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Gralnek I.M.,Technion - Israel Institute of Technology | Gralnek I.M.,GI Outcomes Unit | Ron-Tal Fisher O.,Technion - Israel Institute of Technology | Holub J.L.,Oregon Health And Science University | Eisen G.M.,Oregon Health And Science University
Gastrointestinal Endoscopy | Year: 2013

Background: Data on the role of colonoscopy in hematochezia are almost exclusively derived from clinical experience in tertiary care practice. Objective: To characterize the patient population who received colonoscopy for hematochezia in a consortium of diverse gastroenterology practices. Design: Retrospective analysis. Setting: Clinical Outcomes Research Initiative Database, 2002 to 2008. Patients: Adults undergoing colonoscopy for the indication of hematochezia. Main Outcome Measurements: Demographics, comorbidity, practice setting, adverse events, and colonoscopy procedure characteristics and findings. Age-stratified analyses and analyses of inpatient- versus outpatient-performed colonoscopies were also performed. Results: A total of 966,536 colonoscopies were performed during the study period, 76,186 (7.9%) were performed for evaluation of hematochezia. The majority of patients were white non-Hispanic men younger than 60 years old who underwent colonoscopy at a community practice site (79.1%) and had a low-risk American Society of Anesthesiologists (ASA) score (81.5%), in whom colonoscopy reached the cecum (94.8%), and serious adverse events were rare. Colonoscopy findings were hemorrhoids (64.4%), diverticulosis (38.6%), and polyp or multiple polyps (38.8%). From the overall cohort, 38.3% were 60 years of age and older. The older age cohort had significantly more white non-Hispanic females, high-risk ASA scores, incomplete colonoscopies, and unplanned events. Colonoscopy findings demonstrated significantly higher rates of diverticulosis, polyp or multiple polyps, mucosal abnormality/colitis, tumor, and solitary ulcer (P <.0001). There were 3941 (5.2%) who underwent inpatient-performed colonoscopy. One third of this cohort (32.6%) was defined as having a high ASA score. Limitations: Retrospective database review. Conclusions: These results describe patient populations and characterize colonoscopy findings in individuals presenting with hematochezia primarily in a community practice setting. © 2013 American Society for Gastrointestinal Endoscopy.

Shields H.M.,Beth Israel Deaconess Medical Center | Nardone G.,University of Naples Federico II | Zhao J.,Chongqing Medical University | Wang W.,536 Hospital of PLA | And 12 more authors.
Annals of the New York Academy of Sciences | Year: 2011

The following on prevalence and incidence of adenocarcinomas in Barrett's esphophagus (BE) includes commentaries on the mechanisms of a potential protective effect of proton pump inhibitors (PPIs) on progression of BE to high-grade dysplasia; evaluation of the role of PPIs in decreasing the risk of degeneration; the geographical variations of incidence of BE; the role of the nonmorphologic biomarkers; the relationship between length of BE and development of cancer; the confounding factors in incidence rates of BE; the role of the increase of cell differentiation and apoptosis induced by PPIs in the diminution of cancer risk; the frequency of occult neoplastic foci and unsuspected invasive cancer in surgical specimens; the influence on the indications of endoscopic therapy; the overestimation of regression in surgical series; attempts to evaluate the reasons for variations of cancer incidence in the literature; and progress in screening and surveillance for BE. © 2011 New York Academy of Sciences.

Pasha S.F.,Mayo Medical School | Crowell M.D.,Mayo Medical School | Alexander J.A.,Mayo Medical School | Harris L.A.,Mayo Medical School | And 11 more authors.
European Gastroenterology and Hepatology Review | Year: 2011

Eosinophilic oesophagitis (EoE) is a clinicopathological disorder of the oesophagus, which typically affects young males, and is characterised by clinical symptoms of dysphagia and food impaction. The diagnosis is established by histopathological findings of >15 intraepithelial eosinophils per high power field (eos/HPF) in the oesophageal mucosa. The aetiopathogenesis of this disorder remains unknown, and the earlier concept that EoE is a consequence of gastroesophageal reflux disease (GERD) is under debate. It is now considered to be a separate entity that results from allergic and immunological responses to environmental allergens. Typical endoscopic features include oesophageal corrugations and linear furrows, but the disorder should be suspected in the appropriate clinical setting even in patients with an oesophagus that appears normal. The mainstay of treatment includes anti-inflammatory medications (steroids) and avoidance of allergens. Endoscopic dilation is an option in patients who do not respond to medical management. With the increasing comprehension of the immunopathogenesis of this disorder, immunomodulators and other novel agents may be increasingly utilised in the future, in patients who are refractory to conventional medical management. © Touch Briefings 2011.

Ron-Tal Fisher O.,Technion - Israel Institute of Technology | Gralnek I.M.,Technion - Israel Institute of Technology | Gralnek I.M.,GI Outcomes Unit | Eisen G.M.,Oregon Health And Science University | And 2 more authors.
Gastrointestinal Endoscopy | Year: 2014

Background Data on the use of endoscopic hemostasis performed during colonoscopy for hematochezia are primarily derived from expert opinion and case series from tertiary care settings. Objectives To characterize patients with hematochezia who underwent in-patient colonoscopy and compare those who did and did not receive endoscopic hemostasis. Design Retrospective analysis. Setting Clinical Outcomes Research Initiative National Endoscopic Database, 2002 to 2008. Patients Adults with hematochezia. Interventions None. Main Outcome Measurements Demographics, comorbidities, practice setting, adverse events, and colonoscopy procedural characteristics and findings. Results We identified 3151 persons who underwent in-patient colonoscopy for hematochezia. Endoscopic hemostasis was performed in 144 patients (4.6%). Of those who received endoscopic hemostasis, the majority were male (60.3%), white (83.3%), and older (mean age 70.9 ± 12.3 years); had a low-risk American Society of Anesthesiologists classification (53.9%); and underwent colonoscopy in a community setting (67.4%). The hemostasis-receiving cohort was significantly more likely to be white (83.3% vs 71.0%, P =.02), have more comorbidities (classes 3 and 4, 46.2% vs 36.0%, P =.04), and have the cecum reached (95.8% vs 87.7%, P =.003). Those receiving hemostasis were significantly more likely to have an endoscopic diagnosis of arteriovenous malformations (32.6% vs 2.6%, P =.0001) or a solitary ulcer (8.3% vs 2.1%, P <.0001). Limitations Retrospective database analysis. Conclusions Less than 5% of persons presenting with hematochezia and undergoing inpatient colonoscopy received endoscopic hemostasis. These findings differ from published tertiary care setting data. These data provide new insights into in-patient colonoscopy performed primarily in a community practice setting for patients with hematochezia. © 2014 by the American Society for Gastrointestinal Endoscopy.

Kephart G.M.,Mayo Medical School | Alexander J.A.,Mayo Medical School | Arora A.S.,Mayo Medical School | Romero Y.,Mayo Medical School | And 3 more authors.
American Journal of Gastroenterology | Year: 2010

Objectives: Eosinophilic esophagitis (EoE) is characterized by infiltration of eosinophils into esophageal epithelium. Blood levels of an eosinophil granule protein, eosinophil-derived neurotoxin (EDN), have been proposed as a biomarker for EoE. However, information regarding localization of EDN in the diseased tissues has not been available. The goal of this study was to evaluate the magnitude and distribution of EDN deposition in tissue specimens from the esophagus of EoE patients. Methods: We studied specimens from 10 adult EoE patients and eight histologically normal controls (three under age 17). Sections from mid-esophageal biopsy specimens were stained for EDN by immunofluorescence, using a polyclonal rabbit antibody to EDN. Cellular staining (i.e., infiltration of intact eosinophils) and extracellular staining (i.e., deposition of released EDN) were scored in a blinded manner on an established 7-point scale. Results: Esophageal biopsy specimens from histologically normal controls showed no or few intact eosinophils and no or minimal extracellular EDN deposition. In contrast, EDN staining was clearly observed in specimens from all EoE patients. In some EoE patients, marked extracellular EDN deposition was observed despite relatively small numbers of intact eosinophils. Overall, there was no correlation between the eosinophil infiltration and the extracellular EDN staining scores. Conclusions: Marked tissue deposition of extracellular EDN is present in the esophagus of EoE patients. Tissue eosinophil counts may underestimate how extensively eosinophils are involved, particularly in individuals with marked eosinophil degranulation. Evaluation of EDN staining in esophageal biopsy specimens may be useful to diagnose and manage patients with EoE. © 2010 by the American College of Gastroenterology.

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