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Pathipati MP, Shah ED, Kuo B, Staller KD. Digital health for functional gastrointestinal disorders. Neurogastroenterol Motil 2023; 35:e14296. [PMID: 34796577 PMCID: PMC9117568 DOI: 10.1111/nmo.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders are a common but challenging set of conditions to treat. Gastroenterology practices often struggle to meet the needs of patients with functional disorders given the need for careful monitoring, frequent communication, and management of stressors that occur outside of the clinical setting. In recent years, applications in digital health have created a new set of tools that can improve the care of these patients, including through improved symptom tracking, physiologic monitoring, direct provision of care, and patient support. PURPOSE The purpose of this review is to evaluate how digital applications are being used to manage functional gastrointestinal disorders today, with several examples of relevant technologies and organizations. It also the shortcomings of current treatment strategies and how they can be overcome.
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Affiliation(s)
- Mythili P. Pathipati
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric D. Shah
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle D. Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Staller KD, Badran YR, Rosman DA, Klempner SJ, Judelson R. Case 31-2022: A 72-Year-Old Man with Heartburn, Nausea, and Inability to Eat. N Engl J Med 2022; 387:1415-1424. [PMID: 36239648 DOI: 10.1056/nejmcpc2201239] [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: 11/19/2022]
Affiliation(s)
- Kyle D Staller
- From the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Massachusetts General Hospital, and the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Harvard Medical School - both in Boston
| | - Yousef R Badran
- From the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Massachusetts General Hospital, and the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Harvard Medical School - both in Boston
| | - David A Rosman
- From the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Massachusetts General Hospital, and the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Harvard Medical School - both in Boston
| | - Samuel J Klempner
- From the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Massachusetts General Hospital, and the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Harvard Medical School - both in Boston
| | - Richard Judelson
- From the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Massachusetts General Hospital, and the Departments of Medicine (K.D.S., Y.R.B., S.J.K.), Radiology (D.A.R.), and Pathology (R.J.), Harvard Medical School - both in Boston
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Pathipati MP, Silvernale CJ, Barshop KG, Ha JB, Richter JM, Staller KD. Rectal Evacuation Disorders are Associated With Poor Bowel Preparation in Patients With Chronic Constipation: Results From Two Centers. J Clin Gastroenterol 2022; 56:438-443. [PMID: 34334764 DOI: 10.1097/mcg.0000000000001593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/15/2021] [Indexed: 12/10/2022]
Abstract
INTRODUCTION We evaluated factors that can predict the adequacy of bowel preparation in patients with chronic constipation undergoing colonoscopy. MATERIALS AND METHODS We identified patients with chronic constipation who underwent anorectal manometry and at least 1 colonoscopy at 2 tertiary referral centers from 2003 to 2019. We also identified a subgroup of patients who underwent colonic transit testing through radiopaque marker testing. We determined demographic, medical, and constipation-related factors associated with poor bowel preparation and their effect on standardized quality metrics using univariate and multivariate analyses. RESULTS We identified 274 patients with chronic constipation who underwent anorectal manometry testing. Both outlet dysfunction (prolonged balloon expulsion) and slow-transit constipation were associated with suboptimal bowel preparation. Outlet dysfunction was also associated with decreased cecal intubation rates, adenoma detection rates, and sessile serrated polyp detection rates. In multivariable analyses controlling for demographics and known factors associated with poor bowel preparation, outlet dysfunction was associated with an almost 3-fold odds of suboptimal bowel preparation [odds ratio (OR): 2.9; 95% confidence interval (CI): 1.6-5.1] and a 3-fold reduction in cecal intubation rates (OR: 0.3; 95% CI: 0.1-0.8). Among those with radiopaque marker colonic transit testing available, slow-transit constipation was associated with a >2-fold odds of suboptimal bowel preparation (OR: 2.2; 95% CI: 1.1-4.4). CONCLUSIONS Among a cohort of patients with chronic constipation undergoing colonoscopy, outlet dysfunction was associated with suboptimal bowel preparation and other quality metrics. Constipated patients with a rectal evacuation disorder may represent a subgroup of patients that could benefit from individualized strategies for better bowel preparation.
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Affiliation(s)
- Mythili P Pathipati
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School
| | - Casey J Silvernale
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School
| | - Kenneth G Barshop
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jasmine B Ha
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School
| | - Kyle D Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School
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Scheid JF, Rosenbaum MW, Przybyszewski EM, Krishnan K, Forcione DG, Iafrate AJ, Staller KD, Misdraji J, Lennerz JK, Pitman MB, Pratt DS. Next-generation sequencing in the evaluation of biliary strictures in patients with primary sclerosing cholangitis. Cancer Cytopathol 2021; 130:215-230. [PMID: 34726838 DOI: 10.1002/cncy.22528] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a well-described risk factor for the development of cholangiocarcinoma (CCA). Early detection of CCA in these patients is of great importance because it expands options for therapeutic interventions, including liver transplantation. Current diagnostic tests for the evaluation of biliary strictures are limited to biliary brushing (BB) cytology and fluorescence in situ hybridization (FISH). Next-generation sequencing (NGS) has become an important diagnostic tool in oncology and may be a useful tool for diagnosing CCA on BBs. It is not clear how NGS performs when it is added to BB cytology and FISH in patients with PSC. METHODS This study reports the authors' experience with NGS performed as a prospective cotest with cytology and FISH on BBs obtained from 60 patients with PSC followed at Massachusetts General Hospital. A duct with malignancy was defined as a high-risk (HR) stricture with either high-grade dysplasia or CCA. RESULTS NGS was better than FISH and cytology in detecting HR strictures, which showed multiple genetic mutations in all cases. NGS provided specific mutational information, and NGS results were reproducible in longitudinal samples. CONCLUSIONS Adding NGS to BB cytology and FISH in the evaluation of biliary strictures for patients with PSC may provide additional information that could help to inform clinical management.
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Affiliation(s)
- Johannes F Scheid
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew W Rosenbaum
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Eric M Przybyszewski
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kumar Krishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Anthony J Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle D Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Daniel S Pratt
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.,Autoimmune and Cholestatic Liver Center, Massachusetts General Hospital, Boston, Massachusetts
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Ma W, Li Y, Heianza Y, Staller KD, Chan AT, Rimm EB, Rexrode KM, Qi L. Associations of Bowel Movement Frequency with Risk of Cardiovascular Disease and Mortality among US Women. Sci Rep 2016; 6:33005. [PMID: 27596972 PMCID: PMC5011651 DOI: 10.1038/srep33005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/18/2016] [Indexed: 12/14/2022] Open
Abstract
Emerging evidence suggests a potential impact of gastrointestinal function on cardiometabolic risk. Abnormal bowel movements have been related to various cardiovascular risk factors such as dyslipidemia, hypertension, diabetes, and altered metabolism of bile acids and gut microbiota. However, little is known about whether bowel movement frequency affects risk of cardiovascular disease (CVD) and mortality. In the Nurses' Health Study, bowel movement frequency was self-reported in 1982 by 86,289 women free from CVD and cancer. During up to 30 years of follow-up, we documented 7,628 incident CVD cases and 21,084 deaths. After adjustment for dietary intake, lifestyle, medication use, and other risk factors, as compared with women with daily bowel movement, having bowel movements more than once daily was significantly associated with increased risk of CVD (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.05-1.21), total mortality (HR: 1.17; 95% CI: 1.12-1.22), and cardiovascular mortality (HR: 1.17; 95% CI: 1.07-1.28). With further adjustment for body mass index and diabetes status, the association with total mortality remained significant (HR: 1.10; 95% CI: 1.06-1.15), whereas the associations with incident CVD and cardiovascular mortality were no longer significant. Our results suggest increased bowel movement frequency is a potential risk factor for premature mortality.
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Affiliation(s)
- Wenjie Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112, USA
| | - Kyle D. Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Andrew T. Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Eric B. Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Kathryn M. Rexrode
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Lu Qi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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Alter G, Teigen N, Davis BT, Addo MM, Suscovich TJ, Waring MT, Streeck H, Johnston MN, Staller KD, Zaman MT, Yu XG, Lichterfeld M, Basgoz N, Rosenberg ES, Altfeld M. Sequential deregulation of NK cell subset distribution and function starting in acute HIV-1 infection. Blood 2005; 106:3366-9. [PMID: 16002429 DOI: 10.1182/blood-2005-03-1100] [Citation(s) in RCA: 258] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Natural killer (NK) cells are critical in the first-line defense against viral infections. Chronic HIV-1 infection leads to a perturbation in the NK cell compartment, yet the kinetics of this deregulation and the functional consequences are unclear. Here, we characterized changes in the NK cell compartment longitudinally by multiparameter flow cytometry, starting in acute HIV-1 infection. Acute HIV-1 infection was associated with elevated NK cell numbers, with an expansion of CD3(neg)CD56(dim)CD16(pos) NK cells and an early depletion of CD3(neg)CD56(bright)CD16(neg) NK cells. Ongoing viral replication resulted in a depletion of CD3(neg)CD56(dim)CD16(pos) NK cells with a paralleled increase in functionally anergic CD3(neg)CD56(neg)CD16(pos) NK cells, accompanied by reduced functional activity, as measured by CD107a expression and cytokine secretion. Taken together, these studies demonstrate a sequential impairment of NK cell function with persistent viral replication resulting from a progressive deregulation of NK cell subsets with distinct functional properties.
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Affiliation(s)
- Galit Alter
- Partners AIDS Research Center, Massachusetts General Hospital and Division of AIDS, Harvard Medical School, USA
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