective case‐control study, adult patients with NHL were treated with rituximab, cyclophosphamide, doxorubicin, prednisone, and vincristine (R‐CHOP) or R‐CHOP + etoposide (EPOCH‐R). Patients with liver disease or steatosis were excluded. Abdominal computed tomography was performed pretreatment and at 3‐ to 6‐month intervals and reviewed for steatosis. Patients with de novo steatosis were matched 1:1 to controls by age, sex, and ethnicity. Of 251 treated patients (median follow‐up 53 months), 25 (10%) developed de novo steatosis, with the vast majority (23 of 25; 92%) developing it after chemotherapy. Of those, 14 (61%) developed steatosis within the first 18 months posttreatment and 20 (87%) within 36 months. Cases had higher baseline body mass index (BMI; mean ± SD, 29.0 ± 6.5 versus 26.0 ± 5.2 kg/m2; P = 0.014) and hyperlipidemia (12% versus 2%; P = 0.035). Although their weights did not change during chemotherapy, BMI in cases increased by 2.4 ± 2 kg/m2 (mean ± SD) from end of treatment to steatosis compared to 0.68 ± 1.4 in controls (P = 0.003). Etoposide‐containing regimens were associated with a shorter time to steatosis (median 34 weeks versus 154 weeks; P < 0.001) despite similar baseline risk factors. Conclusion: The recovery period from NHL chemotherapy appears to be a “hot spot” for development of fatty liver, driven by early posttreatment weight gain, especially in subjects with baseline risk factors.
Collapse
Affiliation(s)
- Gil Ben-Yakov
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Hawwa Alao
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD.,Department of Gastroenterology Louis Stokes VA Medical Center Cleveland OH
| | - John P Haydek
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Nancy Fryzek
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Min Ho Cho
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD.,Department of Medicine MedStar Washington Hospital Center Washington DC
| | - Mehdi Hemmati
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD.,Department of Medicine MedStar Health Baltimore MD
| | - Vikram Samala
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Margaret Shovlin
- Lymphoid Malignancies Branch, Center for Cancer Research National Cancer Institute, National Institutes of Health Bethesda MD
| | - Kieron Dunleavy
- Lymphoid Malignancies Branch, Center for Cancer Research National Cancer Institute, National Institutes of Health Bethesda MD
| | - Wyndham Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research National Cancer Institute, National Institutes of Health Bethesda MD
| | - Elizabeth C Jones
- Radiology and Imaging Sciences National Institutes of Health Clinical Center Bethesda MD
| | - Yaron Rotman
- Liver and Energy Metabolism Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| |
Collapse
|
8
|
DeSimone AK, Haydek JP, Sudduth CL, LaBarbera V, Desai Y, Reinertsen E, Manning KD. Encouraging Student Interest in Teaching Through a Medical Student Teaching Competition. Acad Med 2017; 92:1128-1132. [PMID: 28746135 PMCID: PMC5705937 DOI: 10.1097/acm.0000000000001491] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Clinician educators have realized the value not only of assigning teaching roles to medical students but also of offering explicit training in how to teach effectively. Despite this interest in the development of medical students' teaching skills, formal teaching instruction and opportunities for practice are lacking. APPROACH To encourage medical student interest in teaching, the authors developed and implemented a medical student teaching competition (MSTC) at Emory University School of Medicine during the summers of 2014, 2015, and 2016. Each year, eight student finalists were each paired with a physician "teaching coach" and given one month to prepare for the MSTC. During the competition, each finalist delivered an eight-minute presentation to a panel of seven physician and resident judges. The authors describe the development, implementation, and assessment of the MSTC. OUTCOMES Approximately 150 medical students and faculty members attended the MSTC each year. The students in attendance felt that the MSTC made them more likely to seek out opportunities to learn how to teach effectively and to practice teaching. Additionally, some students are now more interested in learning about a career in academic medicine than they were before the MSTC. NEXT STEPS Given the need for more formal initiatives dedicated to improving the teaching skills of doctors-in-training, including medical students, innovative solutions such as the MSTC may enhance a medical school's existing curriculum and encourage student interest in teaching. The MSTC model may be generalizable to other medical schools.
Collapse
Affiliation(s)
- Ariadne K DeSimone
- A.K. DeSimone is a first-year resident, Transitional Year Program, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.J.P. Haydek is a first-year categorical resident, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.C.L. Sudduth is a first-year categorical resident, Department of Surgery, Oregon Health and Science University, Portland, Oregon.V. LaBarbera is a first-year resident, Preliminary Medicine Program, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.Y. Desai is a fourth-year medical student, Emory University School of Medicine, Atlanta, Georgia.E. Reinertsen is a fifth-year MD/PhD student, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, Georgia.K.D. Manning is associate professor, Department of Medicine, Emory University School of Medicine, program director, Transitional Year Program, Department of Medicine, Emory University School of Medicine, and attending physician, Grady Health System, Atlanta, Georgia
| | | | | | | | | | | | | |
Collapse
|
9
|
Tauxe WM, Haydek JP, Rebolledo PA, Neish E, Newman KL, Ward A, Dhere T, Kraft CS. Fecal microbiota transplant for Clostridium difficile infection in older adults. Therap Adv Gastroenterol 2016; 9:273-81. [PMID: 27134658 PMCID: PMC4830097 DOI: 10.1177/1756283x15622600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The objective of this study was to describe the safety of fecal microbiota transplant (FMT) for Clostridium difficile infection (CDI) among older adults. METHODS We performed a case review of all FMT recipients aged 65 or older treated at Emory University Hospital, a tertiary care and referral center for Georgia and surrounding states. RESULTS CDI resolved in 27 (87%) of 31 respondents, including three individuals who received multiple FMTs. Among four whose CDI was not resolved at follow up, three respondents did well initially before CDI recurred, and one individual never eradicated his CDI despite repeating FMT. During the study, five deaths and eight serious adverse events requiring hospitalization were reported within the study group during the follow-up period. Fecal transplant was not a causative factor in these events. The most common adverse event reported in 4 (13%) of 31 respondents was subjective worsening of arthritis. CONCLUSION FMT is a generally safe and effective treatment option for older adults with CDI.
Collapse
Affiliation(s)
| | | | - Paulina A. Rebolledo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kira L. Newman
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Tanvi Dhere
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | | |
Collapse
|
10
|
Valette D, Lian Y, Haydek JP, Hardcastle KI, Davies HML. Alkynoate synthesis through the vinylogous reactivity of rhodium(II) carbenoids. Angew Chem Int Ed Engl 2012; 51:8636-9. [PMID: 22807172 PMCID: PMC3580044 DOI: 10.1002/anie.201204047] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 06/14/2012] [Indexed: 11/06/2022]
Abstract
Siloxy group migration: A rhodium(II) carbenoid approach has been developed for the synthesis of alkynoates. This transformation combines the addition of enol ethers at the vinylogous position of β-siloxy-substituted vinyldiazo derivatives with a siloxy group migration to give the products as single diastereomers.
Collapse
Affiliation(s)
- Damien Valette
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA)
| | - Yajing Lian
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA)
| | - John P. Haydek
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA)
| | - Kenneth I. Hardcastle
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA)
| | - Huw M. L. Davies
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA)
| |
Collapse
|
11
|
Valette D, Lian Y, Haydek JP, Hardcastle KI, Davies HML. Alkynoate Synthesis through the Vinylogous Reactivity of Rhodium(II) Carbenoids. Angew Chem Int Ed Engl 2012. [DOI: 10.1002/ange.201204047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Damien Valette
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA) http://www.chemistry.emory.edu/
| | - Yajing Lian
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA) http://www.chemistry.emory.edu/
| | - John P. Haydek
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA) http://www.chemistry.emory.edu/
| | - Kenneth I. Hardcastle
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA) http://www.chemistry.emory.edu/
| | - Huw M. L. Davies
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, GA 30322 (USA) http://www.chemistry.emory.edu/
| |
Collapse
|