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El Halabi M, Bou Daher H, Rustom LBO, Marrache M, Ichkhanian Y, Kahil K, El Sayed M, Sharara AI. Characteristics and outcome of patients presenting with acute Pancreatitis: A one-year descriptive study from a tertiary care center in Lebanon. Arab J Gastroenterol 2020; 21:106-110. [PMID: 32409259 DOI: 10.1016/j.ajg.2020.04.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 12/16/2022]
Abstract
AIM To determine the aetiology, hospital course, and outcome of patients diagnosed with acute pancreatitis (AP) presenting to the Emergency Department (ED) of a tertiary care center in Lebanon. PATIENTS AND METHODS Using a retrospective cross-sectional study design, records of all patients presenting to the ED with elevated lipase over one calendar year (2016) were reviewed. Patients diagnosed with AP according to the revised Atlanta classification were identified. RESULTS Over one year, a total of 24,133 adult patients visited the ED and 4,976 had serum lipase determination. Of those, 75 patients (mean age 59.4 ± 16.1; range 20-95; M:F 2.1) had confirmed AP accounting for 0.3% of adult ED visits. The most common etiologies were biliary (36%), idiopathic (16%), drugs (13%), and alcohol (11%). Intake of drugs known to be associated with AP was identified in 26% of patients. Alcoholic pancreatitis was more common in males, while biliary pancreatitis was more common in females (p less than 0.05 in both). 63 patients (84%) required regular hospital admission and only 1 (1.3%) required intensive care unit admission and passed away after multiorgan failure. Mean hospital stay was 4.0 ± 4.0 days (range 0-23) with mean hospital charges of $6,637 ± 8,496. CONCLUSION Acute pancreatitis accounts for a relatively small number of emergency visits in Lebanon. Leading etiologies are biliary and drugs, with a low contribution of alcohol compared to the West. The economic burden of AP is important, but outcomes appear largely favorable with an overall mortality of less than 2%.
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Affiliation(s)
- Maan El Halabi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Halim Bou Daher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Luma Basma O Rustom
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Majd Marrache
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yervant Ichkhanian
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karine Kahil
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I Sharara
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
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Kahil K, El Halabi M, Bou Daher H, Rustom LBO, Marrache M, Ichkhanian Y, El Sayed M, Sharara AI. Significant elevations in serum lipase in the emergency department: When it is not pancreatitis! Am J Emerg Med 2019; 38:1033-1034. [PMID: 31810751 DOI: 10.1016/j.ajem.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Karine Kahil
- From the School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maan El Halabi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Halim Bou Daher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Luma Basma O Rustom
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Majd Marrache
- From the School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yervant Ichkhanian
- From the School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I Sharara
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
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Sharara AI, Rustom LBO, Bou Daher H, Rimmani HH, Shayto RH, Minhem M, Ichkhanian Y, Aridi H, Al-Abbas A, Shaib Y, Alami R, Safadi B. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery. Dig Liver Dis 2019; 51:1375-1379. [PMID: 31076325 DOI: 10.1016/j.dld.2019.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is common in obese individuals. Prospective studies investigating validated GERD questionnaires and clinical parameters at identifying erosive esophagitis (EE) in this population are limited. OBJECTIVE To prospectively evaluate the prevalence of GERD in obese patients considered for bariatric surgery and identify risk and predictive factors for EE. METHODS Eligible patients completed two validated questionnaires: GERDQ and Nocturnal Symptom Severity Impact (N-GSSIQ) before routine esophagogastroduodenoscopy. RESULTS 242 consecutive patients were enrolled (130 females; mean age 37.8 ± 11.8 years; mean BMI 40.4 ± 5.3 kg/m2). The overall prevalence of gastroesophageal reflux (GERDQ ≥ 8, EE and/or PPI use) was 62.4%. EE was identified in 82 patients (33.9%) including 13/62 (21.0%) receiving PPIs at baseline. Multivariate logistic regression identified GERDQ ≥ 8 (OR = 6.3, 95%CI 3.0-13.1), hiatal hernia (OR = 4.2, 95%CI 1.6-10.7), abnormal Hill grade (OR = 2.7, 95%CI 1.4-5.4), and tobacco use (OR = 2.5, 95%CI 1.2-4.9) as independent risk factors for EE. A pre-endoscopic composite assessment including GERDQ ≥ 8 and presence of severe nocturnal reflux symptoms had 90% specificity and 20.7% sensitivity in identifying EE (NPV 68.9% and PPV 51.5%). CONCLUSION GERD is highly prevalent in obese patients. Anthropometric data and GERD questionnaires have limited accuracy at predicting erosive disease. Pre-operative endoscopic assessment in this population appears warranted.
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Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Luma Basma O Rustom
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Halim Bou Daher
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein H Rimmani
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rani H Shayto
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Minhem
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yervant Ichkhanian
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hanaa Aridi
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amr Al-Abbas
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yasser Shaib
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi Alami
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Safadi
- Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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El Halabi M, Bou Daher H, Rustom LBO, Marrache M, Ichkhanian Y, Kahil K, El Sayed M, Sharara AI. Clinical utility and economic burden of routine serum lipase determination in the Emergency Department. Int J Clin Pract 2019; 73:e13409. [PMID: 31456308 DOI: 10.1111/ijcp.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/29/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Serum lipase is a rapid and reliable laboratory test central to diagnosing acute pancreatitis (AP). Routine use in the emergency department (ED) setting for all cases of abdominal pain or as part of a standard laboratory biochemical profile may lead to unnecessary expenses. AIM To examine the utility of serum lipase determination at a tertiary care centre ED. METHODS Retrospective cross-sectional study of ED patients having serum lipase determination over a 12-month period. Electronic medical records were reviewed for indication and interpretation leading to additional diagnostic imaging, specialist consultation, interventions or hospital admission. RESULTS A total of 24 133 adult patients visited the ED during the study period: 4976 (20.6%) had serum lipase determination, 614 (12.4%) had abnormal lipase, 130 of which (21.1%) were above the diagnostic threshold for acutre pancreatitis (AP) (>3× ULN). A total of 75 patients had confirmed AP (0.3% of all adult ED visits). The positive and negative predictive values of serum lipase (>3× ULN) for AP were 43.6% and 99.6%, respectively. One thousand eight hundred and ninety patients (38.0%) had no abdominal pain on history or physical examination. In this group, the total charge associated with lipase determination was $51 030 with 251 (13.3%) elevated lipase values triggering cross-sectional abdominal imaging in 61 (24.3%) patients and unwarranted gastroenterology consultation in three (1.2%) for an additional charge of $28 975. CONCLUSIONS Serum lipase is widely overutilised in the emergency setting resulting in unnecessary expenses and investigations. Evidence-based review of clinical guidelines and more restrictive testing can result in substantial cost savings and improved patient care.
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Affiliation(s)
- Maan El Halabi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Halim Bou Daher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Luma Basma O Rustom
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Majd Marrache
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yervant Ichkhanian
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karine Kahil
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I Sharara
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
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Sharara AI, Rustom LBO, Marrache M, Rimmani HH, Bou Daher H, Koussa S, Taher A. Sofosbuvir/velpatasvir for chronic hepatitis C infection in patients with transfusion-dependent thalassemia. Am J Hematol 2019; 94:E43-E45. [PMID: 30394575 DOI: 10.1002/ajh.25339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Ala I. Sharara
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Luma Basma O. Rustom
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Majd Marrache
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Hussein H. Rimmani
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | - Halim Bou Daher
- Division of Gastroenterology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
| | | | - Ali Taher
- Division of Hematology/Oncology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
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Rimmani HH, Rustom LBO, Rahal MA, Shayto RH, Chaar H, Sharara AI. Dexlansoprazole is Effective in Relieving Heartburn during the Fasting Month of Ramadan. Dig Dis 2019; 37:188-193. [PMID: 30625462 DOI: 10.1159/000496091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/23/2018] [Accepted: 12/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Proton pump inhibitors are effective at reducing heartburn. No studies have evaluated their efficacy in Ramadan. Dexlansoprazole has a unique active formulation independent of time-of-day dosing or food. The aim is to investigate the efficacy of dexlansoprazole 60 mg during Ramadan in patients with symptomatic heartburn. METHODS Subjects recruited using poster, radio, and SMS advertisements completed a diary using a mobile-friendly application and received daily SMS reminders. Dexlansoprazole was started on day 8 for 3 weeks. No placebo arm was used in this trial. Primary endpoint was relief of heartburn expressed as mean 24-h free heartburn percentage (24FH%) per weekly period. RESULTS A total of 32 patients were enrolled. During week 1, only 1 person (3.1%) was heartburn-free and mean 24FH% was 41.1 ± 24.8%. On dexlansoprazole, mean 24FH% rose to 63.4 ± 23.8 and 81.6 ± 24.5% in weeks 2 and 4, respectively (p < 0.001 for both). Median 24FH% increased from 35.7% in week 1 to 71.4 and 85.7% in weeks 2 and 4, respectively. Mean Gastroesophageal Reflux Disease Questionnaire (GERDQ) scores decreased from 10.0 ± 3.2 in week 1 to 6.53 ± 2.2 in week 2 (p < 0.001) and 5.87 ± 2.1 in week 4 (p < 0.001). Mean heartburn severity score decreased from 2.5 ± 1.0 to 1.7 ± 0.8 (p = 0.001). Early response was higher in patients with GERDQ scores ≥8 (p = 0.012). CONCLUSION Dexlansoprazole is effective in the treatment of heartburn during Ramadan. Clinicaltrials.gov number: NCT03079050.
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Affiliation(s)
- Hussein H Rimmani
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Luma Basma O Rustom
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mahmoud A Rahal
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rani H Shayto
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Chaar
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
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Sharara AI, Ziade N, Shayto RH, Rustom LBO, Chehab H, Rimmani HH, Hanna K, Chalhoub JM, Sarkis FS, Rahal MA, Soweid A, Mourad FH, Barada K, Harb AH. The Natural History of Incidental Colonic Diverticulosis on Screening Colonoscopy. Can J Gastroenterol Hepatol 2018; 2018:3690202. [PMID: 30631757 PMCID: PMC6304544 DOI: 10.1155/2018/3690202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/27/2018] [Accepted: 11/27/2018] [Indexed: 12/30/2022] Open
Abstract
Background The natural history of colonic diverticulosis is unclear. Methods Patients with incidental diverticulosis identified in a previous prospective cross-sectional screening colonoscopy study were evaluated retrospectively for clinic or hospital visit(s) for diverticular disease (DD= acute diverticulitis or diverticular bleeding) using review of electronic health records and patient phone interview. Results 826 patients were included in the screening colonoscopy study. Three were excluded for prior DD. In all, 224 patients (27.2%; mean age 62.3 ± 8.2) had incidental diverticulosis distributed in the left colon (67.4%), right colon (5.8%), or both (22.8%). Up-to-date information was available on 194 patients. Of those, 144 (74.2%) could be reached for detailed interview and constituted the study population. Over a mean follow-up of 7.0 ± 1.7 years, DD developed in 6 out of 144 patients (4.2%) (4 acute cases of diverticulitis, 1 probable case of diverticular bleeding, and 1 acute case of diverticulitis and diverticular bleeding). Two patients were hospitalized, and none required surgery. The time to event was 5.1 ± 1.6 years and the incidence rate was 5.9 per 1000 patient-years. On multivariate analysis, none of the variables collected at baseline colonoscopy including age, gender, obesity, exercise, fiber intake, alcohol use, constipation, or use of NSAIDs were associated with DD. Conclusion The natural history of incidental diverticulosis on screening colonoscopy was highly favorable in this well-defined prospectively identified cohort. The common scenario of incidental diverticulosis at screening colonoscopy makes this information clinically relevant and valuable to physicians and patients alike.
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Affiliation(s)
- Ala I. Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nathalie Ziade
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rani H. Shayto
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Luma Basma O. Rustom
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hamed Chehab
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein H. Rimmani
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Krystelle Hanna
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean M. Chalhoub
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fayez S. Sarkis
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mahmoud A. Rahal
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Assaad Soweid
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi H. Mourad
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kassem Barada
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali H. Harb
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
BACKGROUND Colonic diverticulosis is the most common incidental lesion found on routine colonoscopy. However, its true natural history is unclear. The aim of this review is to examine the epidemiology of colonic diverticulosis and the incidence of complications, namely acute diverticulitis and diverticular hemorrhage. SUMMARY Many studies have evaluated the epidemiology and risk factors of diverticulosis. Despite the common nature of this entity, little is known about the risk of complications in asymptomatic individuals. It has been suggested that the lifetime risk of acute diverticulitis is 10-25% and that of diverticular hemorrhage is 3-5%. These risk estimates were based on older literature without accurate studies on true prevalence. Three recent retrospective observational cohort studies including subjects identified at colonoscopy have addressed this issue, providing information on the long-term risk of complications of colonic diverticulosis. Cumulative data from these studies support an incidence of acute diverticulitis of 1.5-6.0 per 1,000 patient-years and 0.46 per 1,000 patient-years for diverticular hemorrhage. KEY MESSAGES Diverticulosis is a very common condition in individuals > 50 years of age. Based on population-based colonoscopy studies, the natural history of colonic diverticulosis appears favorable with a far lower incidence of complications than previously thought.
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Affiliation(s)
| | - Ala I. Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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