1
|
Navaneethan U, Njei B, Venkatesh PGK, Sanaka MR. Timing of colonoscopy and outcomes in patients with lower GI bleeding: a nationwide population-based study. Gastrointest Endosc 2014; 79:297-306.e12. [PMID: 24060518 DOI: 10.1016/j.gie.2013.08.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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: 05/06/2013] [Accepted: 08/01/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of urgent colonoscopy in lower GI bleeding (LGIB) remains controversial. Population-based studies on LGIB outcomes are lacking. OBJECTIVE To investigate the impact of the timing of colonoscopy on outcomes of patients with LGIB. DESIGN Cross-sectional study. SETTING Nationwide Inpatient Sample 2010. PATIENTS International Classification of Diseases, Ninth Revision, Clinical Modification codes identified patients with LGIB who underwent colonoscopy. MAIN OUTCOME MEASUREMENTS In-hospital mortality, length of stay, and hospitalization costs in patients who underwent early (≤24 hours) or delayed (>24 hours) colonoscopy. RESULTS A total of 58,296 discharges with LGIB were identified; 22,720 had a colonoscopy performed during the hospitalization. A total of 9156 patients had colonoscopy performed within 24 hours (early colonoscopy), and 13,564 had colonoscopy performed after 24 hours (delayed colonoscopy). There was no difference in mortality in patients with LGIB who had early versus delayed colonoscopy (0.3% vs 0.4%, P = .24). However, patients who underwent early colonoscopy had a shorter length of hospital stay (2.9 vs 4.6 days, P < .001), decreased need for blood transfusion (44.6% vs 53.8%, P < .001), and lower hospitalization costs ($22,142 vs $28,749, P < .001). On multivariate analysis, timing of colonoscopy did not affect mortality (adjusted odds ratio 1.5; 95% confidence interval, 0.7-2.7). On multivariate analysis, delayed colonoscopy was associated with an increase in the length of hospital stay by 1.6 days and an increase in hospitalization costs of $7187. LIMITATIONS Administrative dataset. CONCLUSIONS Early colonoscopy within 24 hours is associated with decreased length of hospital stay and hospitalization costs in patients with LGIB.
Collapse
Affiliation(s)
| | - Basile Njei
- Department of Medicine, University of Connecticut Medical Center, Farmington, Connecticut
| | | | | |
Collapse
|
2
|
Navaneethan U, Kochhar G, Venkatesh PGK, Bennett AE, Rizk M, Shen B, Kiran RP. Random biopsies during surveillance colonoscopy increase dysplasia detection in patients with primary sclerosing cholangitis and ulcerative colitis. J Crohns Colitis 2013; 7:974-81. [PMID: 23523416 DOI: 10.1016/j.crohns.2013.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 10/04/2012] [Revised: 02/13/2013] [Accepted: 02/15/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Patients with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) are at increased risk of colon dysplasia. The role of random vs. target biopsies in these patients has not been investigated. Our aim was to evaluate the yield and clinical impact of random biopsies during surveillance colonoscopies in patients with PSC-UC. METHODS Data from 71 patients (267 colonoscopies) with PSC and UC, who underwent surveillance colonoscopies and followed-up from 2001 to 2011 was obtained. Colonoscopy and pathology reports were reviewed to assess the yield of random biopsies. RESULTS A total of 3975 (median 12) random biopsies were taken during surveillance colonoscopies. Overall, neoplasia was detected in 22 colonoscopies (16 patients): in 8 colonoscopies (36.4%) by targeted biopsies only and in 4 (18.2%) by both targeted and random biopsies. Neoplasia was detected in random biopsies only in 10 (45.5%) colonoscopies in 8 patients. On multivariate analysis, duration of UC (Odds ratio [OR]=1.40; 95% confidence interval [CI], 1.08-1.81; P=0.01), number of random biopsies (per increase by 8) (OR=1.64; 95% CI, 1.18-2.28; P=0.003) and target biopsies during colonoscopy (OR=9.08; 95% CI, 3.18-26.0; P<0.001) independently predicted the presence of dysplasia; endoscopic features of prior inflammation did not. CONCLUSIONS Random biopsies significantly increase the yield of dysplasia in patients with PSC and UC even in the absence of endoscopic features of prior inflammation and significantly impact clinical outcomes.
Collapse
Affiliation(s)
- Udayakumar Navaneethan
- Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.
| | | | | | | | | | | | | |
Collapse
|
3
|
Singh S, Sharma AN, Murad MH, Buttar NS, El-Serag HB, Katzka DA, Iyer PG. Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013; 11:1399-1412.e7. [PMID: 23707461 PMCID: PMC3873801 DOI: 10.1016/j.cgh.2013.05.009] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [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: 03/20/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Central adiposity has been implicated as a risk factor for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), possibly promoting the progression from inflammation to metaplasia and neoplasia. We performed a systematic review and meta-analysis of studies to evaluate the association between central adiposity and erosive esophagitis (EE), BE, and EAC, specifically exploring body mass index (BMI)-independent and gastroesophageal reflux (GERD)-independent effects of central adiposity on the risk of these outcomes. METHODS We performed a systematic search of multiple databases through March 2013. Studies were included if they reported effect of central adiposity (visceral adipose tissue area, waist-hip ratio, and/or waist circumference) on the risk of EE, BE, and EAC. Summary adjusted odds ratio (aOR) estimates with 95% confidence intervals (CIs), comparing highest category of adiposity with the lowest category of adiposity, were calculated by using random-effects model. RESULTS Forty relevant articles were identified. Compared with patients with normal body habitus, patients with central adiposity had a higher risk of EE (19 studies; aOR, 1.87; 95% CI, 1.51-2.31) and BE (17 studies; aOR, 1.98; 95% CI, 1.52-2.57). The association between central adiposity and BE persisted after adjusting for BMI (5 studies; aOR, 1.88; 95% CI, 1.20-2.95). Reflux-independent association of central adiposity and BE was observed in studies that used GERD patients as controls or adjusted for GERD symptoms (11 studies; aOR, 2.04; 95% CI, 1.44-2.90). In 6 studies, central adiposity was associated with higher risk of EAC (aOR, 2.51; 95% CI, 1.54-4.06), compared with normal body habitus. CONCLUSIONS On the basis of a meta-analysis, central adiposity, independent of BMI, is associated with esophageal inflammation (EE), metaplasia (BE), and neoplasia (EAC). Its effects are mediated by reflux-dependent and reflux-independent mechanisms.
Collapse
Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anamay N. Sharma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Navtej S. Buttar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hashem B. El-Serag
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - David A. Katzka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
4
|
Rosini N, Machado MJ, Webster IZ, Moura SAZO, Cavalcante LDS, da Silva EL. Simultaneous prediction of hyperglycemia and dyslipidemia in school children in Santa Catarina State, Brazil based on waist circumference measurement. Clin Biochem 2013; 46:1837-41. [PMID: 24012695 DOI: 10.1016/j.clinbiochem.2013.08.015] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 08/20/2013] [Accepted: 08/27/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Waist circumference (WC) is highly associated with metabolic risk factor clusters (RFC) for chronic non-communicable diseases (NCDs). In this study, we evaluated the use of WC measurements to detect hyperglycemia and dyslipidemia in children and adolescents using the WC cutoff points reported in the Bogalusa Heart study and the New Zealand study. DESIGN AND METHODS Students (n=1011; aged 6 to 14years) were enrolled in a cross-sectional study. Anthropometric indices, fasting glucose, and lipid profiles were measured. The associations between WC measures and serum parameters were investigated by logistic regression models, and the clinical accuracy of the studied parameters was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS The prevalence of increased WC was 30.2% using the New Zealand cutoff points and 13.7% using the Bogalusa cutoff values. In general, children with increased WC exhibited higher concentrations of total cholesterol, triglycerides, LDL-cholesterol, and non-HDL-cholesterol and lower levels of HDL-cholesterol. The areas under the ROC curves (AUC) of the WC measurements were 0.770 (95% CI: 0.744-0.797) and 0.600 (95% CI: 0.569-0.631) using, respectively, the New Zealand and Bogalusa cutoff points for WC, indicating the prediction of simultaneous hyperglycemia, increased levels of non-HDL-cholesterol, and reduced HDL-cholesterol for students with increased WC. There was a significant difference between AUC values (P=0.001). Furthermore, the sensitivity of using WC for detecting RFC in students was 2.0 to 2.5-fold higher with the New Zealand study cutoff values for WC than with those from the Bogalusa study. Logistic regression analysis revealed that increased WC was associated with simultaneous hyperglycemia and dyslipidemia after controlling for differences in sex and age (P<0.01 for all). CONCLUSIONS Children and adolescents exhibited a high prevalence of increased WC associated with other RFCs for NCDs. Increased WC may be used to screen and identify students with elevated clusters of metabolic risk factors for NCDs.
Collapse
Affiliation(s)
- Nilton Rosini
- Post-Graduation Program in Pharmacy, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil; Health Division of the Santa Catarina Government, Brazil
| | | | | | | | | | | |
Collapse
|
5
|
Pollack AZ, Louis GMB, Chen Z, Peterson CM, Sundaram R, Croughan MS, Sun L, Hediger ML, Stanford JB, Varner MW, Palmer CD, Steuerwald AJ, Parsons PJ. Trace elements and endometriosis: the ENDO study. Reprod Toxicol 2013; 42:41-8. [PMID: 23892002 DOI: 10.1016/j.reprotox.2013.05.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/24/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
There has been limited study of trace elements and endometriosis. Using a matched cohort design, 473 women aged 18-44 years were recruited into an operative cohort, along with 131 similarly aged women recruited into a population cohort. Endometriosis was defined as surgically visualized disease in the operative cohort, and magnetic resonance imaging diagnosed disease in the population cohort. Twenty trace elements in urine and three in blood were quantified using inductively coupled plasma mass spectrometry. Logistic regression estimated the adjusted odds (aOR) of endometriosis diagnosis for each element by cohort. No association was observed between any element and endometriosis in the population cohort. In the operative cohort, blood cadmium was associated with a reduced odds of diagnosis (aOR=0.55; 95% CI: 0.31, 0.98), while urinary chromium and copper reflected an increased odds (aOR=1.97; 95% CI: 1.21, 3.19; aOR=2.66; 95% CI: 1.26, 5.64, respectively). The varied associations underscore the need for continued research.
Collapse
Affiliation(s)
- Anna Z Pollack
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Health, 6100 Executive Blvd. Rockville, Maryland 20852, United States.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Amoah AS, Obeng BB, Larbi IA, Versteeg SA, Aryeetey Y, Akkerdaas JH, Zuidmeer L, Lidholm J, Fernández-Rivas M, Hartgers FC, Boakye DA, van Ree R, Yazdanbakhsh M. Peanut-specific IgE antibodies in asymptomatic Ghanaian children possibly caused by carbohydrate determinant cross-reactivity. J Allergy Clin Immunol 2013; 132:639-647. [PMID: 23763976 PMCID: PMC3765958 DOI: 10.1016/j.jaci.2013.04.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [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: 10/17/2012] [Revised: 04/12/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022]
Abstract
Background The prevalence of peanut allergy has increased in developed countries, but little is known about developing countries with high peanut consumption and widespread parasitic infections. Objective We sought to investigate peanut allergy in Ghana. Methods In a cross-sectional survey among Ghanaian schoolchildren (n = 1604), data were collected on reported adverse reactions to peanut, peanut sensitization (serum specific IgE and skin reactivity), consumption patterns, and parasitic infections. In a subset (n = 43) IgE against Ara h 1, 2, 3, and 9 as well as cross-reactive carbohydrate determinants (CCDs) was measured by using ImmunoCAP. Cross-reactivity and biological activity were investigated by means of ImmunoCAP inhibition and basophil histamine release, respectively. Results Adverse reactions to peanut were reported in 1.5%, skin prick test reactivity in 2.0%, and IgE sensitization (≥0.35 kU/L) in 17.5% of participants. Moreover, 92.4% of those IgE sensitized to peanut (≥0.35 kU/L) had negative peanut skin prick test responses. Schistosoma haematobium infection was positively associated with IgE sensitization (adjusted odds ratio, 2.29; 95% CI, 1.37-3.86). In the subset IgE titers to Ara h 1, 2, 3, and 9 were low (<1.3 kU/L), except for 6 moderately strong reactions to Ara h 9. IgE against peanut was strongly correlated with IgE against CCDs (r = 0.89, P < .0001) and could be almost completely inhibited by CCDs, as well as S haematobium soluble egg antigen. Moreover, IgE to peanut showed poor biological activity. Conclusions Parasite-induced IgE against CCDs might account largely for high IgE levels to peanut in our study population of Ghanaian schoolchildren. No evidence of IgE-mediated peanut allergy was found.
Collapse
Affiliation(s)
- Abena S Amoah
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, Accra, Ghana; Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Benedicta B Obeng
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, Accra, Ghana; Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Irene A Larbi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Serge A Versteeg
- Department of Experimental Immunology and Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Yvonne Aryeetey
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Jaap H Akkerdaas
- Department of Experimental Immunology and Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Laurian Zuidmeer
- Department of Experimental Immunology and Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Franca C Hartgers
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel A Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
7
|
Barrio-Lopez MT, Bes-Rastrollo M, Sayon-Orea C, Garcia-Lopez M, Fernandez-Montero A, Gea A, Martinez-Gonzalez MA. Different types of alcoholic beverages and incidence of metabolic syndrome and its components in a Mediterranean cohort. Clin Nutr 2012; 32:797-804. [PMID: 23305606 DOI: 10.1016/j.clnu.2012.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 08/09/2012] [Revised: 11/15/2012] [Accepted: 12/05/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS We prospectively assessed the association between alcohol consumption and the incidence of Metabolic Syndrome (MS) in a Mediterranean cohort. METHODS We included 8103 (mean age: 35.4 years) University graduates free of any MS criteria and followed-up during ≥6 years. Alcohol consumption was collected with a validated 136-item food frequency questionnaire. New-onset cases of MS were defined according to the updated harmonizing criteria. RESULTS We observed 341 incident cases of MS. Consumers of ≥7 drinks/wk presented a significantly higher risk of developing MS (aOR: 1.80; 95% CI: 1.22-2.66; p < 0.001) compared with non-drinkers. In addition, alcohol drinkers (≥7 drinks/wk) had higher risk of hypertriglyceridemia (aOR: 2.07; 95% CI: 1.46-2.93) and impaired fasting glucose (aOR: 1.54; 95% CI: 1.16-2.04). Beer consumption was associated with higher risk for MS (p for trend = 0.027) and higher risk of hypertriglyceridemia (aOR: 1.81; 95% CI: 1.02-3.20), but with lower risk of low HDL-cholesterol criterion (aOR: 0.21; 95% CI: 0.05-0.89) for ≥7 drinks/wk versus no consumption. Non-significant association was observed between wine or liquor consumption and MS. CONCLUSIONS Consumption of at least seven alcoholic drinks per week was associated with a higher risk of developing MS among subjects initially free of any MS criteria.
Collapse
Affiliation(s)
- Maria T Barrio-Lopez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea, 1, 31008 Pamplona, Navarra, Spain; Department of Cardiology and Cardiac Surgery, University Clinic of Navarra, Avenida Pio XII, 36, 31008 Pamplona, Navarra, Spain
| | | | | | | | | | | | | |
Collapse
|