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Stamm R, Aluzaite K, Arnold M, Caspritz T, White C, Schultz M. Challenges for the future: the gastroenterology specialist workforce in New Zealand. N Z Med J 2020; 133:32-40. [PMID: 32777793] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM New Zealand has among the highest rates of colorectal cancer and inflammatory bowel disease in the world. With the imminent rollout of the National Bowel Screening Programme, we sought to determine the capacity of and demand faced by the current gastroenterology specialist workforce, and to compare it with other countries. METHOD Specialists in gastroenterology were asked to complete a questionnaire on their education, number of FTE in the public and private sectors, number of colonoscopies performed, anticipated years to retirement and other associated information. Additional statistics were obtained from personal communication, visits to endoscopy units throughout the country and government datasets. RESULTS In November 2017 there were 93 gastroenterologists in New Zealand, equating to 1.96 gastroenterologist specialists/100,000 population. The response rate was 55%. One quarter of gastroenterologists spent time working in general internal medicine additionally to gastroenterology in public hospitals. Fifty-one percent of gastroenterologists were older than 50 years and 42% aimed to retire within the next 10 years. Four of the 20 district health boards had no gastroenterologists in post. CONCLUSIONS New Zealand has a lower specialist gastroenterologist ratio and older workforce compared with other comparable western countries and may struggle to meet the growing gastroenterology healthcare needs of the population. Substantial regional gastroenterology service inequities exist across the country.
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Affiliation(s)
| | | | - Malcolm Arnold
- Department of Gastroenterology, Hawkes Bay Hospital, Hastings
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Basnayake C, Kamm MA, Salzberg M, Khera A, Liew D, Burrell K, Wilson-O'Brien A, Stanley A, Talley NJ, Thompson AJ. Defining Optimal Care for Functional Gut Disorders - Multi-Disciplinary Versus Standard Care: A Randomized Controlled Trial Protocol. Contemp Clin Trials 2019; 84:105828. [PMID: 31437539 DOI: 10.1016/j.cct.2019.105828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are the commonest reason for gastroenterological consultation, with patients usually seen by a specialist working in isolation. There is a wealth of evidence testifying to the benefit provided by dieticians, behavioral therapists, hypnotherapists and psychotherapists in treating these conditions, yet they rarely form a part of the therapeutic team, and these treatment modalities are rarely offered as part of the therapeutic management. There has been little examination of different models of care for FGIDs. We hypothesize that multi-disciplinary integrated care is superior to standard specialist-based care in the treatment of functional gut disorders. METHODS The "MANTRA" (Multidisciplinary Treatment for Functional Gut Disorders) study compares comprehensive multi-disciplinary outpatient care with standard hospital outpatient care. Consecutive new referrals to the gastroenterology and colorectal outpatient clinics of a single secondary and tertiary care hospital of patients with an FGID, defined by the Rome IV criteria, will be included. Patients will be prospectively randomized 2:1 to multi-disciplinary (gastroenterologist, gut-hypnotherapist, psychiatrist, behavioral therapist ('biofeedback') and dietician) or standard care (gastroenterologist or colorectal surgeon). Patients are assessed up to 12 months after completing treatment. The primary outcome is an improvement on a global assessment scale at the end of treatment. Symptoms, quality of life, psychological well-being, and healthcare costs are secondary outcome measures. DISCUSSION There have been few studies examining how best to deliver care for functional gut disorders. The MANTRA study will define the clinical and cost benefits of two different models of care for these highly prevalent disorders. TRIAL REGISTRATION NUMBER Clinicaltrials.govNCT03078634 Registered on Clinicaltrials.gov, completed recruitment, registered on March 13th 2017. Ethics and Dissemination: Ethical approval has been received by the St Vincent's Hospital Melbourne human research ethics committee (HREC-A 138/16). The results will be disseminated in peer-reviewed journals and presented at international conferences. Protocol version 1.2.
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Affiliation(s)
- Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | | | - Angela Khera
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Danny Liew
- Monash University, Melbourne, Australia.
| | - Kathryn Burrell
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.
| | - Amy Wilson-O'Brien
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Annalise Stanley
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.
| | | | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
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Stasi E, Michielan A, Morreale GC, Tozzi A, Venezia L, Bortoluzzi F, Triossi O, Soncini M, Leandro G, Milazzo G, Anderloni A. Five common errors to avoid in clinical practice: the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) Choosing Wisely Campaign. Intern Emerg Med 2019; 14:301-308. [PMID: 30499071 DOI: 10.1007/s11739-018-1992-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/10/2018] [Accepted: 11/20/2018] [Indexed: 02/08/2023]
Abstract
Modern medicine provides almost infinite diagnostic and therapeutic possibilities if compared to the past. As a result, patients undergo a multiplication of tests and therapies, which in turn may trigger further tests, often based on physicians' attitudes or beliefs, which are not always evidence-based. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) adhered to the Choosing Wisely Campaign to promote an informed, evidence-based approach to gastroenterological problems. The aim of this article is to report the five recommendations of the AIGO Choosing Wisely Campaign, and the process used to develop them. The AIGO members' suggestions regarding inappropriate practices/interventions were collected. One hundred and twenty-one items were identified. Among these, five items were selected and five recommendations were developed. The five recommendations developed were: (1) Do not request a fecal occult blood test outside the colorectal cancer screening programme; (2) Do not repeat surveillance colonoscopy for polyps, after a quality colonoscopy, before the interval suggested by the gastroenterologist on the colonoscopy report, or based on the polyp histology report; (3) Do not repeat esophagogastroduodenoscopy in patients with reflux symptoms, with or without hiatal hernia, in the absence of different symptoms or alarm symptoms; (4) Do not repeat abdominal ultrasound in asymptomatic patients with small hepatic haemangiomas (diameter < 3 cm) once the diagnosis has been established conclusively; (5) Do not routinely prescribe proton pump inhibitors within the context of steroid use or long-term in patients with functional dyspepsia. AIGO adhered to the Choosing Wisely Campaign and developed five recommendations. Further studies are needed to assess the impact of these recommendations in clinical practice with regards to clinical outcome and cost-effectiveness.
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Affiliation(s)
- Elisa Stasi
- Gastroenterology Unit, National Institute of Gastroenterology "S. De Bellis" Research Hospital, Via Turi 27, 70013, Castellana Grotte, Ba, Italy.
| | - Andrea Michielan
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Santa Chiara, Trento, Italy
| | | | | | - Ludovica Venezia
- Gastroenterology Unit, AOU Città della Salute e della Scienza Turin, Turin, Italy
| | | | | | - Marco Soncini
- Gastroenterology Unit, San Carlo Borromeo Hospital, Milan, Italy
| | - Gioacchino Leandro
- Gastroenterology Unit, National Institute of Gastroenterology "S. De Bellis" Research Hospital, Via Turi 27, 70013, Castellana Grotte, Ba, Italy
| | - Giuseppe Milazzo
- Department of Medicine, Ospedale Vittorio Emanuele III, Salemi, Tp, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy
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Selby K, Jensen CD, Zhao WK, Lee JK, Slam A, Schottinger JE, Bacchetti P, Levin TR, Corley DA. Strategies to Improve Follow-up After Positive Fecal Immunochemical Tests in a Community-Based Setting: A Mixed-Methods Study. Clin Transl Gastroenterol 2019; 10:e00010. [PMID: 30829917 PMCID: PMC6407828 DOI: 10.14309/ctg.0000000000000010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/07/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The effectiveness of fecal immunochemical test (FIT) screening for colorectal cancer depends on timely colonoscopy follow-up of positive tests, although limited data exist regarding effective system-level strategies for improving follow-up rates. METHODS Using a mixed-methods design (qualitative and quantitative), we first identified system-level strategies that were implemented for improving timely follow-up after a positive FIT test in a large community-based setting between 2006 and 2016. We then evaluated changes in time to colonoscopy among FIT-positive patients across 3 periods during the study interval, controlling for screening participant age, sex, race/ethnicity, comorbidity, FIT date, and previous screening history. RESULTS Implemented strategies over the study period included setting a goal of colonoscopy follow-up within 30 days of a positive FIT, tracking FIT-positive patients, early telephone contact to directly schedule follow-up colonoscopies, assigning the responsibility for follow-up tracking and scheduling to gastroenterology departments (vs primary care), and increasing colonoscopy capacity. Among 160,051 patients who had a positive FIT between 2006 and 2016, 126,420 (79%) had a follow-up colonoscopy within 180 days, including 67% in 2006-2008, 79% in 2009-2012, and 83% in 2013-2016 (P < 0.001). Follow-up within 180 days in 2016 varied moderately across service areas, between 72% (95% CI 70-75) and 88% (95% CI 86-91), but there were no obvious differences in the pattern of strategies implemented in higher- vs lower-performing service areas. CONCLUSIONS The implementation of system-level strategies coincided with substantial improvements in timely colonoscopy follow-up after a positive FIT. Intervention studies are needed to identify the most effective strategies for promoting timely follow-up.
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Affiliation(s)
- Kevin Selby
- Kaiser Permanente Division of Research, Oakland, California, USA
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Wei K. Zhao
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Jeffrey K. Lee
- Kaiser Permanente Division of Research, Oakland, California, USA
| | | | - Joanne E. Schottinger
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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Menees SB, Kim HM, Schoenfeld P. Split-dose bowel preparation improves adequacy of bowel preparation and gastroenterologists’ adherence to National Colorectal Cancer Screening and Surveillance Guidelines. World J Gastroenterol 2018; 24:716-724. [PMID: 29456410 PMCID: PMC5807674 DOI: 10.3748/wjg.v24.i6.716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/29/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To quantify the impact of split-dose regimen on endoscopists’ compliance with guideline recommendations for timing of repeat colonoscopy in patients with normal colonoscopy or 1-2 small polyps (< 10 mm).
METHODS A retrospective chart review of all endoscopy reports was undertaken in average-risk individuals > 50 years old with a normal screening colonoscopy and 1-2 small polyps. Data were abstracted from two time periods, pre and post-split-dose bowel preparation institution. Main outcome measurements were recommendation for timing of repeat colonoscopy and bowel preparation quality. Bivariate analysis by χ2 tests and Student’s t-tests were performed to assess differences between the two cohorts. Multivariable logistic regression was used with guideline consistent recommendations as the dependent variables and an indicator for 2011 cohort as the primary predictor.
RESULTS Four thousand two hundred and twenty-five patients were included in the study; 47.0% (1987) prior to the institution of split dose bowel preparation, and 53.0% (2238) after the institution of split dose bowel preparation. Overall, 82.2% (n = 3472) of the colonoscopies were compliant with guideline recommendations, with a small but significantly increased compliance rate in year 2011 (83.7%) compared to year 2009 (80.4%, P = 0.005), corresponding to an unadjusted odds ratio of 1.25 (95%CI: 1.07-1.47; P = 0.005). Colonoscopies with either “Adequate” or “Excellent” had increased from 30.6% in year 2009 to 39.6% in year 2011 (P < 0.001). However, there was no significant difference in poor/inadequate category of bowel preparation as there was a mild increase from 4.6% in year 2009 to 5.1% in year 2011 (P = 0.50).
CONCLUSION Split-dose bowel regimen increases endoscopists’ compliance to guidelines in average-risk patients with normal colonoscopy or 1-2 small polyps.
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Affiliation(s)
- Stacy Bartnik Menees
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI 48105, United States
- Division of Gastroenterology, Ann Arbor Veterans’ Administration Hospital, Ann Arbor, MI 48105, United States
| | - H Myra Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI 48105, United States
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48105, United States
| | - Philip Schoenfeld
- Division of Gastroenterology, John D. Dingell VA Medical Center, Detroit, MI 48201, United States
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Dubois H, Schmidt PT, Creutzfeldt J, Bergenmar M. Person-centered endoscopy safety checklist: Development, implementation, and evaluation. World J Gastroenterol 2017; 23:8605-8614. [PMID: 29358869 PMCID: PMC5752721 DOI: 10.3748/wjg.v23.i48.8605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a “checklist intervention”.
METHODS The checklist, based on previously published safety checklists, was developed and locally adapted, taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team’s performance were conducted before and after the introduction of the checklist. In addition, questionnaires focusing on patient participation, collaboration climate, and patient safety issues were collected from patients and staff.
RESULTS A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted (from 0% at baseline to 87% after 10 mo, P < 0.001), and remained high among nurses (93% at baseline vs 96% after 10 mo, P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist, but compliance was suboptimal: All items in the observed nurse-led “summaries” were included in 56% of these interactions, and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff, items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist, but this did not result in statistical significance (P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist; hence, no statistical difference was noted.
CONCLUSION The intervention led to increased patient identity verification by physicians - a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.
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Affiliation(s)
- Hanna Dubois
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
| | - Peter T Schmidt
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm 17177, Sweden
| | - Johan Creutzfeldt
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm 17177, Sweden
| | - Mia Bergenmar
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm 17176, Sweden
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Abadi ATB. Resistance to clarithromycin and gastroenterologist’s persistence roles in nomination for Helicobacter pylori as high priority pathogen by World Health Organization. World J Gastroenterol 2017; 23:6379-6384. [PMID: 29085187 PMCID: PMC5643263 DOI: 10.3748/wjg.v23.i35.6379] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/06/2017] [Accepted: 08/25/2017] [Indexed: 02/07/2023] Open
Abstract
Due to the increasing prevalence of clarithromycin resistance, future of management of Helicobacter pylori (H. pylori) infections need to be recognized. To now, clarithromycin was the best effective, well-tolerated and safe antibiotic used in treatment of the bacterium, but, increasing trend of resistance reduced efficacy of recommended regimens. Indeed, gastroenterologists are mostly unable to start appropriate therapy-according to the sensitivity profile-due to the certain difficulties in routine H. pylori culture procedure and being time consuming method. This announcement by World Health Organization (WHO) was an onset to reconsider current challenging dilemma about H. pylori clarithromycin resistant isolates. Therefore, investigating of various factors affecting this nomination by WHO is highly welcomed. In fact, WHO enumerated more than 16 pathogens which seriously threats human life and public health, thus better management or effective guidelines are necessary. Here for the first time, we nominated this phenomenon as ‘‘gastroenterologist’s persistence’’ which should be equally investigated as antibiotic resistance. The ability of gastroenterologists to win the game against H. pylori infections is highly influenced by their collaboration with diagnostic laboratories to apply susceptibility patterns before any prescription. In conclusion, closer collaboration between two important partners (gastroenterologists and microbiologists) in management of H. pylori infection may hopefully trigger an era to remedy current crisis in clarithromycin resistance, a later gastric cancer can be practically preventable.
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Affiliation(s)
- Amin Talebi Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115, Iran
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Troncoso LL, Biancardi AL, de Moraes Jr HV, Zaltman C. Ophthalmic manifestations in patients with inflammatory bowel disease: A review. World J Gastroenterol 2017; 23:5836-5848. [PMID: 28932076 PMCID: PMC5583569 DOI: 10.3748/wjg.v23.i32.5836] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/29/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.
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Affiliation(s)
- Leandro Lopes Troncoso
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Ana Luiza Biancardi
- Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | | | - Cyrla Zaltman
- Department of Internal Medicine, Gastroenterology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
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