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Farooq U, Tarar ZI, El Alayli A, Kamal F, Niu C, Qureshi K. Analyzing the utility of renal replacement therapy to manage hepatorenal syndrome in alcoholic hepatitis without liver transplantation: a nationwide analysis. J Gastroenterol Hepatol 2024; 39:560-567. [PMID: 37953474 DOI: 10.1111/jgh.16388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Hepatorenal syndrome (HRS) frequently complicates alcoholic hepatitis (AH) and portends poor survival in this population. Published literature indicates mixed benefits from renal replacement therapy (RRT) for HRS refractory to medical management. Therefore, we sought to assess the utilization of RRT in AH and clinical outcomes at a national level. METHODS Using the International Classification of Diseases, Tenth Revision (ICD-10) codes, we identified adult patients with AH with a coexisting diagnosis of HRS from the National Readmission Database 2016 through 2019. Mortality, morbidity, and resource utilization were compared. We compared proportions using the Fisher exact test and computed adjusted P-values based on multivariate regression analysis. Analyses were performed using Stata, version 14.2, considering a two-sided P < 0.05 as statistically significant. RESULTS A total of 73 203 patients with AH were included in the analysis (mean age 46.2 years). A total of 3620 individuals had HRS diagnosis (5%), of which 14.7% (n: 532) underwent RRT. HRS patients receiving RRT had a higher mortality rate than those who did not (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI]: 1.3-2.6, P: 0.01), along with higher resource utilization. Only those patients with HRS who underwent liver transplantation (LT) experienced a mortality reduction (24.4% for those not receiving RRTs and 36.5% for those receiving RRT). CONCLUSIONS RRT is associated with higher mortality and morbidity when offered to patients with AH and HRS, who do not undergo LT. Therefore, our results suggest careful selection of AH patients when deciding to initiate RRT for HRS.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
| | - Abdallah El Alayli
- Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Faisal Kamal
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chengu Niu
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Kamran Qureshi
- Division of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, Missouri, USA
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Farooq U, Abbasi AF, Tarar ZI, Chaudhary AJ, Kamal F. Understanding the role of frailty in local and systemic complications and healthcare resource utilization in acute pancreatitis: Findings from a national cohort. Pancreatology 2024; 24:6-13. [PMID: 38072685 DOI: 10.1016/j.pan.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/17/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Acute pancreatitis (AP) is a significant gastrointestinal cause of hospitalization with increasing incidence. Risk stratification is crucial for determining AP outcomes, but the association between frailty and AP outcomes is poorly understood. Moreover, age disparities in severity indices for AP complicate risk assessment. This study investigates frailty's impact on local and systemic complications in AP, readmission rates, and healthcare resource utilization. METHODS Using the National Readmission Database from 2016 to 2019, we identified adult AP patients and assessed frailty using the Frailty Risk Score. Our analysis included local and systemic complications, resource utilization, readmission rates, procedures performed, and hospitalization outcomes. Multivariate regression was employed, and statistical significance was set at P < 0.05 using Stata version 14.2. RESULTS Among 1,134,738 AP patients, 6.94 % (78,750) were classified as frail, with a mean age of 63.42 years and 49.71 % being female. Frail patients experienced higher rates of local complications (e.g., pseudocyst, acute pancreatic necrosis, walled-off necrosis) and systemic complications (e.g., pleural effusion, acute respiratory distress syndrome, sepsis, abdominal compartment syndrome) compared to non-frail patients. Frailty was associated with increased readmission rates and served as an independent predictor of readmission. Frail patients had higher inpatient mortality (7.11 % vs. 1.60 %), longer hospital stays, and greater hospitalization costs. CONCLUSION Frailty in AP patients is linked to elevated rates of local and systemic complications, increased mortality, and higher healthcare costs. Assessing frailty is crucial in AP management as it provides a valuable tool for risk stratification and identifying high-risk patients, thereby improving overall outcomes.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, 14621, USA.
| | - Abu Fahad Abbasi
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - Ammad J Chaudhary
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Faisal Kamal
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Saleem S, Tarar ZI, Aziz M, Alsamman MA, Tansel A, Abell TL. Cannabis Use in Patients with Gastroparesis. Cannabis Cannabinoid Res 2023; 8:1100-1105. [PMID: 36067326 DOI: 10.1089/can.2022.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: The primary aim was to determine the prevalence of cannabis use among patients hospitalized for gastroparesis. The secondary aim was to identify independent variables associated with cannabis use compared with noncannabis-related gastroparesis hospitalization. Methods: We use the nationwide inpatient sample database from January 2012 to December 2014. The patients included in this study were the ones with primary diagnosis of gastroparesis and cannabis use. The analysis was performed using the Statistical Package for the Social Sciences 27 (SPSS) and a multivariable regression was conducted to identify independent variables. Results: We found 50,170 patients with a primary diagnosis of gastroparesis. The prevalence of cannabis use among patients hospitalized for gastroparesis was 4.2%. Multivariate regression analysis was performed, adjusting for confounders. The variables found to increase the odds of cannabis use in gastroparesis populations independently were age interval of 18-35 and 36-50 years, male, Black and Asian, median household income 1-25th percentile, Medicaid insurance, no charge hospitalization, and smoking. Cannabis use was associated with lower odds of vomiting. Conclusion: Patients who used cannabis were younger and of African American, Asian, or Pacific Islander descent. They had Medicaid insurance and a lower median household income.
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Affiliation(s)
- Saad Saleem
- Department of Internal Medicine, Sunrise Hospital and Medical Center, Las Vegas, Nevada, USA
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
| | - Muhammad Aziz
- Department of Gastroenterology, Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Mohd Amer Alsamman
- Department of Gastroenterology, Georgetown University, Washington, District of Columbia, USA
| | - Aylin Tansel
- Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas L Abell
- Department of Gastroenterology, University of Louisville, Louisville, Kentucky, USA
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Tarar ZI, Farooq U, Zafar Y, Gandhi M, Raza S, Kamal F, Tarar MF, Ghouri YA. Burden of anxiety and depression among hospitalized patients with irritable bowel syndrome: a nationwide analysis. Ir J Med Sci 2023; 192:2159-2166. [PMID: 36593438 DOI: 10.1007/s11845-022-03258-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIM Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder that affects patients both physically and mentally. Our study aimed to investigate the burden of psychiatric disorders in IBS patients. METHODS We conducted a retrospective analysis of the National inpatient sample (NIS) from 2016 to 2019. We recruited patients admitted with a diagnosis of IBS and determined the prevalence of anxiety, depression, and suicide attempt/ideation. RESULTS We found a total of 1,256,325 hospitalizations with a diagnosis of IBS. Among them, 478,515 (38.1%) had anxiety and 344,165 (27.4%) had depression. The prevalence of psychiatric disorders including anxiety (38.1% vs. 15.1%), depression (38.1% vs. 15.1%), bipolar disorder (5.22% vs. 2.38%), suicidal attempt/Ideation (3.22% vs. 2.38%), and eating disorder (0.32% vs. 0.08%) was significantly higher in IBS patient population when compared to general adult population (p < 0.001). Patients with IBS had greater odds of anxiety (AOR 2.88, 95% CI 2.85-2.91, P < 0.001), depression (AOR 2.16, 95% CI 2.14-2.19, P < 0.001) and suicidal attempt/ideation (AOR 1.94, 95% CI 1.88-2.00, P < 0.001) in comparison to general population. IBS subtypes including diarrhea-predominant, constipation-predominant and mixed type were independently associated with increased odds of anxiety, depression, and suicide attempt/ideation. Patients with IBS and a co-diagnosis of anxiety or depression had increased mean length of hospital stay by 0.48 (95% CI 0.43-0.52, P < 0.001) and 0.52 (95% CI 0.06-0.97, P < 0.03) days, respectively. CONCLUSION The presence of IBS is associated with an increased associated prevalence of psychiatric disorders such as anxiety, depression, and suicide attempt/ideation.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA.
| | - Umer Farooq
- Rochester General Hospital, Rochester, NY, USA
| | - Yousaf Zafar
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Mustafa Gandhi
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Samina Raza
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Faisal Kamal
- Department of Gastroenterology, University of California, San Francisco, USA
| | - Moosa F Tarar
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Yezaz A Ghouri
- Division of Gastroenterology & Hepatology, School of Medicine at Columbia, University of Missouri, Columbia, MO, USA
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Tarar ZI, Farooq U, Nawaz A, Gandhi M, Ghouri YA, Bhatt A, Cash BD. Prevalence of Fibromyalgia and Chronic Fatigue Syndrome among Individuals with Irritable Bowel Syndrome: An Analysis of United States National Inpatient Sample Database. Biomedicines 2023; 11:2594. [PMID: 37892968 PMCID: PMC10604744 DOI: 10.3390/biomedicines11102594] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023] Open
Abstract
Background and Aim: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with other somatic disorders. We studied the prevalence and predictors of fibromyalgia and chronic fatigue syndrome (CFS) in IBS patients. Methods: We used the National Inpatient Sample and included hospitalization of individuals with IBS, using ICD-10 codes, from 2016-2019. The prevalence and predictors of fibromyalgia and CFS in IBS patients were studied. Univariate and multivariate patient- and hospital-level regression models were used to calculate the adjusted odds of fibromyalgia and CFS in the IBS patient population. Results: Of 1,256,325 patients with an ICD-10 code of IBS included in the study, 10.73% (134,890) also had ICD-10 codes for fibromyalgia and 0.42% (5220) for CFS. The prevalence of fibromyalgia and CFS was significantly higher in IBS patients (adjusted odds ratio (AOR) 5.33, 95% confidence interval (CI) 5.24-5.41, p < 0.001, and AOR 5.40, 95% CI 5.04-5.78, p < 0.001, respectively) compared to the general adult population without IBS. IBS-diarrhea, IBS-constipation, and IBS-mixed types were independently associated with increased odds of fibromyalgia and CFS. Increasing age (AOR 1.02, 95% CI 1.01-1.04, p 0.003; AOR 1.02, 95% CI 1.01-1.03, p 0.001), female gender (AOR 11.2, 95% CI 11.1-11.4, p < 0.001; AOR 1.86, 95% CI 1.78-1.93, p < 0.001) and white race (AOR 2.04, 95% CI 1.95-2.12, p < 0.001; AOR 1.69, 95% CI 1.34-2.13, p < 0.001) were independent predictors of increased odds of fibromyalgia and CFS, respectively. Conclusions: It appears that IBS is associated with an increased prevalence of somatic disorders such as fibromyalgia and CFS.
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Affiliation(s)
- Zahid Ijaz Tarar
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Umer Farooq
- Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO 63103, USA;
| | - Ahmad Nawaz
- Division of Gastroenterology and Hepatology, Suny Upstate Medical University, Syracuse, NY 13210, USA
| | - Mustafa Gandhi
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Yezaz A. Ghouri
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Asmeen Bhatt
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Elective Surgery, Department of Surgery, University of Texas Health Medical School, Houston, TX 77030, USA
| | - Brooks D. Cash
- Division of Gastroenterology & Hepatology, University of Texas Health-McGovern Medical School and UT Health Science Center at Houston, St. Houston, TX 77054, USA
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Tarar ZI, Farooq U, Gandhi M, Saleem S, Daglilar E. Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis. Clin Endosc 2023; 56:578-589. [PMID: 37157959 PMCID: PMC10565436 DOI: 10.5946/ce.2023.027] [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: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND/AIMS The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact of Child-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patients with cirrhosis compared with those without cirrhosis. METHODS We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patients with hepatic cirrhosis. RESULTS Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosis was 15.5% (95% confidence interval [CI], 11.8%-19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%-7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%-4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%-3.8%; I2=83.4%), and perforation 0.3% (95% CI, 0.1%-0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16-1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis (RR, 1.25; 95% CI, 1.06-1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59-2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77-1.70; I2=12%), and perforation (RR, 1.20; 95% CI, 0.59-2.43; I2=0%). CONCLUSION Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Umer Farooq
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Mustafa Gandhi
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Saad Saleem
- Department of Medicine, Sunrise Hospital and Medical Center, Las Vegas, NV, USA
| | - Ebubekir Daglilar
- Department of Gastroenterology and Hepatology, Charleston area Medical Center, West Virginia University School of Medicine, Charleston, WV, USA
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Tarar ZI, Farooq U, Gandhi M, Zafar MU, Saleem S, Kamal F. Safety and indications for endoscopic retrograde cholangiopancreatography in liver transplant patients: an analysis of the United States' National Inpatient Sample database. Ann Gastroenterol 2023; 36:459-465. [PMID: 37396010 PMCID: PMC10304520 DOI: 10.20524/aog.2023.0801] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 07/04/2023] Open
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) is performed to treat biliary complications after a liver transplantation; however, the previously available literature on the safety of ERCP in liver transplant patients is limited. We aimed to study the safety of ERCP in liver transplant patients. Methods We used a National Inpatient Sample database from 2016-2019 to identify patients who underwent ERCP and had a history of a liver transplantation, using the international classification of diseases, 10th revision. Multivariate logistic regression analysis was conducted to determine the odds of post-ERCP complications in liver transplant recipients. Results Liver transplant patients who underwent ERCP had a higher rate of post-ERCP pancreatitis and bleeding compared to the general adult population (11.39% vs. 9.19%, 0.83% vs. 0.53%, respectively). However, the adjusted odds of post-ERCP pancreatitis (adjusted odds ratio [aOR] 1.13, 95% confidence interval [CI] 0.86-1.49; P=0.36) and bleeding (aOR 1.41, 95%CI 0.58-3.46; P=0.45) were similar in both the liver transplant and no-transplant groups. There was no difference in the odds of post-ERCP cholangitis (aOR 1.26, 95%CI 0.80-2.01; P=0.32), and sepsis (aOR 0.94, 95%CI 0.66-1.34; P=0.76) between liver transplant and no transplant groups. Biliary stricture was the most common indication for ERCP in the liver transplant group, whereas choledocholithiasis was the main reason for ERCP in the general adult population. Conclusions ERCP is a safe procedure for treating biliary complications in liver transplant patients. The odds of post-ERCP complications (pancreatitis, bleeding, sepsis, cholangitis) in liver transplant patients are comparable to those in patients with no transplantation.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO (Zahid Ijaz Tarar, Mustafa Gandhi)
| | - Umer Farooq
- Department of Medicine, Rochester General Hospital, Rochester, NY (Umer Farooq)
| | - Mustafa Gandhi
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO (Zahid Ijaz Tarar, Mustafa Gandhi)
| | | | - Saad Saleem
- Department of Medicine, Sunrise Hospital and Medical Center, Las Vegas, NV (Saad Saleem)
| | - Faisal Kamal
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, PA (Faisal Kamal), USA
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Goraya MHN, Inayat F, Taj S, Awan JR, Mohyudin A, Ali SH, Afzal A, Ashraf MJ, Zaman MA, Akhtar Z, Nawaz G, Tarar ZI. Acute ischemic colitis associated with oral decongestant use: a systematic review. J Clin Transl Res 2023; 9:195-205. [PMID: 37275581 PMCID: PMC10238105] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/26/2022] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Background and Aim Acute ischemic colitis (IC) has been linked with the use of oral decongestants. However, clinical evidence on this association remains limited. We aim to evaluate the occurrence and clinical outcomes of acute IC following over-the-counter (OTC) use of pseudoephedrine and phenylephrine. Methods We conducted a systematic review of the MEDLINE, Google Scholar, Scopus, and Embase databases between inception and July 20, 2022. Specific search terms were used. The inclusion criteria consisted of English-language articles describing acute IC secondary to pseudoephedrine or phenylephrine. Results A total of 18 case reports (level of clinical evidence: IV) fulfilled our inclusion criteria. The mean age of patients was 51.6 ± 15.3 years, with 14 (77.8%) cases reported in women. The clinical presentation was mainly related to abdominal pain 16 (88.9%), hematochezia 15 (83.3%), and/or abdominal tenderness 10 (55.6%). The medical background showed that 5 (27.8%) patients were previously healthy. In the 13 (72.2%) patients with comorbidities, hypertension 6 (46.2%), a history of tobacco use 5 (38.5%), and psychiatric illnesses 4 (30.8%) were commonly reported. Leukocytosis was encountered in 13 (72.2%) patients. Diagnostic investigations included a combination of computed tomography scan and colonoscopy in 10 (55.6%), colonoscopy alone in 6 (33.3%), and flexible sigmoidoscopy in 1 (5.6%) patient. Colonoscopic biopsy was the mainstay of diagnosis in 15 (83.3%) patients. Treatment was based on supportive care in 18 (100%), concurrent antibiotic use in 2 (11.1%), and surgical intervention in 1 (5.6%) patient. Recurrent episodes of IC occurred in 4 (22.2%) patients. Conclusions Acute IC secondary to oral decongestants remains a rare but important clinical phenomenon. Clinical suspicion and imaging findings are important for the early diagnosis. Relevance to Patients In unexplained cases of IC, clinicians should specifically inquire about oral decongestants since they are OTC and patients commonly fail to reveal their usage. These drugs should be avoided for transient cold symptoms, especially in women.
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Affiliation(s)
| | - Faisal Inayat
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Sobaan Taj
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Junaid Rasul Awan
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Adil Mohyudin
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Syed Hasan Ali
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Arslan Afzal
- Department of Internal Medicine, Woodhull Medical Center, Brooklyn, NY, USA
| | | | | | - Zahra Akhtar
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Gul Nawaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Zahid Ijaz Tarar
- Department of Gastroenterology, University of Missouri School of Medicine, Columbia, MO, USA
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:238-246. [DOI: 10.13105/wjma.v11.i5.238] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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Saleem S, Tarar ZI, Amjad W, Malik A, Ishtiaq R, Abell TL. Association between Gastroparesis and Rheumatoid Arthritis: A US Population-Based Study. South Med J 2023; 116:443-447. [PMID: 37263604 DOI: 10.14423/smj.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) have a high prevalence of nausea, vomiting, postprandial fullness, and abdominal pain; these are symptoms that are similar to those in gastroparesis (GP). The aim of this study was to assess the association between GP and RA and the determinants of GP. METHODS We identified patients with RA and patients with GP from the 2012-2014 National Inpatient Sample database. The t test and the χ2 test were used for continuous and categorical variables, respectively. We determined the association between RA and GP and independent predictors of GP by multivariate analysis. RESULTS Of 1,514,960 patients with RA, there were 1070 hospitalizations in which a primary diagnosis of GP was identified. The GP odds ratio in RA was found to be 1.36 and the 95% confidence interval was 1.24 to 1.49 (P < 0.0001). The variables increasing the odds of GP were age intervals of 18 to 35 years, 36 to 50 years, and 51 to 65 years; being female, White, or Black; a median household income in the 26th to 50th and the 51st to 75th percentiles; having diabetes mellitus; and having RA. CONCLUSIONS An increased likelihood of 36% of GP among patients with RA was determined. White and Black patients younger than age 65 showed a greater risk of developing GP.
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Affiliation(s)
- Saad Saleem
- From the Department of Internal Medicine, Sunrise Hospital and Medical Center, Las Vegas, Nevada
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia
| | - Waseem Amjad
- Department of Internal Medicine, Albany Medical Center, Albany, New York
| | - Adnan Malik
- Department of Internal Medicine, University of Alabama, Birmingham
| | - Rizwan Ishtiaq
- Department of Internal Medicine, St. Vincent Mercy Medical Center, Toledo, Ohio
| | - Thomas L Abell
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky
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Tarar ZI, Farooq U, Gandhi M, Ghous G, Saleem S, Kamal F, Imam Z, Jamil L. Effect of radiofrequency ablation in addition to biliary stent on overall survival and stent patency in malignant biliary obstruction: an updated systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:646-653. [PMID: 37129575 DOI: 10.1097/meg.0000000000002568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/03/2023]
Abstract
OBJECTIVES Radiofrequency ablation (RFA) is used in addition to stent placement to manage extrahepatic malignant biliary obstruction. We aimed to study the effect of RFA on overall survival (OS) and stent patency in malignant biliary obstruction. METHODS A comprehensive literature search was performed from inception to May 2022 for all studies measuring the effect of RFA plus stents compared to stents placement only on OS and stent patency in patients with malignant biliary obstruction. We measured differences in OS, stent patency, and odds of adverse events. A random effect model was used to pool data for stent patency, OS, and adverse event. RESULTS A total of 17 studies (14 observational and 3 RCT) containing 1766 patients were included in the analysis. The weighted pooled mean survival difference was 58.5 days [95% confidence interval (CI): 32.6-84.4, I2 = 71%] in favor of the RFA treatment group. The weighted mean difference in stent patency was better in the RFA plus stent group by 45.3 days (95% CI: 30.1-60.5, I2 = 16.4%) compared to stent only group. The pooled odds of adverse events were the same in both groups [odds ratio (OR) 1.52, 95% CI: 0.96-2.43, I2 = 59%], and no serious adverse event was seen in either group, or no death reported secondary to RFA procedure. No difference in stent patency based on procedure type, including percutaneous transhepatic cholangiography versus endoscopic retrograde cholangiopancreatography (P = 0.06), and an underline cause of bile duct obstruction was found (P = 0.261). CONCLUSION RFA treatment, in addition to stent placement in malignant biliary obstruction, potentially improves OS and stent patency duration.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Medicine, University of Missouri School of Medicine, Columbia, Columbia, MO
| | - Umer Farooq
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Mustafa Gandhi
- Department of Medicine, University of Missouri School of Medicine, Columbia, Columbia, MO
| | - Ghulam Ghous
- Department of Medicine, University of Missouri School of Medicine, Columbia, Columbia, MO
| | - Saad Saleem
- Department of Medicine, Sunrise Hospital and Medical Center, Las Vegas, Nevada
| | - Faisal Kamal
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Zaid Imam
- Department of Gastroenterology and Hepatology, William Beaumont Medical Center, Royal Oak, Michigan, USA
| | - Laith Jamil
- Department of Gastroenterology and Hepatology, William Beaumont Medical Center, Royal Oak, Michigan, USA
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12
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Gandhi M, Tarar ZI, Farooq U, Saleem S, Chela HK, Daglilar E. The COVID-19 Infection Resulted Delayed Esophagogastroduodenoscopy in Patients Admitted with Variceal Bleeding: Hospital-Based Outcomes of a National Database. Diseases 2023; 11:diseases11020075. [PMID: 37218888 DOI: 10.3390/diseases11020075] [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] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023] Open
Abstract
During the COVID-19 pandemic in 2020, most healthcare services, including inpatient and outpatient procedures, got delayed. We reviewed the effect of COVID-19 infection on the timing of esophagogastroduodenoscopy (EGD) in variceal bleeding patients and analyzed the complications of delayed EGD. Using the National Inpatient Sample (NIS) 2020, we identified patients admitted for variceal bleeding with COVID-19 infection. We performed a multivariable regression analysis and adjusted it for patient and hospital-related variables. The International Classification of Disease Tenth Revision (ICD-10) codes were used for patient selection. We measured the effect of COVID-19 on the timing of EGD and further analyzed the effect of delayed EGD on hospital-based outcomes. A total of 49,675 patients diagnosed with variceal upper gastrointestinal bleeding were analyzed, out of which 915 (1.84%) were COVID-19 positive. Variceal bleeding patients who were COVID-positive had a significantly lower rate of EGD performed within the first 24 h of admission (36.1% vs. 60.6% p = 0.001) compared to the patients who tested negative for COVID-19. The performance of EGD within 24 h of admission resulted in a decrease in all-cause mortality by 70% (adjusted odds ratio (AOR) 0.30, 95% CI 0.12-0.76, p = 0.01) compared to EGD after 24 h. A significant decrease was noted in the odds of ICU admission rate (AOR 0.37, 95% CI 0.14-0.97, p = 0.04) in patients who got EGD within the first 24 h of admission. No difference in odds of sepsis (AOR 0.44, 95% CI 0.15-1.30, p = 0.14) and vasopressor use (AOR 0.34, 95% CI 0.04-2.87, p = 0.32) was seen in COVID positive vs. COVID negative group. The hospital mean length of stay (2.14 days, 95% CI 4.35-0.06, p = 0.06), mean total charges ($51,936, 95% CI $106,688-$2816, p = 0.06), and total cost (11,489$, 95% CI 30,380$-7402$, p = 0.23) was similar in both COVID-positive and -negative groups. In our study, we found that the presence of COVID-19 infection in variceal bleeding patients resulted in a significant delay in EGD compared to COVID-negative patients. This delay in EGD resulted in increased all-cause mortality and intensive care unit admissions.
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Affiliation(s)
- Mustafa Gandhi
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65211 USA
| | - Zahid Ijaz Tarar
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65211 USA
| | - Umer Farooq
- Rochester General Hospital, Rochester, NY 14621, USA
| | - Saad Saleem
- Department of Medicine, Sunrise Hospital and Medical Center, Las Vegas, NV 89109, USA
| | - Harleen Kaur Chela
- Department of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University School of Medicine, Charleston, WV 25304, USA
| | - Ebubekir Daglilar
- Department of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University School of Medicine, Charleston, WV 25304, USA
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Awan JR, Akhtar Z, Inayat F, Farooq A, Goraya MHN, Ishtiaq R, Malik S, Younus F, Kazmi S, Ashraf MJ, Khan AA, Tarar ZI. Acute acalculous cholecystitis as a rare gastroenterological association of COVID-19: a case series and systematic review. J Clin Transl Res 2023; 9:133-143. [PMID: 37179790 PMCID: PMC10171317] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/19/2023] [Accepted: 03/07/2023] [Indexed: 05/15/2023] Open
Abstract
Background and Aim Acute acalculous cholecystitis (AAC) is an acute inflammatory disease of the gallbladder in the absence of cholecystolithiasis. It is a serious clinicopathologic entity, with a high mortality rate of 30-50%. A number of etiologies have been identified that can potentially trigger AAC. However, clinical evidence on its occurrence following COVID-19 remains scarce. We aim to evaluate the association between COVID-19 and AAC. Methods We report our clinical experience based on 3 patients who were diagnosed with AAC secondary to COVID-19. A systematic review of the MEDLINE, Google Scholar, Scopus, and Embase databases was conducted for English-only studies. The latest search date was December 20, 2022. Specific search terms were used regarding AAC and COVID-19, with all associated permutations. Articles that fulfilled the inclusion criteria were screened, and 23 studies were selected for a quantitative analysis. Results A total of 31 case reports (level of clinical evidence: IV) of AAC related to COVID-19 were included. The mean age of patients was 64.7 ± 14.8 years, with a male-to-female ratio of 2.1:1. Major clinical presentations included fever 18 (58.0%), abdominal pain 16 (51.6%), and cough 6 (19.3%). Hypertension 17 (54.8%), diabetes mellitus 5 (16.1%), and cardiac disease 5 (16.1%) were among the common comorbid conditions. COVID-19 pneumonia was encountered before, after, or concurrently with AAC in 17 (54.8%), 10 (32.2%), and 4 (12.9%) patients, respectively. Coagulopathy was noted in 9 (29.0%) patients. Imaging studies for AAC included computed tomography scan and ultrasonography in 21 (67.7%) and 8 (25.8%) cases, respectively. Based on the Tokyo Guidelines 2018 criteria for severity, 22 (70.9%) had grade II and 9 (29.0%) patients had grade I cholecystitis. Treatment included surgical intervention in 17 (54.8%), conservative management alone in 8 (25.8%), and percutaneous transhepatic gallbladder drainage in 6 (19.3%) patients. Clinical recovery was achieved in 29 (93.5%) patients. Gallbladder perforation was encountered as a sequela in 4 (12.9%) patients. The mortality rate in patients with AAC following COVID-19 was 6.5%. Conclusions We report AAC as an uncommon but important gastroenterological complication following COVID-19. Clinicians should remain vigilant for COVID-19 as a possible trigger of AAC. Early diagnosis and appropriate treatment can potentially save patients from morbidity and mortality. Relevance for Patients AAC can occur in association with COVID-19. If left undiagnosed, it may adversely impact the clinical course and outcomes of patients. Therefore, it should be considered among the differential diagnoses of the right upper abdominal pain in these patients. Gangrenous cholecystitis can often be encountered in this setting, necessitating an aggressive treatment approach. Our results point out the clinical importance of raising awareness about this biliary complication of COVID-19, which will aid in early diagnosis and appropriate clinical management.
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Affiliation(s)
| | - Zahra Akhtar
- University of Texas Medical Branch, Galveston, TX, USA
| | - Faisal Inayat
- Allama Iqbal Medical College, Lahore, Pakistan
- Corresponding author: Faisal Inayat Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore 54550, Punjab, Pakistan. Tel: +92 321 774 3758 Fax: +92 42 9923 1443
| | | | | | - Rizwan Ishtiaq
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Sana Malik
- University Maternity Hospital Limerick, Limerick, Ireland
| | | | - Sana Kazmi
- Dow University of Health Sciences, Karachi, Pakistan
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Farooq U, Tarar ZI, Faggen AE, Aziz M, Chandan S, Ahmed Z, Kouanda A, Dai SC, Munroe CA, Adler DG. Efficacy and safety of EUS-guided biliary drainage for benign biliary obstruction - A systematic review and meta-analysis. Endosc Ultrasound 2023; 12:228-236. [PMID: 36751758 PMCID: PMC10237615 DOI: 10.4103/eus-d-22-00077] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/09/2022] [Indexed: 02/09/2023] Open
Abstract
Background and Objectives ERCP is the first line of treatment for benign and malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. Recently, several studies have evaluated the role of EUS-BD in the management of benign biliary obstruction. This meta-analysis evaluates the efficacy and safety of EUS-BD in the management of benign biliary obstruction. Methods We reviewed several databases from inception to July 8, 2022, to identify studies evaluating the efficacy and safety of EUS-BD in the management of benign biliary obstruction. Our outcomes of interest were technical success, clinical success, and adverse events. Pooled rates with 95% confidence intervals (CIs) for all outcomes were calculated using a random effects model. Subgroup analyses were performed including patients with normal anatomy versus surgically altered anatomy (SAA). Heterogeneity was assessed by I2 statistic. Results We included 14 studies with 329 patients. The pooled rate (95% CI) of technical success was 88% (83%, 92%). The pooled rate (95% CI) of technical success for patients with SAA and normal anatomy was 92% (85%, 96%) and 83% (75%, 89%), respectively. The pooled rates (95% CI) of clinical success and adverse events were 89% (83%, 93%) and 19% (13%, 26%), respectively. We found low heterogeneity in most of the analyses. Conclusions EUS-BD is an effective and safe option in patients with benign biliary obstruction and should be considered after a failed attempt at ERCP or when ERCP is not technically possible.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wade Lee-Smith
- Mulford Health Sciences Library, University of Toledo, Toledo, OH, USA
| | - Sachit Sharma
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA
| | - Zahid Ijaz Tarar
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Alec E. Faggen
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, OH, USA
| | - Saurabh Chandan
- Division of Gastroenterology, Creighton University Medical Center, Omaha, NE, USA
| | - Zohaib Ahmed
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Abdul Kouanda
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Craig A. Munroe
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA
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15
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Saleem S, Tarar ZI, Aziz M, Ishtiaq R, Guzman Rojas P, Abell TL. Gastroparesis in geriatrics population: A United States population study. Am J Med Sci 2023; 365:226-231. [PMID: 36521532 DOI: 10.1016/j.amjms.2022.12.003] [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] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/18/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older patients with upper gastrointestinal diseases may lack disease-specific symptoms that are required to make the correct diagnosis. This study aimed to compare the gastroparesis demographics, clinical presentation, and surgical management between the older adult and young populations. METHODS The National Inpatient Sample database was used between the years 2012 and 2014 with the primary diagnosis of gastroparesis. Patients were further divided based on their age into two groups: 70 years or older and younger than 70 years. RESULTS The older adults were more likely to have early satiety and bloating compared to younger population with an odds ratio (OR) = 3.79; 95% Confidence Interval (95%CI) 2.80- 5.11, p < 0.0001 and OR = 2.80, 95%CI 2.07-3.78, p<0.0001 respectively. Older adults had low odds of having nausea with vomiting (OR = 0.86, 95%CI 0.76-0.95, p = 0.003), or abdominal pain (OR = 0.56, 95%CI 0.50-0.63, p<0.0001). CONCLUSIONS Older adults had more early satiety and bloating, whereas younger patients had more nausea with vomiting and abdominal pain.
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Affiliation(s)
- Saad Saleem
- Department of Internal Medicine, Sunrise Hospital and Medical Center, Las Vegas, NV, United States
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO, United States
| | - Muhammad Aziz
- Department of Gastroenterology, University of Toledo, Toledo, OH, United States
| | - Rizwan Ishtiaq
- Department of Internal Medicine, St. Vincent Mercy Medical Center, Toledo, OH, United States
| | - Patricia Guzman Rojas
- Department of Internal Medicine, University of Louisville, Louisville, KY, United States
| | - Thomas L Abell
- Department of Medicine, University of Louisville, Louisville, KY, United States.
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16
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:38-46. [DOI: 10.13105/wjma.v11.i1.38] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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Farooq U, Gondal AB, Franco D, Tarar ZI, Mahmood S. Validation of Tokyo Guidelines 2018 for Safety and Mortality Benefit from Urgent
ERCP
in Acute Cholangitis across Different Age Groups. J Hepato Biliary Pancreat 2022. [DOI: 10.1002/jhbp.1275] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital Berwyn IL
| | - Amlish B. Gondal
- Department of Internal Medicine, Guthrie Robert Packer Hospital Sayre PA USA
| | - Diana Franco
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital Berwyn IL
| | - Zahid Ijaz Tarar
- Department of Internal Medicine University of Missouri Columbia MO
| | - Sultan Mahmood
- Division of Gastroenterology, Hepatology & Nutrition University at Buffalo Buffalo NY
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18
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Tarar ZI, Farooq U, Kamal F, Nawaz A, Saleem S, Ghous G, Basar O, Chela HK, Tahan V, Daglilar E. Safety of anticoagulation use for treatment of portal vein thrombosis in liver cirrhosis and its effect on hospital-based outcomes: an insight from a US nationwide database. Postgrad Med J 2022:7158378. [PMID: 36008113 DOI: 10.1136/pmj-2022-141915] [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] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIM Anticoagulation use for portal vein thrombosis (PVT) in patients with advanced liver disease is controversial. We investigated the effect of anticoagulation on outcomes in patients with PVT with cirrhosis. METHODS We reviewed National Inpatient Sample data from 2016 to 2018 to identify patients with PVT. Our outcomes were in-hospital mortality, variceal bleeding, hepatic encephalopathy, acute kidney injury (AKI), hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP), sepsis and hospital resource utilisation. RESULTS We included 60 505 patients with PVT, out of whom 6.63% (4015) were on anticoagulation. The overall mortality in the anticoagulation group was 2.12% compared with 9.72% in the no anticoagulation group. The adjusted odds of mortality were low in the anticoagulation group (adjusted OR (AOR) 0.27, 95% CI 0.15 to 0.46, p<0.001). Patients on anticoagulation had 29% lower odds of variceal bleeding (AOR 0.71, 95% CI 0.53 to 0.96, p=0.03). Lower odds of HRS (AOR 0.56, 95% CI 0.37 to 0.85, p=0.01) and AKI (AOR 0.57, 95% CI 0.48 to 0.69, p<0.001) were also seen in the anticoagulation group. Patients in the anticoagulation group also showed lower odds of SBP (AOR 0.62, 95% CI 0.43 to 0.89, p=0.01) and sepsis (AOR 0.57, 95% CI 0.35 to 0.93, p=0.03). Anticoagulation use resulted in shorter hospital stay by 1.15 days (adjusted length of stay -1.15, 95% CI -1.51 to -0.79, p<0.001). The mean difference in total hospital charges between the anticoagulation and the no anticoagulation group was -$20 034 (95% CI -$27 077 to -$12 991, p<0.001). CONCLUSION Our analysis found that anticoagulation use is safe and associated with better outcomes in patients with PVT with advanced liver disease.
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Affiliation(s)
- Zahid Ijaz Tarar
- Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Umer Farooq
- Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA
| | - Faisal Kamal
- Gastroenterology, University of California San Francisco, San Francisco, California, USA
| | - Ahmad Nawaz
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saad Saleem
- Internal Medcine, Sunrise Hospital and Medical Center, Las Vegas, Nevada, USA
| | - Ghulam Ghous
- Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Omer Basar
- Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Harleen Kaur Chela
- Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Veysel Tahan
- Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ebubekir Daglilar
- Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA
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19
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Farooq U, Tarar ZI, Chela HK, Tahan V, Daglilar E. Analysis of Hospitalization and Mortality by Race and Ethnicity Among Adults With Variceal Upper Gastrointestinal Hemorrhage, 2008-2018. JAMA Netw Open 2022; 5:e2222419. [PMID: 35849400 PMCID: PMC9294996 DOI: 10.1001/jamanetworkopen.2022.22419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study examines mortality associated with variceal upper gastrointestinal hemorrhage during an 11-year period by race and ethnicity.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia
| | - Harleen Kaur Chela
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia
| | - Veysel Tahan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia
| | - Ebubekir Daglilar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia
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20
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Farooq U, Tarar ZI, Kamal F, Malik A, Bresnahan J, Abegunde AT. Is acid suppression associated with the increased length of stay in diabetic ketoacidosis patients? A nationwide analysis. J Intern Med 2022; 292:136-145. [PMID: 35212056 PMCID: PMC9311185 DOI: 10.1111/joim.13466] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) patients present with low serum bicarbonate ( HCO3-${\rm{HCO}}_{3}^{-} $ ), and an increase in its level to ≥15 mEq/L is considered one of the criteria for DKA resolution. Both proton pump inhibitors and histamine-2 receptor antagonists inhibit downstream functioning of H+ /K+ ATPase in the gastric parietal cells, which results in the decreased secretion of HCO3-${\rm{HCO}}_{3}^{-} $ into the bloodstream. OBJECTIVES We aimed to introduce the hypothesis that DKA patients on acid-suppressive medications may have a delayed rise in serum HCO3-${\rm{HCO}}_{3}^{-} $ to >15 mEq/L that may cause increased hospital length of stay (LOS) and sought to compare the outcomes of such patients. For the sake of simplicity, conditions requiring acid suppression are grouped under the term peptic ulcer disease (PUD) in this study. METHODS This is a retrospective study using Nationwide Inpatient Sample employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of DKA. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's t-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses. RESULTS DKA patients with PUD had higher adjusted LOS, intensive care unit admission, and total hospital costs. Mortality and morbidity indicators were similar in both groups. The variables found to be independent predictors of increased LOS were malnutrition, Clostridium difficile infection, pneumonia, Glasgow Coma Scale score of 3-8, and higher Charlson comorbidity score. CONCLUSION We found that Clostridium difficile and pneumonia predicted longer LOS in DKA patients with concomitant PUD, hinting at the possible role of acid suppression in prolonging the LOS in such patients. However, further studies are needed to examine the effect of lesser HCO3-${\rm{HCO}}_{3}^{-} $ generation on LOS.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
| | - Faisal Kamal
- Department of Gastroenterology, University of California San Francisco, San Francisco, California, USA
| | - Adnan Malik
- Department of Internal Medicine, Loyola University Health System, Maywood, Illinois, USA
| | - Joseph Bresnahan
- Department of Gastroenterology, Loyola Medicine/MacNeal Hospital Berwyn, Illinois, USA
| | - Ayokunle T Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, Illinois, USA
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Farooq U, Tarar ZI, Malik A, Amin MK, Sifuentes H. How does cirrhosis impact mortality, morbidity, and resource utilization in non-variceal upper gastrointestinal bleeding? A nationwide analysis. Prz Gastroenterol 2022; 18:204-215. [PMID: 37538292 PMCID: PMC10395061 DOI: 10.5114/pg.2022.115232] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/02/2022] [Indexed: 08/05/2023]
Abstract
Introduction Upper gastrointestinal bleeding is common in liver cirrhosis patients. Studies have described the prognostic impact of liver disease in non-variceal upper gastrointestinal bleeding (NVUGIB), but a direct subgroup comparison is lacking using a large database. Aim To study the impact of NVUGIB on hospital-based outcomes in patients with cirrhosis. Material and methods This is a retrospective study using Nationwide Inpatient Sample (NIS) employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of NVUGIB. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's t-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses. Results Of 107,001,355 discharges, 957,719 had a diagnosis of NVUGIB. Of those, 92,439 had cirrhosis upon admission. NVUGIB patients with cirrhosis had higher adjusted odds of mortality and intensive care unit (ICU) admission than patients without cirrhosis (adjusted odds ratio (AOR) for mortality 1.31, p < 0.001, ICU admission AOR = 1.29, p < 0.001). NVUGIB patients with cirrhosis had shorter length of stay (LOS) by 0.44 days (p < 0.001), greater hospital costs per day ($3114 vs. $2810, p < 0.001), and lower odds of acute kidney injury (AOR = 0.81, p < 0.001). In addition, the cirrhotic patients had higher odds of receiving endoscopic therapy (AOR = 1.08, p < 0.001). There was no difference between the 2 groups' requirements of packed red blood cell transfusion, parenteral nutrition, hypovolaemic shock, and endotracheal intubation. We also identified novel independent predictors of mortality from NVUGIB in cirrhosis patients. Conclusions Cirrhosis presents greater mortality and morbidity burden and greater healthcare resource utilization from NVUGIB.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital Berwyn, IL, USA
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO, USA
| | - Adnan Malik
- Department of Internal Medicine, Loyola University Health System, Maywood, IL, USA
| | - Muhammad Kashif Amin
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Humberto Sifuentes
- Department of Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Tarar ZI, Khan HA, Inayat F, Goraya MHN, Raza M, Ibrahim F, Akhtar Z, Malik A, Davis RM. Hemosuccus Pancreaticus: A Comprehensive Review of Presentation Patterns, Diagnostic Approaches, Therapeutic Strategies, and Clinical Outcomes. J Investig Med High Impact Case Rep 2022; 10:23247096211070388. [PMID: 35045737 PMCID: PMC8796068 DOI: 10.1177/23247096211070388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemosuccus pancreaticus is a rare but potentially torrential and life-threatening cause of acute upper gastrointestinal bleeding. It is described as an intermittent hemorrhage from the major duodenal papilla via the main pancreatic duct. Peripancreatic pseudoaneurysm following chronic pancreatitis is a common underlying etiology. However, gastroduodenal artery pseudoaneurysm-related hemosuccus pancreaticus remains exceedingly rare in the etiological spectrum of upper gastrointestinal bleeding. We hereby delineate a rare case of hemosuccus pancreaticus associated with gastroduodenal artery pseudoaneurysm in a patient who initially presented with abdominal pain and hematochezia. He was successfully managed with coil embolization without recurrence or sequelae. Furthermore, we conducted a search of the MEDLINE (PubMed and Ovid) database for relevant studies on hemosuccus pancreaticus published between inception and September 15, 2021. The available clinical evidence on causes, presentation patterns, diagnosis, and management was analyzed and summarized. This article highlights the rarity, the intermittent nature of hemorrhage, and the lack of a standardized diagnostic approach for this elusive disease. Clinicians should remain cognizant of hemosuccus pancreaticus, especially in patients presenting with symptoms and signs of intermittent gastrointestinal bleeding and abdominal pain. Prompt diagnosis carries paramount importance in saving patients from repeat hospital admissions and disease-associated morbidity and mortality. Conventional angiography with coil embolization may constitute an effective treatment strategy.
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Affiliation(s)
| | | | - Faisal Inayat
- Allama Iqbal Medical College, Lahore, Pakistan
- Faisal Inayat, MBBS, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore 54550, Punjab, Pakistan.
| | | | - Mohsin Raza
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | | | - Adnan Malik
- Loyola University Medical Center, Maywood, IL, USA
| | - Ryan M. Davis
- University of Missouri School of Medicine, Columbia, MO, USA
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Farooq U, Tarar ZI, Franco D, Haseeb A. Racial differences in hospitalizations for acute cholangitis: a nationwide time trend analysis, 2008-2018. Ann Gastroenterol 2022; 35:547-550. [PMID: 36061153 PMCID: PMC9399573 DOI: 10.20524/aog.2022.0728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background The data on racial epidemiologic trends for acute cholangitis (AC) are scarce. Therefore, we conducted a longitudinal assessment of the racial breakdown of AC-related hospitalizations in the United States (US) over 11 years (2008-2018). Methods Using the National Inpatient Sample, we retrieved adult (>18 years) patients with AC. The adjusted yearly hospitalization rate per 100,000 for each race category was calculated based on the US population estimate for July 1 of the corresponding year obtained from the US Census Bureau. We followed Healthcare Cost and Utilization Project recommendations to: (1) derive a time-interrupted trend (before and after 2015), after determining that the International Classification of Diseases coding change affected AC hospitalizations because of more specific coding in the tenth revision; and (2) generate proportionate estimates using revised trend weights. Results A total of 321,849 patients with AC were included in the analysis. Before 2015, the overall hospitalizations (per 100,000 persons) increased from 16.03 in 2008 to 20.76 in 2014 (P<0.001). Following 2015, the overall hospitalizations increased from 14.34 in 2016 to 14.70 in 2018 (P=0.04). After Whites, Asians represented the ethnic group with the highest race-specific AC hospitalizations per 100,000 persons. Conclusions This cohort study demonstrated an overall rising and disproportionate rate among different races for AC-related hospitalizations. Even though Asians constitute only 6.5% of the US population, they represent the ethnic minority with most hospitalizations for AC.
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Affiliation(s)
- Umer Farooq
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL (Umer Farooq, Diana Franco)
- Correspondence to: Umer Farooq, MD, Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, 3249 S Oak Park Ave, Berwyn, IL 60402, e-mail:
| | - Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO (Zahid Ijaz Tarar)
| | - Diana Franco
- Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL (Umer Farooq, Diana Franco)
| | - Abdul Haseeb
- Department of Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL (Abdul Haseeb), USA
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Tarar ZI, Zafar MU, Farooq U, Basar O, Tahan V, Daglilar E. The Progression of Celiac Disease, Diagnostic Modalities, and Treatment Options. J Investig Med High Impact Case Rep 2021; 9:23247096211053702. [PMID: 34693776 PMCID: PMC8767653 DOI: 10.1177/23247096211053702] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Celiac disease (CD) is an autoimmune disorder that affects genetically predisposed individuals who are sensitive to gluten and related proteins. It affects children and adults with increasing prevalence in the older age groups. Both adaptive and innate immune responses play role in CD pathogenesis which results in damage of lamina propria and deposition of intraepithelial lymphocytes. There are other proposed mechanisms of CD pathogenesis like gastrointestinal infections, intestinal microbiota, and early introduction of gluten. The diagnosis of CD is based on clinical symptoms and serological testing, though a majority of cases are asymptomatic, and small intestinal biopsies are required to confirm the diagnosis. Celiac disease is generally associated with other autoimmune diseases, and it is advisable to test these patients for diseases like type 1 diabetes mellitus, Addison’s disease, thyroid diseases, inflammatory bowel disease, and autoimmune hepatitis. The patient with a new diagnosis of CD requires close follow-up after starting treatment to see symptom improvement and check dietary compliance. A newly diagnosed patient is advised to follow with a dietitian to better understand the dietary restrictions as about 20% of patients stay symptomatic even after starting treatment due to noncompliance or poor understanding of diet restrictions. The most effective treatment for CD is a gluten-free diet, but work on non-dietary therapy is in process and few medications are in the clinical trial phase.
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Affiliation(s)
| | | | - Umer Farooq
- Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA
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25
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Farooq U, Gondal AB, Susheela A, Tarar ZI, Malik A, Zafar MU, Sharif A, Ghous G. Does the Route of Cocaine Use Affect the Mortality and Outcomes of Cocaine-Induced Intestinal Ischemia? A Systematic Review. J Investig Med High Impact Case Rep 2021; 9:23247096211051921. [PMID: 34663104 PMCID: PMC8529301 DOI: 10.1177/23247096211051921] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intestinal ischemia results from diminished perfusion of the colon resulting in tissue hypoxia. Anecdotal reports suggest that cocaine-induced intestinal ischemia has the highest mortality and longer length of stay among the vasoconstrictors. The present study aimed to summarize the available studies in the literature to assess the effect of routes of consumption on the outcomes of cocaine-induced intestinal ischemia. We conducted a systematic search of MEDLINE from inception through October 2019. Studies of cocaine-induced intestinal ischemia were included if data were available on comorbidities, mortality, and hospital length of stay (LOS). The study's primary outcomes were mortality and need for surgery, while secondary outcomes included the hospital length of stay, LACE index, and hospital score. Statistical tests used included linear and binary logistic regression. STATA 2015 was used, and P < 0.05 was statistically significant. Of the 304 studies, 8 case series and 45 case reports (n = 69 patients) met the inclusion criteria. Different routes of cocaine use had similar mortality odds and the need for surgery for intestinal ischemia. Hospital LOS showed significant difference among the subgroups. Readmission scores (LACE and hospital score) were higher for intravenous and smoking than ingestion and intranasal use (P < 0.05). In conclusion, different routes of cocaine use appear to have similar mortality odds for intestinal ischemia, which vary significantly among the different routes of cocaine consumption for the length of stay and readmission scores. Prompt recognition of the route of cocaine use is vital to improve the outcome. Large-scale and well-designed observational studies are needed to investigate this topic further.
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Affiliation(s)
- Umer Farooq
- Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA
| | | | | | | | - Adnan Malik
- Loyola University Health System, Maywood, IL, USA
| | | | - Aftab Sharif
- Mercy Health Grand Rapids, Grand Rapids, MI, USA
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Tarar ZI, Zafar MU, Farooq U, Ghous G, Shoukat HMH, Kuwajima V. Does Performing Endoscopy Sooner Have an Impact on Outcomes in Patients With Acute Nonvariceal Upper Gastrointestinal Hemorrhage? A Systematic Review. Cureus 2021; 13:e16092. [PMID: 34367748 PMCID: PMC8330500 DOI: 10.7759/cureus.16092] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background Endoscopy is the cornerstone for the diagnosis and treatment of nonvariceal upper gastrointestinal bleeding. Regarding the management of nonvariceal bleeding, the administration of crystalloid solution and proton pump inhibitors before endoscopy is well established, but the optimal timing of endoscopy has been a matter of debate and a subject of many investigational studies. The need for urgent endoscopy arises to provide prompt redress to acute bleeding, decrease the length of stay, and lower mortality from ongoing bleeding. Objective This study aimed to determine if endoscopy performed within 24 hours of presentation improves outcomes in terms of mortality, hospital length of stay, and rebleeding in individuals presenting with nonvariceal upper gastrointestinal bleed with any risk. Methodology We performed a systematic review of two large databases (PubMed and Google Scholar) to incorporate all studies published after 2000. We included studies with nonvariceal upper gastrointestinal bleeding and excluded those reporting variceal gastrointestinal hemorrhage. Results We reviewed eight studies that qualified after meeting our inclusion and exclusion criteria. We divided these studies into three separate groups based on the timing of endoscopy. Only two studies found a difference in mortality that was statistically significant in patients who underwent endoscopy within 24 hours of presentation. One study showed lower mortality in a patient who underwent urgent endoscopy, but it did not reach statistical significance. Other studies did not show any statistical difference in mortality, hospital length of stay, and rebleeding rates. The studies showed conflicting evidence on the amount of blood transfusion, though urgent endoscopy was found to be difficult in few studies due to blood obscuring the lesion. Conclusions While data suggest that there is a potential benefit in performing endoscopy sooner, there is no concrete evidence to point to a particular time range. Before performing endoscopy, the American Society for Gastrointestinal Endoscopy (2012) recommends adequate resuscitation with crystalloid solutions, blood transfusions, and antisecretory and prokinetic agent therapy. More investigational studies are needed to formulate a time-sensitive flow sheet to approach endoscopy in patients with nonvariceal upper gastrointestinal bleeding. A strict criterion is also needed to delineate patients into low-risk and high-risk groups. Doing so would provide a systematic approach to help with mortality, rebleeding, and healthcare resource utilization.
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Affiliation(s)
| | | | - Umer Farooq
- Internal Medicine, Loyola Medicine, MacNeal Hospital, Berwyn, USA
| | - Ghulam Ghous
- Hematology/Oncology, University of Missouri, Columbia, USA
| | | | - Vanessa Kuwajima
- Gastroenterology and Hepatology, University of Missouri, Columbia, USA
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Ghous G, Shoukat HMH, Tarar ZI, Zafar MU, McGreevy JW. Encephalitis Associated With Hemophagocytic Lymphohistiocytosis Secondary to Immune Checkpoint Inhibitors: An Unfamiliar Spin-Off. Cureus 2021; 13:e16079. [PMID: 34345559 PMCID: PMC8324828 DOI: 10.7759/cureus.16079] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/09/2022] Open
Abstract
Checkpoint inhibitors (CPI) have become mainstream in standard therapy in various tumors, especially in malignant melanoma. Despite their widespread beneficial effects, these inhibitors are also notorious for immune-related adverse events (irAEs). Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation. We report a case of a 33-year-old male having a history of metastatic melanoma on immunotherapy (status post two cycles of ipilimumab/nivolumab) admitted for persistent fever and elevated liver enzymes. Additional work showed anemia, thrombocytopenia, hypertriglyceridemia, and hyperferritinemia which meet the diagnostic criteria of histiocyte society HLH-2004. The patient was effectively treated with oral prednisone. Moreover, further complications encompassed slurred speech, word-finding difficulties, ataxia, and lower extremity hyperreflexia concerning for autoimmune encephalitis. He was treated with high-dose IV methylprednisolone (1 gram/day for 3 days) with improvement in symptoms. Autoimmune encephalitis associated with HLH can be fatal - high-dose IV methylprednisolone should be considered, but this avenue still needs to be explored.
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Affiliation(s)
- Ghulam Ghous
- Internal Medicine, University of Missouri Columbia, Columbia, USA
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Abstract
Pancreatitis is inflammation of pancreas associated most commonly with chronic
alcoholism and gallstones. Other less common causes of pancreatitis are
hyperlipidemia, infections, surgery, trauma, post endoscopic retrograde
cholangiopancreatography, and drugs. Drugs are now increasingly recognized as a
cause of pancreatitis, and high suspicion and exclusion of other most common
causes is required before considering drug-induced pancreatitis. There are few
case reports of acute pancreatitis in the literature after statin use, but out
of these, only 3 are after starting pravastatin. We are reporting a case of
49-year-old male who presented with nausea, vomiting, and abdominal pain. His
laboratory findings were significant for lipase more than 10 000 on admission,
and computed tomography scan of abdomen was showing peripancreatic fat stranding
and inflammation. After exclusion of most common causes of pancreatitis,
pravastatin was found probable culprit for his symptoms, which he started taking
2 weeks ago. We also reviewed the literature on statins-induced acute
pancreatitis. With increased uses of statins, physician need to be vigilant to
suspect statins as a culprit in cases of pancreatitis with unknown etiology.
Prompt discontinuation of statins is required in these cases.
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Affiliation(s)
- Zahid Ijaz Tarar
- University of Missouri, Columbia, MO,
USA
- Zahid Ijaz Tarar, MD, Department of
Internal Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO 65211,
USA.
| | | | | | - Umer Farooq
- Loyola Medicine, MacNeal Hospital,
Berwyn, IL, USA
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Affiliation(s)
- Jacob E Lee
- MS-2, University of Missouri, Columbia, MO Department of Internal Medicine, University of Missouri, Columbia, MO Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA Department of Internal Medicine, Dayton, OH
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Abstract
Hyperplastic polyp of the esophagus is a rare condition and most of the time asymptomatic. We report a case of a 69-year-old female with scleroderma who presented with worsening dysphagia, regurgitation of food, and non-cardiac chest pain. Upper endoscopy showed a nodular lesion in the distal esophagus. Biopsy of the lesion showed features of hyperplastic polyp without any metaplastic changes. She was started on anti-acid therapy and an outpatient upper endoscopy was performed which showed no residual polyp.
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Affiliation(s)
- Zahid Ijaz Tarar
- Internal Medicine, University of Missouri-Columbia, Columbia, USA
| | - Veysel Tahan
- Gastroenterology & Hepatology, University of Missouri-Columbia, Columbia, USA
| | - Feng Yin
- Pathology, University of Missouri-Columbia, Columbia, USA
| | - Ebubekir Daglilar
- Gastroenterology & Hepatology, University of Missouri-Columbia, Columbia, USA
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Malik A, Inayat F, Goraya MHN, Almas T, Ishtiaq R, Malik S, Tarar ZI. Jejunal Dieulafoy's Lesion: A Systematic Review of Evaluation, Diagnosis, and Management. J Investig Med High Impact Case Rep 2021; 9:2324709620987703. [PMID: 33472441 PMCID: PMC7829607 DOI: 10.1177/2324709620987703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022] Open
Abstract
Jejunal Dieulafoy's lesion is an exceedingly rare but important cause of gastrointestinal bleeding. It frequently presents as a diagnostic and therapeutic conundrum due to the rare occurrence, intermittent bleeding symptoms often requiring prompt clinical action, variability in the detection and treatment methods, and the risk of rebleeding. We performed a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding jejunal Dieulafoy's lesio from inception till June 2020. A total of 136 cases were retrieved from 76 articles. The mean age was 55 ± 24 years, with 55% of cases reported in males. Patients commonly presented with melena (33%), obscure-overt gastrointestinal bleeding (29%), and hemodynamic compromise (20%). Hypertension (26%), prior gastrointestinal surgery (14%), and valvular heart disease (13%) were the major underlying disorders. Conventional endoscopy often failed but single- and double-balloon enteroscopy identified the lesion in 96% and 98% of patients, respectively. There was no consensus on the treatment. Endoscopic therapy was instituted in 64% of patients. Combination therapy (34%) with two or more endoscopic modalities, was the preferred approach. With regard to endoscopic monotherapy, hemoclipping (19%) and argon plasma coagulation (4%) were frequently employed procedures. Furthermore, direct surgical intervention in 32% and angiographic embolization was performed in 4% of patients. The rebleeding rate was 13.4%, with a mean follow-up duration of 17.6 ± 21.98 months. The overall mortality rate was 4.4%. Jejunal Dieulafoy's lesion is still difficult to diagnose and manage. Although the standard diagnostic and therapeutic modalities remain to be determined, device-assisted enteroscopy might yield promising outcomes.
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Affiliation(s)
- Adnan Malik
- Loyola University Medical Center,
Maywood, IL, USA
| | - Faisal Inayat
- Allama Iqbal Medical College, Lahore,
Punjab, Pakistan
| | | | - Talal Almas
- Royal College of Surgeons in Ireland,
Dublin, Ireland
| | | | - Sohira Malik
- Nishter Medical University, Multan,
Punjab, Pakistan
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Abstract
Hemophilia is an X-linked recessive hereditary disorder that classically affects males due to the presence of only one X chromosome in males. Females are usually carriers due to the presence of counterpart X chromosome, but many times manifestations of hemophilia are seen in heterozygous carrier females. This is a result of skewed lionization, in which more normal X chromosomes are converted to bar body, and more abnormal chromosomes remain active in body cells, causing the dominant manifestation of the disease. The severity of manifestations is directly proportional to the level of the clotting factor in the blood. The disease can be severe enough to cause life-threatening bleeding, especially during delivery. Physicians usually reluctant to assume hemophilia in the differential diagnosis of the bleeding disorders in women but manifesting carrier females with hemophilia are not uncommon. Our review of the literature will give an opportunity to understand this issue more precisely as well as will discuss the disease manifestations and its updated management.
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Affiliation(s)
| | - Ghulam Ghous
- Internal Medicine, University of Missouri, Columbia, USA
| | | | | | - Namra Ajmal
- Pathology, King Edward Medical University, Mayo Hospital, Lahore, PAK
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Ghous G, Shoukat HMH, Tarar ZI, Zafar MU. A Review of Interstitial Pneumonitis Caused by Elotuzumab Through Case Discussions and Academic Writings. Cureus 2020; 12:e11162. [PMID: 33251069 PMCID: PMC7686952 DOI: 10.7759/cureus.11162] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patients with relapsed or refractory multiple myeloma have undergone two or three previous therapies are now being treated with a humanized IgG1 monoclonal antibody elotuzumab (HuLuc63) that targets F7 signalling lymphocytic activation molecule F7 (SLAMF7)- a signalling lymphocytic activation molecule. It is combined with dexamethasone and lenalidomide/pomalidomide for therapy. Adverse effects associated with elotuzumab consists of peripheral neuropathy, fever, constitutional symptoms (fatigue, headache, decreased appetite), and infections. A rare side effect of interstitial lung disease has only been observed in a single case. There are two case studies presented below of hypoxic respiratory failure upon this monoclonal antibody treatment both were successfully treated with steroid therapy. This article brings forth the hypothesis that elotuzumab can cause pneumonitis, and discontinuation of elotuzumab along with high-dose corticosteroids helps reverse the pneumonitis.
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