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Golob J, Rao K, Berinstein J, Chey W, Owyang C, Kamada N, Higgins P, Young V, Bishu S, Lee A. The Fecal Microbiome in Quiescent Crohn's Disease with Persistent Gastrointestinal Symptoms Show Enrichment of Oral Microbes But Depletion of Butyrate and Indole Producers. medRxiv 2023:2023.05.16.23290065. [PMID: 37292648 PMCID: PMC10246066 DOI: 10.1101/2023.05.16.23290065] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background and Aims Even in the absence of inflammation, persistent symptoms in Crohn's disease (CD) are prevalent and negatively impact quality of life. We aimed to determine whether quiescent CD patients with persistent symptoms ( qCD+symptoms ) have changes in microbial structure and functional potential compared to those without symptoms ( qCD-symptoms ). Methods We performed a prospective multi-center observational study nested within the SPARC IBD study. CD patients were included if they had evidence of quiescent disease as defined by fecal calprotectin level < 150 mcg/g. Persistent symptoms were defined by the CD-PRO2 questionnaire. Active CD ( aCD ), diarrhea-predominant irritable bowel syndrome ( IBS-D ), and healthy controls ( HC ) were included as controls. Stool samples underwent whole genome shotgun metagenomic sequencing. Results A total of 424 patients were analyzed, including 39 qCD+symptoms, 274 qCD-symptoms, 21 aCD, 40 IBS-D, and 50 HC. Patients with qCD+symptoms had a less diverse microbiome, including significant reductions in Shannon diversity ( P <.001) and significant differences in microbial community structure ( P <.0001), compared with qCD-symptoms, IBS-D, and HC. Further, patients with qCD+symptoms showed significant enrichment of bacterial species that are normal inhabitants of the oral microbiome, including Klebsiella pneumoniae (q=.003) as well as depletion of important butyrate and indole producers, such as Eubacterium rectale (q=.001), Lachnospiraceae spp . (q<.0001), and Faecalibacterium prausnitzii (q<.0001), compared with qCD-symptoms. Finally, qCD+symptoms showed significant reductions in bacterial tnaA genes, which mediate tryptophan metabolism, as well as significant tnaA allelic variation, compared with qCD-symptoms. Conclusion The microbiome in patients with qCD+symptoms show significant changes in diversity, community profile, and composition compared with qCD-symptoms. Future studies will focus on the functional significance of these changes. What You Need to Know Background: Persistent symptoms in quiescent Crohn's disease (CD) are prevalent and lead to worse outcomes. While changes in the microbial community have been implicated, the mechanisms by which altered microbiota may lead to qCD+symptoms remain unclear.Findings: Quiescent CD patients with persistent symptoms demonstrated significant differences in microbial diversity and composition compared to those without persistent symptoms. Specifically, quiescent CD patients with persistent symptoms were enriched in bacterial species that are normal inhabitants of the oral microbiome but depleted in important butyrate and indole producers compared to those without persistent symptoms.Implications for Patient Care: Alterations in the gut microbiome may be a potential mediator of persistent symptoms in quiescent CD. Future studies will determine whether targeting these microbial changes may improve symptoms in quiescent CD.
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Chey W, Cash B, Lacy B, Cohen S, Zeitzoff L, Cekola P, Araujo Torres K, Epstein M. Peppermint Oil is Highly Effective for the Treatment of Adults with IBS: Results from a Self-Reported Survey. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Feingold JH, Drossman DA, Chey W, Kurlander JE, Morris CB, Bangdiwala S, Keefer L. Preliminary development and validation of the Patient-Physician Relationship Scale for physicians for disorders of gut-brain interaction. Neurogastroenterol Motil 2021; 33:e13976. [PMID: 32875659 PMCID: PMC8065374 DOI: 10.1111/nmo.13976] [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: 01/29/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND An effective patient-physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). After developing a PPR questionnaire for patients, we sought to develop and validate an IBS-specific instrument to measure physician expectations of the PPR. METHODS We conducted focus groups about PPRs among 15 clinicians who treat patients with IBS from community and academic centers. Qualitative analysis was used to generate the Patient-Physician Relationship Scale -Physician RESULTS: The PPRS-Physician contained 35 questions pertaining to interpersonal and psychosocial features considered desirable or undesirable in a relationship with IBS patients. 1113 physicians (22%) completed the survey. Physicians were predominantly middle-aged (mean = 55.1 years), male (85.0%), white (74.5%), and practiced primarily within group settings (61.6%), with an average of 25.7% of their patients having IBS. Factor analysis revealed three relevant factors: interfering attributes, positive attributes, and personal connection. The scale ranged from possible 0 to 100 (mean = 83.8; SD = 8.38). Cronbach's alpha reliability measure of the scale was 0.938, indicating high internal consistency. There was a significant moderate, positive correlation between JSPE and the PPRS (P < 0.001, r = 0.488), establishing concurrent validity. CONCLUSIONS We describe the development and validation of the first questionnaire to measure physician expectations of the PPR. This instrument can be used clinically, and for future studies on physician communication.
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Affiliation(s)
- Jordyn H. Feingold
- Department of Gastroenterology, Icahn School of Medicine at
Mount Sinai, New York, NY, USA
| | - Douglas A. Drossman
- Center for Education and Practice of Biopsychosocial Care,
UNC Center for Functional GI and Motility Disorders and Drossman Gastroenterology,
Chapel Hill, NC, USA
| | - William Chey
- Department of Gastroenterology, University of Michigan
School of Medicine, Ann Arbor, MI, USA
| | - Jacob E. Kurlander
- Department of Gastroenterology, University of Michigan
School of Medicine, Ann Arbor, MI, USA
| | - Carolyn B. Morris
- Center for Education and Practice of Biopsychosocial Care,
UNC Center for Functional GI and Motility Disorders and Drossman Gastroenterology,
Chapel Hill, NC, USA
| | - Shrikant Bangdiwala
- Department of Biostatistics, Gillings School of Global
Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Laurie Keefer
- Department of Gastroenterology, Icahn School of Medicine at
Mount Sinai, New York, NY, USA
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Mullin G, Chey W, Crowe SE. The 2019 James W. Freston Conference: Food at the Intersection of Gut Health and Disease. Gastroenterology 2020; 159:20-25. [PMID: 32224128 PMCID: PMC7707161 DOI: 10.1053/j.gastro.2020.03.036] [Citation(s) in RCA: 2] [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] [Received: 02/22/2020] [Accepted: 03/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Freston Conference Faculty AnanthakrishanAshwinMBBS, MPH4Garcia-BailoBibianaMSc, PhD5DellonEvanMD, MPH, AGAF6DiBaiseJohnMD7FasanoAlessioMD8HallerEmilyMS, RDN2HamiltonMatthew J.MD9KleinSamMD10LebwohlBenjaminMD, AGAF11LeungJohnMD1213LewisJamesMD, MSCE, AGAF14NguyenLindaMD, AGAF15PandolfinoJohnMD, AGAF16ParrishCarol ReesMS, RDN17ScarlataKateRDN18TackJanMD PhD19FryeJeanettaMD17HarerKimberelyMD20ZevallosVictorPhD21SrinivasanSachinMD22VermaSandeepMD23Jansson-KnodellClaireMD24DiaVermontPhD25RifkinSamaraMD20PaceLauraMD, PhD26
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Abstract
Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders encountered in clinical practice. It is a heterogeneous disorder with a multifactorial pathogenesis. Recent studies have demonstrated that an imbalance in gut bacterial communities, or "dysbiosis", may be a contributor to the pathophysiology of IBS. There is evidence to suggest that gut dysbiosis may lead to activation of the gut immune system with downstream effects on a variety of other factors of potential relevance to the pathophysiology of IBS. This review will highlight the data addressing the emerging role of the gut microbiome in the pathogenesis of IBS and review the evidence for current and future microbiome based treatments.
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Affiliation(s)
- Stacy Menees
- Division of Gastroenterology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - William Chey
- Division of Gastroenterology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA
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Palsson OS, Whitehead WE, van Tilburg MAL, Chang L, Chey W, Crowell MD, Keefer L, Lembo AJ, Parkman HP, Rao SS, Sperber A, Spiegel B, Tack J, Vanner S, Walker LS, Whorwell P, Yang Y. Rome IV Diagnostic Questionnaires and Tables for Investigators and Clinicians. Gastroenterology 2016; 150:S0016-5085(16)00180-3. [PMID: 27144634 DOI: 10.1053/j.gastro.2016.02.014] [Citation(s) in RCA: 355] [Impact Index Per Article: 44.4] [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: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 12/19/2022]
Abstract
The Rome IV Diagnostic Questionnaires were developed to screen for functional gastrointestinal disorders (FGIDs), serve as inclusion criteria in clinical trials, and support epidemiological surveys. Separate questionnaires were developed for adults, children/adolescents, and infants/toddlers. For the adult questionnaire, we first surveyed 1,162 adults without gastrointestinal disorders, and recommended the 90th percentile symptom frequency as the threshold for defining what is abnormal. Diagnostic questions were formulated and verified with clinical experts using a recursive process. The diagnostic sensitivity of the questionnaire was tested in 843 patients from 9 gastroenterology clinics, with a focus on clinical diagnoses of irritable bowel syndrome (IBS), functional constipation (FC), and functional dyspepsia (FD). Sensitivity was 62.7% for IBS, 54.7% for FD, and 32.2% for FC. Specificity, assessed in a population sample of 5,931 adults, was 97.1% for IBS, 93.3% for FD, and 93.6% for FC. Excess overlap among IBS, FC, and FD was a major contributor to reduced diagnostic sensitivity, and when overlap of IBS with FC was permitted, sensitivity for FC diagnosis increased to 73.2%. All questions were understandable to at least 90% of individuals, and Rome IV diagnoses were reproducible in ¾ of patients after one month. Validation of the pediatric questionnaires is ongoing.
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Affiliation(s)
- Olafur S Palsson
- Bioinformatics Building Room 4111, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080
| | - William E Whitehead
- Bioinformatics Building Room 4112, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Miranda A L van Tilburg
- Bioinformatics Building Room 4008 Campus Box 7080 University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7080
| | - Lin Chang
- Center for Neurobiology of Stress, David Geffen School of Medicine, UCLA Los Angeles,California
| | - William Chey
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Laurie Keefer
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Henry P Parkman
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Satish Sc Rao
- Director, Digestive Health Center, Medical College of GeorgiaGeorgia Regents University, Augusta, Georgia
| | - Ami Sperber
- Kibbutz Farod, House 86, D.N. Bikat Bet Hakerem, 2010000, Israel
| | | | - Jan Tack
- K. U. Leuven, Center for GI Research, Herestraat 49, Leuven 3000, Belgium
| | - Stephen Vanner
- Division of Gastroenterology, Kingston General Hospital, Ontario, Canada
| | - Lynn S Walker
- Department of Pediatrics, Adolescent Division, Vanderbilt University Medical Center, 2146 Belcourt Ave, Nashville TN 37212
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Almario CV, Chey W, Kaung A, Whitman C, Fuller G, Reid M, Nguyen K, Bolus R, Dennis B, Encarnacion R, Martinez B, Talley J, Modi R, Agarwal N, Lee A, Kubomoto S, Sharma G, Bolus S, Chang L, Spiegel BM. Computer-generated vs. physician-documented history of present illness (HPI): results of a blinded comparison. Am J Gastroenterol 2015; 110:170-9. [PMID: 25461620 PMCID: PMC4289091 DOI: 10.1038/ajg.2014.356] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 08/08/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Healthcare delivery now mandates shorter visits with higher documentation requirements, undermining the patient-provider interaction. To improve clinic visit efficiency, we developed a patient-provider portal that systematically collects patient symptoms using a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS). AEGIS also automatically "translates" the patient report into a full narrative history of present illness (HPI). We aimed to compare the quality of computer-generated vs. physician-documented HPIs. METHODS We performed a cross-sectional study with a paired sample design among individuals visiting outpatient adult gastrointestinal (GI) clinics for evaluation of active GI symptoms. Participants first underwent usual care and then subsequently completed AEGIS. Each individual thereby had both a physician-documented and a computer-generated HPI. Forty-eight blinded physicians assessed HPI quality across six domains using 5-point scales: (i) overall impression, (ii) thoroughness, (iii) usefulness, (iv) organization, (v) succinctness, and (vi) comprehensibility. We compared HPI scores within patient using a repeated measures model. RESULTS Seventy-five patients had both computer-generated and physician-documented HPIs. The mean overall impression score for computer-generated HPIs was higher than physician HPIs (3.68 vs. 2.80; P<0.001), even after adjusting for physician and visit type, location, mode of transcription, and demographics. Computer-generated HPIs were also judged more complete (3.70 vs. 2.73; P<0.001), more useful (3.82 vs. 3.04; P<0.001), better organized (3.66 vs. 2.80; P<0.001), more succinct (3.55 vs. 3.17; P<0.001), and more comprehensible (3.66 vs. 2.97; P<0.001). CONCLUSIONS Computer-generated HPIs were of higher overall quality, better organized, and more succinct, comprehensible, complete, and useful compared with HPIs written by physicians during usual care in GI clinics.
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Affiliation(s)
- Christopher V. Almario
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Division of Digestive Diseases, UCLA, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - William Chey
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI
| | - Aung Kaung
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Cynthia Whitman
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Garth Fuller
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Mark Reid
- Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Ken Nguyen
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Roger Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Buddy Dennis
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA
| | - Rey Encarnacion
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA
| | - Bibiana Martinez
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Jennifer Talley
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Rushaba Modi
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Division of Digestive Diseases, UCLA, Los Angeles, CA
| | - Nikhil Agarwal
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Division of Digestive Diseases, UCLA, Los Angeles, CA
| | - Aaron Lee
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Scott Kubomoto
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Gobind Sharma
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sally Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Lin Chang
- Division of Digestive Diseases, UCLA, Los Angeles, CA
| | - Brennan M.R. Spiegel
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
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Sharma P, Chey W, Hunt R, Laine L, Malfertheiner P, Wani S. Endoscopy of the esophagus in gastroesophageal reflux disease: are we losing sight of symptoms? Another perspective. Dis Esophagus 2009; 22:461-6. [PMID: 19191851 DOI: 10.1111/j.1442-2050.2008.00934.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 12/11/2022]
Abstract
Gastroesophageal reflux disease (GERD) is an extremely common chronic disorder associated with impaired quality of life and huge economic burden. Recently, an International Consensus Group developed a global definition of GERD (The Montreal Definition): a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The traditional endoscopy-based classification of GERD patients into one of three groups - non-erosive reflux disease, erosive esophagitis, and Barrett's esophagus - is fraught with several limitations. Due to the lack of a gold standard, GERD is a symptom-based diagnosis, and hence symptom evaluation will remain the primary means by which treatment decisions are made for patients with suspected GERD. We propose that patients reporting the predominant GERD-like symptoms (GERS) in the primary care setting be classified based upon their response to an empiric trial of acid suppressive therapy: complete response to acid suppressive therapy, partial response to acid suppressive therapy, and no response to acid suppressive therapy. Given the limitations of objective medical testing, implementation of our proposed new symptom-based classification of patients with GERS would guide primary care physicians on when to refer patients to a gastroenterologist, which in turn could help in better resource utilization. Validation of this proposed classification by well-designed prospective multicenter studies is awaited.
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Affiliation(s)
- Prateek Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Missouri 64128-2295, USA.
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Portlock CS, Hamlin P, Noy A, Chey W, Gaydos CA, Palomba L, Schwartz I, Corcoran S, Rosenzweig L, Walker D, Papanicolaou G, Markowitz A. Infectious disease associations in advanced stage, indolent lymphoma (follicular and nonfollicular): developing a lymphoma prevention strategy. Ann Oncol 2007; 19:254-8. [PMID: 17965114 DOI: 10.1093/annonc/mdm484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Eradication of Helicobacter pylori in gastric mucosa-associated lymphoid tumor can result in lymphoma remission. We prospectively identified/treated infections in nonbulky, advanced stage indolent lymphoma (follicular; nonfollicular lymphoma) eligible for observation. MATERIALS AND METHODS Stool H. pylori, hepatitis C and Borrelia serologies, Borrelia and Chlamydia fixed tissue PCR, Chlamydia peripheral blood mononuclear cell PCR and hydrogen breath test for small bowel bacterial overgrowth (SBBO) were obtained. RESULTS Fifty-six patients were enrolled. Positive infections: H. pylori (13); hepatitis C (3); SBBO (11). Negative: Borrelia (13); Chlamydophila psittaci (12, except one PCR). Lymphoma responses to antimicrobial therapy: H. pylori [one complete response (CR), 24+ months; one transient near CR]; hepatitis C [two CRs, 18+ and 30+ months; one partial response (PR) but hepatitis C virus persistent]; SBBO (one PR, 30+ months). Patients with associated infections, but without lymphoma CR, have required lymphoma treatment sooner than those without initial infections (treatment-free survival at 23.4 months median follow-up, 40.5% versus 74.7%, P = 0.01), indicating a different biology. CONCLUSION Infections are common in advanced stage indolent lymphoma (37.5% in our series). Anecdotal lymphoma responses have been seen and three have been durable CRs (18 to 30+ months) with infection eradication alone. The identification and treatment of associated infections may be a first step towards developing a lymphoma prevention strategy.
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Affiliation(s)
- C S Portlock
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
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Metz DC, Comer GM, Soffer E, Forsmark CE, Cryer B, Chey W, Pisegna JR. Three-year oral pantoprazole administration is effective for patients with Zollinger-Ellison syndrome and other hypersecretory conditions. Aliment Pharmacol Ther 2006; 23:437-44. [PMID: 16423003 PMCID: PMC6736592 DOI: 10.1111/j.1365-2036.2006.02762.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Zollinger-Ellison syndrome and idiopathic hypersecretion are gastrointestinal hypersecretory conditions requiring long-term maintenance. AIMS The safety and efficacy data for short-term (6-month) treatment of Zollinger-Ellison syndrome and idiopathic hypersecretion with oral pantoprazole were previously published. This study extends the initial observations to 3 years. METHODS The primary efficacy end point for this report was the control of gastric acid secretion in the last hour before the next dose of oral pantoprazole (acid output of <10 mmol/h; <5 mmol/h in subjects with prior acid-reducing surgery). Dose titration was permitted to a maximum of 240 mg per 24 h. RESULTS Twenty-four subjects completed the study. The acid output of 28 of 34 subjects was controlled at initial enrolment. The mean acid output rates were <10 mmol/h throughout the 36 months of treatment for 90-100% of the patients. The majority of the patients were controlled with b.d. doses of 40 or 80 mg pantoprazole at 36 months (acid output was controlled in 24 of 24 subjects). Pantoprazole was generally well tolerated with minimal adverse events reported. CONCLUSIONS Maintenance oral pantoprazole therapy up to 3 years at dosages of 40-120 mg b.d. was effective and well tolerated in patients with Zollinger-Ellison syndrome and other hypersecretory conditions.
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Affiliation(s)
- D C Metz
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
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11
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Portlock CS, Noy A, Hamlin P, Qin J, Rosenzweig L, Corcoran S, Chey W, Papanicolaou G, Markowitz A. Infectious disease associations in indolent lymphoma (follicular, FL and non-follicular, nFL): Developing a lymphoma prevention strategy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6701] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. S. Portlock
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - A. Noy
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - P. Hamlin
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - J. Qin
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - L. Rosenzweig
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - S. Corcoran
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - W. Chey
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - G. Papanicolaou
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - A. Markowitz
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
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12
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Abstract
BACKGROUND AND STUDY AIMS Endoscopic biliary sphincterotomy in patients with sphincter of Oddi dysfunction (SOD) is associated with a high risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), which may be secondary to residual pancreatic sphincter hypertension. It was hypothesized that botulinum toxin injection could be used to reduce pancreatic sphincter hypertension temporarily in SOD patients after biliary sphincterotomy, thereby reducing the rate of procedure-induced pancreatitis. PATIENTS AND METHODS All patients undergoing ERCP with manometry due to a suspected biliary SOD were asked to participate in the study. Patients with elevated basal sphincter pressures were randomly assigned to receive either botulinum toxin or a sham saline injection after biliary sphincterotomy. Fifty units of botulinum toxin were delivered via a sclerotherapy needle in the form of two 25-U injections of 0.25 ml each into the pancreatic sphincter. In patients in the sham arm, 0.50 ml of saline was injected into the duodenal lumen. RESULTS Between 12 February 1999 and 29 November 2000, a total of 98 patients were referred for ERCP with manometry; 86 consented to participate in the study, and 26 had elevated baseline pressures and underwent random assignment. Twelve received botulinum toxin injection and 14 were randomly assigned to receive the sham injection. A total of six patients in the sham group (43 %) developed procedure-induced pancreatitis, compared with three patients in the botulinum toxin group (25 %; P = 0.34). CONCLUSIONS Biliary sphincterotomy in patients with sphincter of Oddi dysfunction without pancreatic protection is risky and should no longer be carried out. This study demonstrates that botulinum toxin injection into the residual pancreatic sphincter after biliary sphincterotomy is technically feasible and safe, showing a trend toward a reduced post-ERCP pancreatitis rate in patients with sphincter of Oddi dysfunction. Further studies will need to confirm the validity of these experimental results before this technique can be used routinely.
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Affiliation(s)
- A Gorelick
- Connecticut Gastroenterology Consultants, PC, New Haven, Connecticut, USA
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13
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Metz DC, Soffer E, Forsmark CE, Cryer B, Chey W, Bochenek W, Pisegna JR. Maintenance oral pantoprazole therapy is effective for patients with Zollinger-Ellison syndrome and idiopathic hypersecretion. Am J Gastroenterol 2003; 98:301-7. [PMID: 12591045 DOI: 10.1111/j.1572-0241.2003.07262.x] [Citation(s) in RCA: 25] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Maintenance proton pump inhibitor (PPI) therapy is effective for gastric acid hypersecretory states, although data with pantoprazole are limited. The aim of this study was to evaluate the safety and efficacy of long term p.o. pantoprazole in individuals with hypersecretion. METHODS All subjects had Zollinger-Ellison syndrome or idiopathic hypersecretion. Baseline acid output was measured in the presence of prior maintenance antisecretory therapy before pantoprazole exposure. The starting dose was 40 mg b.i.d. in most cases, and the dose was adjusted to document control within the first 2 wk of therapy. The maximal allowable dose was 240 mg daily. Acid output was measured on day 28 and then quarterly from month 3. The primary efficacy endpoint was documented control of acid secretion at 6 months, i.e., acid output in the last 1 h before the next dose of therapy of <10 mEq/h (<5 mEq/h in subjects with prior acid-reducing surgery). RESULTS A total of 26 subjects had Zollinger-Ellison syndrome (six with multiple endocrine neoplasia syndrome type 1) and nine had idiopathic hypersecretion. Pre-enrollment therapy included omeprazole in 27 subjects and lansoprazole in eight, and 82.4% of subjects were controlled on their prior regimens. With upward dose titration, acid output was controlled in all subjects by day 10 and in all but two (6%) at the 6-month time point. Median acid secretion on therapy at 6 months was <2 mEq/h (mean 2.2 mEq/h; range 0-10.5 mEq/h) at a dose of 40 mg b.i.d. for 24 subjects, 80 mg b.i.d. for seven subjects, and 120 mg b.i.d. for two subjects. During the course of the study, five subjects required doses of 240 mg daily. Pantoprazole was generally well tolerated. No cases of anterior optic ischemic neuropathy occurred. Five subjects died during follow-up, all because of events unrelated to the study drug. CONCLUSIONS Maintenance p.o. pantoprazole therapy at a dose of 80-240 mg/day in divided doses was both effective and generally well tolerated for patients with Zollinger-Ellison syndrome and idiopathic hypersecretion.
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Affiliation(s)
- David C Metz
- University of Pennsylvania Medical Center, Division of Gastroenterology, Philadelphia 19104, USA
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O'Keefe SJD, Lee RB, Anderson FP, Gennings C, Abou-Assi S, Clore J, Heuman D, Chey W. Physiological effects of enteral and parenteral feeding on pancreaticobiliary secretion in humans. Am J Physiol Gastrointest Liver Physiol 2003; 284:G27-36. [PMID: 12488233 DOI: 10.1152/ajpgi.00155.2002] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [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] [Indexed: 01/31/2023]
Abstract
In the nutritional management of digestive disorders, it is important to know the relative secretory and metabolic responses to enteral and parenteral feeding. Twenty-seven healthy volunteers were studied while receiving either oral drinks or duodenal infusions of a complex formula diet, duodenal or intravenous infusions of elemental (protein as free amino acids, low fat) formulae, or saline. Pancreaticobiliary secretory responses were measured by nasoduodenal polyethylene glycol perfusion and aspiration, while monitoring blood hormone and nutrient levels. Diets were matched for protein (1.5 g x kg(-1) x d(-1)) and energy (40 kcal x kg(-1) x d(-1)). Compared with placebo, all oroenteral diets stimulated amylase, lipase, trypsin, and bile acid secretion and increased plasma concentrations of gastrin and cholecystokinin, whereas intravenous feeding did not. The complex formula produced a similar response whether given as drinks or duodenal infusions. Changing the duodenal formula to elemental reduced enzyme secretion by 50%, independently of CCK. Higher increases in plasma insulin, glucose, and amino acids were noted with intravenous feeding. Delivering food directly to the intestine by a feeding tube does not reduce pancreaticobiliary secretion. Enteral "elemental" formulae diminish, but only intravenous feeding avoids pancreatic stimulation. Intravenous administration impairs metabolic clearance.
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Affiliation(s)
- Stephen J D O'Keefe
- Medical College of Virginia and Virginia Commonwealth University and McGuire Veterans Administration Hospital, Richmond 23298, USA.
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Abstract
BACKGROUND AND STUDY AIMS The use of pure cut electrocautery current for endoscopic sphincterotomy lowers pancreatitis rates following endoscopic retrograde cholangiopancreatography (ERCP), but at the expense of greater localized bleeding which partially obscures the endoscopic view. We hypothesized that localized bleeding could be decreased by using blended current at the end of the sphincterotomy, without losing the benefit associated with pure cut current of lower post-ERCP pancreatitis benefit. PATIENTS AND METHODS Patients undergoing sphincterotomy were randomly allocated to receive pure cut current alone or a sequential combination of pure cut then blended current. In the sequential combination patients, the first 75 - 80 % of the sphincterotomy was done using pure cut current at 30 W and the remainder completed at a blend 2 setting (pure cut plus coagulation current), also at 30 W. RESULTS 142 patients were enrolled in the study. No statistical difference was noted between the two groups in the rates of overall pancreatitis or bleeding requiring transfusion. When comparing visible bleeding rates (more than a few drops), we found that there was significantly more bleeding (P < 0.05) in the pure cut group (31/75, 41 %) at the time of sphincterotomy compared with the sequential combination group (16/67, 23 %). CONCLUSIONS A sequential combination of pure cut and blended current for sphincterotomy caused less visible bleeding than pure cut alone. This occurred without a change in the rate of post-ERCP pancreatitis.
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Affiliation(s)
- A Gorelick
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-0362, USA
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Pop-Busui R, Chey W, Stevens MJ. Severe hypertension induced by the long-acting somatostatin analogue sandostatin LAR in a patient with diabetic autonomic neuropathy. J Clin Endocrinol Metab 2000; 85:943-6. [PMID: 10720019 DOI: 10.1210/jcem.85.3.6401] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 26-yr-old woman with type 1 diabetes and severe symptomatic autonomic neuropathy was treated with the long-acting somatostatin analogue Sandostatin LAR for intractable diarrhea. Her diarrhea had previously been successfully managed with three daily injections of octreotide without adverse consequences. She was given a single dose of Sandostatin LAR and within 2 weeks reported the development of increasingly frequent and severe headaches. Three weeks after the injection, she was admitted to hospital with severe hypertension, which eventually resolved with the administration of antihypertensive agents. No other underlying cause of the hypertension was discovered. Rechallenge of the patient with octreotide resulted in a transient hypertensive episode, which lasted 3 h. Severe hypertension, therefore, seems to be a possible adverse effect of treatment of diabetic diarrhea with somatostatin analogues, which should be used with great caution in subjects with severe autonomic dysfunction.
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Affiliation(s)
- R Pop-Busui
- Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0678, USA
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Abstract
We report the case of a patient with central nervous system Whipple's disease who developed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient did not exhibit any gastrointestinal symptoms and initially was diagnosed based on neurologic findings and a duodenal biopsy that was positive for Tropheryma whippelii by the polymerase chain reaction. Radiologic involvement of the hypothalamus suggested Whipple's disease as the likely etiology of the syndrome of inappropriate antidiuretic hormone secretion. With antimicrobial therapy, the patient's serum sodium level and symptoms showed improvement.
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Affiliation(s)
- M A Marinella
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA
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Marinella. MA, Chey W. The Syndrome of Inappropriate Antidiuretic Hormone Secretion in a Patient With Whipple's Disease. Am J Med Sci 1997. [DOI: 10.1016/s0002-9629(15)40103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Steiner E, Velt P, Gutierrez O, Schwartz S, Chey W. Hepatocellular carcinoma presenting with intractable diarrhea. A radiologic-pathologic correlation. Arch Surg 1986; 121:849-51. [PMID: 3013124 DOI: 10.1001/archsurg.1986.01400070119025] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 44-year-old woman with hepatocellular carcinoma presented with intractable watery diarrhea and her condition was evaluated angiographically. Surgical ablation of the tumor resulted in complete resolution of the diarrhea. The tumor cells of the hepatocellular carcinoma were found to contain vasoactive intestinal polypeptide, gastrin, and prostaglandinlike immunoactivity. To our knowledge, this is the first report of such an association.
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Abstract
The depolarization-coupled efflux of endogenous ascorbate is demonstrated using rat synaptosome preparations and a rat cortical cup method. Ascorbate and catecholamines (monitored as a methodological control) were quantitated by high pressure liquid chromatography with electrochemical detection. In vitro potassium ion induces ascorbate efflux in a concentration-dependent, although calcium ion-dependent, manner. Veratridine also induces ascorbate efflux and its effect can be blocked by tetrodotoxin. In vivo, ascorbate efflux was likewise stimulated by increased potassium ion and by veratridine. In addition, electrical stimulation of medial lemniscus was accompanied by an increased efflux of ascorbate from somatosensory cortex. These results are intriguing in light of the recent evidence for the interaction of ascorbate with several neurotransmitter systems.
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Menguy R, Chey W. Experiences with the treatment of alkaline reflux gastritis. Surgery 1980; 88:482-8. [PMID: 7423371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Between 1973 and 1978, we have treated 34 patients with alkaline reflux gastritis. All but one had a history of prior gastric surgery. Ten patients had severe diarrhea due to dumping or vagotomy or both. Eleven of the patients had undergone 17 unsuccessful remedial operations. Except for one patient whose gastrojejunostomy was dismantled and two patients who had interposition of a Henle loop between the stomach and the duodenum, all the patients were managed by construction of a 40 cm Roux-en-Y limb. In 10 patients with diarrhea, a 7 to 8 cm antiperistaltic segment was positioned 80 cm distal to the stomach. Ancillary procedures such as vagotomy and Hill hiatal hernia repair were done in some of the patients. Bile gastritis was well controlled by the 40 cm Roux limb. The short reversed segment placed 80 cm from the stomach effectively controlled diarrhea whether it was due to dumping or vagotomy and did not cause any of the problems of gastric stasis that we and others have observed with reversed segments positioned next to the stomach.
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Abstract
A simple new liquid chromatographic technique has been applied to transmitter release studies in brain slice preparations. This method, which gives direct readings of picomoles of endogenous transmitter released, has been shown to yield reliable results with a variety of brain slice manipulations.
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Blank CL, McCreery RL, Wightman RM, Chey W, Adams RN, Reid JR, Smissman EE. Intracyclization rates of 6-hydroxydopamine and 6-aminodopamine analogs under physiological conditions. J Med Chem 1976; 19:178-80. [PMID: 1246041 DOI: 10.1021/jm00223a035] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
It is agreed that the neurotoxic action of 6-hydroxydopamine and 6-aminodopamine is related to their ease of oxidation. The initial oxidation products, the p-quinone and p-quinone imine, readily undergo 1,2-intracyclization. These reactions could represent an important loss of active neurotoxic agent available uptake. A variety of substituted 6-aminodopamine analogs was prepared and their formal potentials and cyclization rates were measured accurately. The effect of the balance of ease of oxidation vs. rate of cyclization on their neurotoxicity was examined. The results are in general accord with in vivo lifetimes for 6-hydroxydopamine and 6-aminodopamine in rat caudate nucleus.
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