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Solanki S, Kichloo A, Dahiya DS, Solanki D, Singh J, Wani F, Albosta M, Ghimire S, Haq KF, Khan HM, Jafri SM, Siddiqui MA, Zuchelli T. Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: Analysis of Trends and Outcomes From the National Inpatient Sample Database. J Clin Gastroenterol 2022; 56:618-626. [PMID: 34107514 PMCID: PMC9257052 DOI: 10.1097/mcg.0000000000001573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/06/2021] [Indexed: 01/28/2023]
Abstract
GOALS We aimed to assess outcomes of patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to determine whether these patients had different outcomes relative to patients without cirrhosis. BACKGROUND ERCP is an important procedure for treatment of biliary and pancreatic disease. However, ERCP is relatively technically difficult to perform when compared with procedures such as esophagogastroduodenoscopy or colonoscopy. Little is known about how ERCP use affects patients with liver cirrhosis. STUDY Using patient records from the National Inpatient Sample (NIS) database, we identified adult patients who underwent ERCP between 2009 and 2014 using International Classification of Disease, Ninth Revision coding and stratified data into 2 groups: patients with liver cirrhosis and those without liver cirrhosis. We compared baseline characteristics and multiple outcomes between groups and compared outcomes of diagnostic versus therapeutic ERCP in patients with cirrhosis. A multivariate regression model was used to estimate the association of cirrhosis with ERCP outcomes. RESULTS A total of 1,038,258 hospitalizations of patients who underwent ERCP between 2009 and 2014 were identified, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. Of the patients with cirrhosis, 21,835 (69.8%) received therapeutic ERCP and 9459 (30.2%) received diagnostic ERCP. Patients with cirrhosis had more ERCP-associated hemorrhages (2.5% vs. 1.2%; P <0.0001) compared with noncirrhosis patients but had lower incidence of perforations (0.1% vs. 0.2%; P <0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P <0.0001). Cholecystitis was the same between groups (2.3% vs. 2.3%; P <0.0001). In patients with cirrhosis, those who received therapeutic ERCP had higher post-ERCP pancreatitis (7.9% vs. 5.1%; P <0.0001) and ERCP-associated hemorrhage (2.7% vs. 2.1%; P <0.0001) but lower incidences of perforation and cholecystitis (0.1% vs. 0.3%; P <0.0001) and cholecystitis (1.9 vs. 3.1%; P <0.0001) compared with those who received diagnostic ERCP. CONCLUSIONS Use of therapeutic ERCP in patients with liver cirrhosis may lead to higher risk of complications such as pancreatitis and postprocedure hemorrhage, whereas diagnostic ERCP may increase the risk of pancreatitis and cholecystitis in patients with cirrhosis. Comorbidities in cirrhosis patients may increase the risk of post-ERCP complications and mortality; therefore, use of ERCP in cirrhosis patients should be carefully considered, and further studies on this patient population are needed.
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Affiliation(s)
- Shantanu Solanki
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton
| | - Asim Kichloo
- Departments of Medicine
- Department of Medicine, Central Michigan University College of Medicine, Saginaw
| | - Dushyant S. Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Saginaw
| | | | - Jagmeet Singh
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton
| | - Farah Wani
- Family Medicine, Samaritan Medical Center, Watertown, NY
| | - Michael Albosta
- Department of Medicine, Central Michigan University College of Medicine, Saginaw
| | | | - Khwaja F. Haq
- Department of Gastroenterology, Henry Ford Hospital, Detroit, MI
| | - Hafiz M.A. Khan
- Department of Gastroenterology, Guthrie Robert Packer Hospital, Sayre, PA
| | | | | | - Tobias Zuchelli
- Department of Gastroenterology, Henry Ford Hospital, Detroit, MI
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Kichloo A, Solanki S, Haq KF, Dahiya D, Bailey B, Solanki D, Singh J, Albosta M, Wani F, Aljadah M, Shah H, Khan H, Jafri SM. Association of non-alcoholic fatty liver disease with gallstone disease in the United States hospitalized patient population. World J Gastrointest Pathophysiol 2021; 12:14-24. [PMID: 33815863 PMCID: PMC8008957 DOI: 10.4291/wjgp.v12.i2.14] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/27/2020] [Accepted: 01/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gallstones and cholecystectomy have been proposed as risk factors for non-alcoholic fatty liver disease (NAFLD). The reason for this may be that both gallstones, as well as NAFLD share several risk factors with regards to their development. Currently, there is a lack of sufficient evidence showing an association between these clinical conditions. AIM To determine whether there is a meaningful association between gallstones and cholecystectomy with NAFLD. METHODS We queried the National Inpatient Sample database from the years 2016 and 2017 using International Classification of Diseases, 10th revision, Clinical Modification diagnosis codes to identify hospitalizations with a diagnosis of gallstone disease (GSD) (includes calculus of gallbladder without cholecystitis without obstruction and acquired absence of gallbladder) as well as NAFLD (includes simple fatty liver and non-alcoholic steatohepatitis). Odds ratios (ORs) measuring the association between GSD (includes gallstones and cholecystectomy) and NAFLD were calculated using logistic regression after adjusting for confounding variables. RESULTS Out of 14294784 hospitalizations in 2016-2017, 159259 were found to have NAFLD. The prevalence of NAFLD was 3.3% in patients with GSD and 1% in those without. NAFLD was prevalent in 64.3% of women with GSD as compared to 35.7% of men with GSD. After controlling for various confounders associated with NAFLD and GSD, multivariate-adjusted analysis showed that there was an association between NAFLD with gallstones [OR = 6.32; 95% confidence interval (CI): 6.15-6.48] as well as cholecystectomy (OR = 1.97; 95%CI: 1.93-2.01). The association between NAFLD and gallstones was stronger in men (OR = 6.67; 95%CI: 6.42-6.93) than women (OR = 6.05; 95%CI: 5.83-6.27). The association between NAFLD and cholecystectomy was stronger in women (OR = 2.01; 95%CI: 1.96-2.06) than men (OR = 1.85; 95%CI: 1.79-1.92). P value was less than 0.001 for all comparisons. CONCLUSION NAFLD is more prevalent in women with GSD than men. The association between NAFLD and cholecystectomy/gallstones indicates that they may be risk factors for NAFLD.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
| | - Shantanu Solanki
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Khwaja F Haq
- Department of Gastroenterology, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Dushyant Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
| | - Beth Bailey
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
| | - Dhanshree Solanki
- Health Administration, Rutgers University, New Brunswick, NJ 08901, United States
| | - Jagmeet Singh
- Department of Nephrology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Michael Albosta
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
| | - Farah Wani
- Family Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
| | - Michael Aljadah
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Harshil Shah
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Hafiz Khan
- Department of Gastroenterology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Syed-Mohammed Jafri
- Department of Gastroenterology, Henry Ford Hospital, Detroit, MI 48202, United States
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Iqbal U, Khara HS, Akhtar D, Hu Y, Anwar H, Haq KF, Siddiqui HU, Bergenstock MK, Shellenberger MJ. Safety and Efficacy of Nitazoxanide-Based Regimen for the Eradication of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis. Gastroenterology Res 2020; 13:260-268. [PMID: 33447305 PMCID: PMC7781276 DOI: 10.14740/gr1342] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
Background Helicobacter pylori (HP) is the most common cause of gastritis worldwide. Clarithromycin-based triple therapy or bismuth-based quadruple therapy is usually considered the first-line treatment, however with around 30% failure rate for both regimens. Drug resistance of clarithromycin and metronidazole is a growing concern in some parts of the world. Therefore, there is a need for effective eradication regimen for HP. Nitazoxanide, a bactericidal thiazolide antibiotic, has been shown to be effective in HP infection. We conducted a systematic review and meta-analysis to evaluate the efficacy of nitazoxanide-based regimen for the eradication of HP. Methods We have searched PubMed, Embase, Ovid Medline and Cochrane library database from inception to December 9, 2020 to identify studies that utilized nitazoxanide in the treatment regimen for HP eradication. Our primary outcome was pooled eradication rate of HP. Results Thirteen studies including 1,028 patients met our inclusion criteria and were analyzed in a meta-analysis. HP eradication was successful in 867 patients with a pooled eradication rate of 86% (95% confidence interval (CI): 79-90%) with 84% heterogeneity. A subgroup analysis that included 230 patients who failed other prior eradication regimens revealed a pooled eradication rate of 85% (95% CI: 69-94%) without heterogeneity. In a subgroup analysis, highest eradication rates were achieved with levofloxacin, doxycycline, nitazoxanide and proton pump inhibitor with a pooled eradication rate of 92% (88-95%). Conclusion Nitazoxanide-based regimen is safe and effective in the eradication of HP infection. It is also successful as a salvage therapy in patients who have failed prior treatments.
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Affiliation(s)
- Umair Iqbal
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Harshit S Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Daud Akhtar
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger Medical Center, Danville, PA 17822, USA
| | - Hafsa Anwar
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ 08638, USA
| | - Khwaja F Haq
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| | - Hafiz U Siddiqui
- Department of Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Marika K Bergenstock
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Matthew J Shellenberger
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
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Chakinala RC, Solanki S, Haq KF, Singh J, Shah H, Solanki D, Kichloo A, Haq KS, Burney AH, Waqar S, Vyas M, Chugh S, Nabors C. Dieulafoy's Lesion: Decade-Long Trends in Hospitalizations, Demographic Disparity, and Outcomes. Cureus 2020; 12:e9170. [PMID: 32802607 PMCID: PMC7424366 DOI: 10.7759/cureus.9170] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Dieulafoy's lesion is a relatively rare, but potentially life-threatening, condition where a tortuous arteriole, most commonly in the stomach, may bleed and lead to significant gastrointestinal hemorrhage. Limited epidemiological data exist on patient characteristics and the annual number of hospitalizations associated with such lesions. The aim of our study is to determine the inpatient burden of Dieulafoy’s lesion. Methods We analyzed the National Inpatient Sample (NIS) database for all subjects with a discharge diagnosis of Dieulafoy's lesion of the stomach, duodenum, and colon using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 537.84 and 569.86 as the primary or secondary diagnosis during the period from 2002 to 2011. Statistical significance of variation in the number of hospital discharges and demographics during the study period was achieved using the Cochrane-Armitage trend test. Results In 2002, there were 1,071 admissions with a discharge diagnosis of Dieulafoy's lesion as compared to 7,414 in 2011 (p < 0.0001). Dieulafoy's lesion was found to be most common in the age group of 65-79 years (p < 0.0001). Overall, it was found to be more common in males as compared to females (p = 0.0261). The white race was most commonly affected amongst all the races. The average cost of care per hospitalization increased from $14,992 in 2002 to $25,594 in 2011 (p < 0.0001). Conclusion There has been a steady rise in the number of inpatient admissions with Dieulafoy's lesions. Advances in diagnostic techniques likely play a key role in the higher detection rates along with the possible involvement of other unknown factors. Men, in the age group of 65 to 79 years, and Whites were found to have significantly higher admission rates than all other groups, with a significant increase in the cost of care.
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Affiliation(s)
| | - Shantanu Solanki
- Hospital-Based Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Khwaja F Haq
- Gastroenterology, Henry Ford Hospital, Detroit, USA
| | - Jagmeet Singh
- Nephrology, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Harshil Shah
- Internal Medicine, Independent Researcher, Sayre, USA
| | | | - Asim Kichloo
- Internal Medicine, Central Michigan University, Saginaw, USA
| | - Khwaja S Haq
- Medicine, Kingsbrook Jewish Medical Center, Brooklyn, USA
| | - Azam H Burney
- Medicine, Kingsbrook Jewish Medical Center, Brooklyn, USA
| | | | - Manasee Vyas
- Medicine, Mahatma Gandhi Institute of Health Sciences, Mumbai, IND
| | - Savneek Chugh
- Nephrology, Westchester Medical Center, Valhalla, USA
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Solanki S, Haq KF, Khan MA, Chakinala RC, Mehta S, Haq KS, Mansuri U, Khan Z, Gandhi D, Singh J, Chugh SS. Gastrointestinal Hemorrhage in Acute Kidney Injury Patients on Hemodialysis. Cureus 2019; 11:e5652. [PMID: 31700754 PMCID: PMC6822547 DOI: 10.7759/cureus.5652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Gastrointestinal bleeding (GIB) has been reported to be more common in patients with chronic renal failure and end-stage renal disease requiring hemodialysis with higher mortality than in the general population. Limited epidemiological data exist on the annual number of hospitalizations, demographic variation, cost of care, and outcomes for GIB in patients with acute kidney injury (AKI) requiring and not requiring hemodialysis (HD). The main objective of this study was to analyze the trends of GIB in patients with AKI requiring HD and those not requiring HD during hospitalization. Methods and Results We analyzed the National (Nationwide) Inpatient Sample (NIS) database for all subjects with a discharge diagnosis of AKI as the primary or secondary diagnosis during the period from 2001 to 2011. Subjects with a discharge diagnosis of hemodialysis and GIB were then identified from the pool and trends were analyzed. A significant rise in the annual number of hospitalizations with AKI was found with a greater proportion being discharged without HD. From 2001 to 2011, there were 19,393,811 hospitalizations with a discharge diagnosis of AKI of which 1,424,692 (7.3%) received HD (HD group), whereas 17,969,119 (92.7%) did not receive HD (non-HD group) (p < 0.0001). The male gender was more commonly affected by GIB than the female gender in both groups (p < 0.0001). The cost of care per hospitalization for GIB patients in the HD group increased over the study period with average found to be $61,463 (adjusted for inflation, p < 0.0001), whereas for GIB patients in the non-HD group, it showed a slight decrease in trend with the average found to be $28,419 (p < 0.0001). All-cause mortality was higher for GIB patients in the HD group (38.1%) than in the non-HD group (25.1%) (p < 0.0001). Conclusions GIB is more common and associated with higher all-cause inpatient mortality in patients receiving HD in comparison to non-HD patients.
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Chakinala RC, Kumar A, Barsa JE, Mehta D, Haq KF, Solanki S, Tewari V, Aronow WS. Downhill esophageal varices: a therapeutic dilemma. Ann Transl Med 2018; 6:463. [PMID: 30603651 DOI: 10.21037/atm.2018.11.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal varices can cause life-threatening complications and are most often a sequela of liver disease. Although a rare cause of gastrointestinal bleeding, downhill variceal bleeding secondary to superior vena cava (SVC) obstruction should be considered in the differential diagnosis for patients with upper gastrointestinal hemorrhage. We discuss two such cases of downhill esophageal varices presenting with hematemesis in patients with end stage renal disease and no history of cirrhosis. These varices were thought to be secondary to SVC occlusion caused by complications from previous dialysis catheters. However, their difficult anatomy posed a significant challenge to the therapeutic interventions.
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Affiliation(s)
- Raja Chandra Chakinala
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Anila Kumar
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Jonathan E Barsa
- Department of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Dhruv Mehta
- Department of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Khwaja F Haq
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Shantanu Solanki
- Division of General Medicine, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Virendra Tewari
- Department of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Abstract
Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Nancy Gupta
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Khwaja F Haq
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Bijal Doshi
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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