Gastroenterology Medicine Research Articles

Safety of Everolimus in Living Donor Liver Transplantation Recipients with Severe Renal Dysfunction with Low Estimated Glomerular Filtration Rate: Can Everolimus Help in Renal Recovery?

Gastroenterology Medicine & Research Safety of Everolimus in Living Donor Liver Transplantation Recipients with Severe Renal Dysfunction with Low Estimated Glomerular Filtration Rate: Can Everolimus Help in Renal Recovery? Ashok Thorat, Long-Bin Jeng*, Horng-Ren Yang Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan *Corresponding author: Long-Bin Jeng, Organ Transplantation Center, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan Submission: December 07, 2017; Published: December 15, 2017 DOI: 10.31031/GMR.2017.01.000505 ISSN 2637-7632Volume1 Issue1

Role of Menopausal Status in Dyssynergic Defecation Diagnosed by 3D High-Resolution Anorectal Manometry

Introduction: Dyssynergic Defecation (DD) is the most common cause of constipation in tertiary referral centers and is predominantly found in women. Previous studies have established a positive association between age and DD. While lack of estrogen has been implicated in pelvic floor weakness, it has rarely been studied in relation to DD. In addition, no study has used 3D High Resolution Anorectal Manometry (3D-HRARM) to decipher if a relationship exists between women with a confirmed diagnosis of PFD and menopausal status. Methods: A retrospective review of all (3D-HRARM) was performed at the Drexel University College of Medicine Gastroenterology Motility Center between January 2015 and August 2016. Background data on female patients was collected as well as risk factors for DD including: surgical history, obstetric history, menopausal status, hormone replacement, birth control, history of episiotomies, and history of abuse. Results: Of the 3D-HRARMs completed, 88%(157/179) were female and 91%(143/157) of the females had an abnormal 3D-HRAM. The subset of abnormal 3D-HRAMs with pelvic floor dysfunction (PFD) was 62% (97/157). These women were further subdivided into Type -1(35%;34/97), -2(9%;9/97), -3(31%;30/97), and -4(25%;24/97). Fifty percent (55/109) were postmenopausal. Systemic or local hormone use in postmenopausal women was clearly documented in 20%(11/55) and 7%(4/55) respectively. When comparing women with PFD and without PFD, there was a significant difference noted in age (49 vs 44, p Conclusion: This is the first study to specifically evaluate the relationship between women with a diagnosis of PFD by 3D-HRARM and menopausal status. We raise the possibility that menopausal status in addition to traditionally taught risk factors, is integrally involved in the development of PFD. The lack of correlation between PFD and hormonal replacement in postmenopausal women may be secondary to our small numbers; however, we strongly suggest that post-menopausal women with symptoms of DD be referred for anorectal physiologic studies.

Liver Transplantation in Egypt

Gastroenterology Medicine & Research Liver Transplantation in Egypt Mai I Mehrez* National Hepatology and Tropical Medicine Research Institute, Egypt *Corresponding author: Mai I Mehrez, Fellow of Hepatology, National Hepatology and Tropical Medicine Research Institute, Egypt Submission: July 31, 2017; Published: November 13, 2017 DOI: 10.31031/GMR.2017.01.000503 ISSN 2637-7632Volume1 Issue1

Improved Results for Endoscopic Colorectal Stenting with Establishment of a Common Endoscopic Centre for Gastroenterologists and Surgeons

Gastroenterology Medicine & Research Improved Results for Endoscopic Colorectal Stenting with Establishment of a Common Endoscopic Centre for Gastroenterologists and Surgeons Antonietta lamazza, Enrico Fiori and Antonio V Sterpetti* *Corresponding author: Antonio V Sterpetti, Istituto pietro valdoni, University of Rome Sapienza, Policlinico Umberto I- Viale del Policlinico 00167 Rome, Italy Submission: August 02, 2017; Published: August 18, 2017 DOI: 10.31031/GMR.2017.01.000501 ISSN 2637-7632Volume1 Issue1

Basic Science Luminal

Basic Science Luminal

The Nurse as the Discussion Opener During Ward Rounds: An Observation Study in the Wards of a Finnish University Hospital

Background: Ward rounds serve as a forum for sharing information between the patient and health care professionals. In order to ensure the multiprofessional nature of the rounds, the nurse’s expertise and knowledge of the patient’s situation is needed. The nurse’s presence during the ward rounds is necessary to ensure patient satisfaction and the quality of the patient’s treatment, even though nurses rarely participate in discussions during the ward rounds. Aim: To describe how active nurses are as discussion openers during ward rounds and to compare the activity of nurses working in different specialities as discussion openers, in addition to investigating the significance of background factors. Methods: The data were collected in a Finnish university hospital in 2012-2013 by observing ward round situations with patients (N=365) on different speciality wards using an observation form. Results: The nurses were fairly passive in initiating discussions about the patient’s physical status and passive in opening a discussion on the patient’s psychological status. The nurses were passive in opening discussions concerning the planning or evaluation of the patient’s treatment. Nurses specializing in gastric surgery or internal medicine in gastroenterology initiated discussions more actively than nurses in other specialties. Nurses opened discussions more often in the context of emergency care patients than in connection with patients who had arrived at the hospital for an elective procedure. Conclusion: Nurses should use their expertise in opening discussions on the patient’s physical and psychological state, as well as decision-making regarding the planning and evaluation of treatment. Support from managers in different professional groups is important for increasing the participation of nurses during ward rounds. In the future, it would be interesting to study the shared experience of nurses, physicians and patients regarding the ward rounds, as well as the patients’ own experiences.

The Nurse as the Discussion Opener During Ward Rounds: An Observation Study in the Wards of a Finnish University Hospital

Background: Ward rounds serve as a forum for sharing information between the patient and health care professionals. In order to ensure the multiprofessional nature of the rounds, the nurse’s expertise and knowledge of the patient’s situation is needed. The nurse’s presence during the ward rounds is necessary to ensure patient satisfaction and the quality of the patient’s treatment, even though nurses rarely participate in discussions during the ward rounds. Aim: To describe how active nurses are as discussion openers during ward rounds and to compare the activity of nurses working in different specialities as discussion openers, in addition to investigating the significance of background factors. Methods: The data were collected in a Finnish university hospital in 2012-2013 by observing ward round situations with patients (N=365) on different speciality wards using an observation form. Results: The nurses were fairly passive in initiating discussions about the patient’s physical status and passive in opening a discussion on the patient’s psychological status. The nurses were passive in opening discussions concerning the planning or evaluation of the patient’s treatment. Nurses specializing in gastric surgery or internal medicine in gastroenterology initiated discussions more actively than nurses in other specialties. Nurses opened discussions more often in the context of emergency care patients than in connection with patients who had arrived at the hospital for an elective procedure. Conclusion: Nurses should use their expertise in opening discussions on the patient’s physical and psychological state, as well as decision-making regarding the planning and evaluation of treatment. Support from managers in different professional groups is important for increasing the participation of nurses during ward rounds. In the future, it would be interesting to study the shared experience of nurses, physicians and patients regarding the ward rounds, as well as the patients’ own experiences.

The relation between liver histopathology and GGT levels in viral hepatitis: more important in hepatitis B.

To investigate the relationship between gamma-glutamyl transpeptidase (GGT) levels and histopathological status determined by biopsy in patients with chronic hepatitis B and C. Patients with chronic hepatitis B and C who were referred to the Uludağ University Faculty of Medicine Gastroenterology outpatient clinic between January 2005-January 2011 and underwent liver biopsy were included in the study. Overall, 246 patients with hepatitis B and 151 patients with hepatitis C were enrolled. According to the evaluation based on the Ishak score, patients with a histological activity index (HAI) between 0-12 were defined as low activity, and those with an HAI between 13-18 were defined as high activity. In addition, patients with a fibrosis score of 0-2 were defined as low fibrosis, and those with a score between 3-6 were defined as high fibrosis; comparisons were made accordingly. In patients with hepatitis B, the mean GGT level was 38.86±42.4 (IU/L) in the low activity group and 60.44±44.4 (IU/L) in the high activity group (p<0.05). In hepatitis B patients, the mean GGT level was 26.89±14.83 (IU/L) in the low fibrosis group, whereas it was 65.60±59.7 (IU/L) in the high fibrosis group (p<0.001). There was no significant difference between HAI and fibrosis group with regard to GGT levels in the hepatitis C patients. In conclusion, it is proposed that in patients with chronic viral hepatitis, GGT levels can be taken into consideration to predict advanced histological liver damage, especially in patients with hepatitis B.

P-18 * PATIENT'S TYPE FALLING UNDER THE CATEGORY OF ALCOHOL DEPENDENCE, HARMFUL USE OF ALCOHOL, AND HAZARDOUS DRINKING AND THE DIRECTION OF SUPPORT IN INPATIENTS OF GASTROENTEROLOGICAL MEDICINE DEPARTMENT

Introduction. In this investigation, 34.0% of 141 inpatients of gastroenterological medicine department with their consent had a score of 8 or higher in AUDIT. Types of those patients were investigated. Method. Alcohol abuse (diagnosed based on ICD-10) and hazardous drinking were analyzed for patients (n = 55) with an AUDIT score of 8 or higher. Patients were classified in a case-code matrix using age, gender, AUDIT score, diagnosis, presence/absence of alcohol abuse treatment, motivational stage by Prochaska, cognitive function, life expectancy as codes. This investigation was conducted with approval from the Ethical Committee of University of Tsukuba. There was no conflict of interest. Result. Types included patients with (1) alcohol abuse, in the preparation or later stage of change, with no previous treatment for alcohol abuse; (2) a history of alcohol abuse treatment and progressed physical disease due to relapse; (3) alcohol abuse and life expectancy of several months due to malignant disease; (4) alcohol abuse in the pre-contemplation stage of change, with impaired cognition function in some cases; and (5) harmful use of alcohol or hazardous drinking in the pre-contemplation stage of change. Conclusion. Support should be tailored by patients' type of alcohol abuse.

The frequency of complications and the etiology of disease in patients with liver cirrhosis in erzurum.

This study included 100 patients diagnosed with liver cirrhosis who presented at Atatürk University Faculty of Medicine Gastroenterology clinic and polyclinic. The etiology of liver cirrhosis and the incidence of its complications have been investigated. The etiological classification of liver cirrhosis in our patients was as follows: 47 hepatitis B virus hepatitis, 11 hepatitis C virus hepatitis, 5 HBV+HDV hepatitis, 4 Budd Chiari syndrome, 2 chronic alcohol abuse, 2 ischemic heart disease, 1 autoimmune hepatitis, 1 sclerosing cholangitis, 1 hydatid cyst. In 26 patients we could not find any etiological condition. These patients were called cryptogenic cirrhosis patients.When we examined the complications of liver cirrhosis, it appeared that there were ascites in 83 patient. In 56 patients, esophageal variceal bleeding occurred. There was spontaneous bacterial peritonitis in 42 patients. Hepatorenal syndrome occurred in 26 patients. Finally, in 3 patients we detected hepatorenal syndrome. The most common causes in the etiology of liver cirrhosis are viral, especially HBV. Many of the patients were in decompensated phase when diagnosed. We found that there was a close relation between the frequency of complications and mortality in liver cirrhosis.

In Response

Department of Tropical Medicine Gastroenterology and Hepatology Ain Shams University, Abbasiya Cairo, Egypt The author declares that there is nothing to disclose.

The Environment Within: Exploring the Role of the Gut Microbiome in Health and Disease

The human genome codes for approximately 23,000 genes,1 yet some experts have suggested that the total information coded by the human genome alone is not enough to carry out all of the body’s biological functions.2 A growing number of studies suggest that part of what determines how the human body functions may be not only our own genes, but also the genes of the trillions of microorganisms that reside on and in our bodies. The genomes of the bacteria and viruses of the human gut alone are thought to encode 3.3 million genes.3 “The genetic richness and complexity of the bugs we carry is much richer than our own,” says Jayne Danska, an immunologist at the Hospital for Sick Children Research Institute in Ontario, Canada. “They serve as a buffer and interpreter of our environment. We are chimeric organisms.” Figure 1 False-color scanning electron micrograph shows the surface of the colon mucosa with pink clusters of rod-shaped bacteria, possibly Escherichia coli, attached. The genomes of the bacteria and viruses of the human gut alone are thought to encode 3.3 million ... A role for gut microbes in gastrointestinal function has been well documented since researchers first described differences in the fecal bacteria of people with inflammatory bowel disease.4 The molecular mechanisms responsible for the gut microbiome’s impact on metabolism and diseases throughout the body remain largely unknown. However, researchers are beginning to decipher how the microorganisms of the human intestinal tract influence biological functions beyond the gut and play a role in immunological, metabolic, and neurological diseases.

The Impact of Network Medicine in Gastroenterology and Hepatology

In the footsteps of groundbreaking achievements made by biomedical research, another scientific revolution is unfolding. Systems biology draws from the chaos and complexity theory and applies computational models to predict emerging behavior of the interactions between genes, gene products, and environmental factors. Adaptation ofsystems biology to translational and clinical sciences has been termed network medicine, and is likely to change the way we think about preventing, predicting, diagnosing, and treating complex human diseases. Network medicine finds gene-disease associations by analyzing the unparalleled digital information discovered and created by high-throughput technologies (dubbed as "omics" science) and links genetic variance to clinical disease phenotypes through intermediate organizational levels of life such as the epigenome, transcriptome, proteome, and metabolome. Supported by large reference databases, unprecedented data storage capacity, and innovative computational analysis, network medicine is poised to find links between conditions that were thought tobe distinct, uncover shared disease mechanisms and key drivers of the pathogenesis, predict individual disease outcomes and trajectories, identify novel therapeutic applications, and help avoid off-target and undesirable drug effects. Recent advances indicate that these perspectives are increasingly within our reach for understanding and managing complex diseases of the digestive system.

P306 Efficacy and safety of low-molecular weight heparin for the prevention of venous thromboembolism in patients with severe ulcerative colitis

P306 Efficacy and safety of low-molecular weight heparin for the prevention of venous thromboembolism in patients with severe ulcerative colitis A. Papa1 *, A. Armuzzi2, L. Guidi3, I. De Vitis4, G. Mocci5, C. Felice4, M. Marzo6, D. Pugliese1, G.L. Rapaccini7. 1Catholic University of Rome, Internal Medicine and Gastroenterology Complesso Integrato Columbus, Rome, Italy, 2Complesso Integrato Columbus, Gastroenterology Unit, Rome, Italy, 3Universita Cattolica Del Sacro Cuore, O.U. Gastroenterology Columbus, Rome, Italy, 4Universita Cattolica Del Sacro Cuore, Complesso integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy, 5Catholic University of Rome, Internal Medicine Gastroenterology, Rome, Italy, 6Complesso Integrato Columbus, Medicina Interna e Gastroenterologia, Rome, Italy, 7Catholic University of Rome, Complesso Integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy

P307 The clinical course of rectovaginal fistulas in Crohn's disease since the introduction of anti TNF drugs

P306 Efficacy and safety of low-molecular weight heparin for the prevention of venous thromboembolism in patients with severe ulcerative colitis A. Papa1 *, A. Armuzzi2, L. Guidi3, I. De Vitis4, G. Mocci5, C. Felice4, M. Marzo6, D. Pugliese1, G.L. Rapaccini7. 1Catholic University of Rome, Internal Medicine and Gastroenterology Complesso Integrato Columbus, Rome, Italy, 2Complesso Integrato Columbus, Gastroenterology Unit, Rome, Italy, 3Universita Cattolica Del Sacro Cuore, O.U. Gastroenterology Columbus, Rome, Italy, 4Universita Cattolica Del Sacro Cuore, Complesso integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy, 5Catholic University of Rome, Internal Medicine Gastroenterology, Rome, Italy, 6Complesso Integrato Columbus, Medicina Interna e Gastroenterologia, Rome, Italy, 7Catholic University of Rome, Complesso Integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy

Medical Education: A Key Partner in Realizing Personalized Medicine in Gastroenterology

Completion of the human genome sequence heralds an era that utilizes the “individual patient’s genome [to] help determine the optimal approach to care, whether it is preventive, diagnostic, or therapeutic,”1 defining personalized medicine broadly to provide biomarkers for disease prevention and treatment, new targets for drug development, and tools to make drugs safer and more efficacious. Limitations to personalized medicine include genetic testing availability, cost, insurance coverage, ethical concerns, scientific progress, and evidence of clinical usefulness; education in these areas may help to bridge a growing knowledge gap between science and practitioners. Genomic information and pharmacogenetic testing have already improved our understanding and treatment of common gastrointestinal disorders such as inflammatory bowel disease (IBD), peptic ulcer disease, and colon cancer, but training at every level must integrate new concepts and treatment options. Medical educators must prepare physicians, the public, trainees, and other health care workers to realize personalized medicine’s promise to deliver “the right dose of the right drug for the right patient at the right time.” Along with scientific advances, educational tools have advanced significantly in the communication age and can reach target audiences more quickly than previously, for example, the delay of teaching Mendelian genetic principles until Gregor Mendel’s work was rediscovered and disseminated almost 40 years after publication. The gastrointestinal tract represents a unique model for investigating, understanding, and teaching the broadest implications of personalized medicine and clinical genomics. Uniquely, the digestive tract contains complex interactions between networks of host mucosal defense mechanisms and a vast, coexistent luminal microflora and other luminal contents, with important ramifications in disorders such as IBD and Helicobacter pylori-associated disorders. In addition, recent insights offer new strategies for the diagnosis and treatment of colon cancer and other malignancies. A targeted survey of important recent breakthroughs will provide a basis for educational strategies in personalized medicine in gastroenterology.

Embracing complexity

A subset of patients with inflammatory bowel disease have markedly impaired quality of life. In this issue, Mussell et al. report that patients' self-rated health status and disease-related concerns were determined at least as strongly by their habitual use of depressive coping patterns as by their disease activity. Although past disease severity may have confounded these results, the finding that quality of life is better for patients armed with a positive approach to problem-handling suggests that psychologically oriented interventions could have far-reaching benefits for selected patients. Since evidence is accumulating that stress and distress can worsen tissue inflammation and clinical course in animal models and in clinical populations with inflammatory bowel disease, we may dare to hope that interventions aimed at improving patients' stress tolerance, depressive symptoms, and coping capacities might not only improve perceived quality of life but could potentially decrease bowel inflammation and reduce some patients' need for toxic medications or surgery. Designing, applying, and evaluating such interventions should be a major item on the agenda of psychosomatic medicine in gastroenterology, and biological reductionism should be replaced by the biopsychosocial model.

American Board of Internal Medicine Gastroenterology Recertification: How Can ACG Help?

American Board of Internal Medicine Gastroenterology Recertification: How Can ACG Help?

A CASE OF MECKEL'S DIVERTICULUM WITH MASSIVE ANAL BLEEDING

A 31-year-old man was emergently admitted to the department of gastroenterological medicine in our hospital because of abrupt massive anal bleeding. Upper and lower gastrointestinal endoscopy and angiography faild to identify the bleeding site. A total of about 7500ml of anal bleeding was noted during these three days, but hemostasis was achieved conservatively. Intestinal fluoroscopy revealed a true diverticulum with peristalsis in the contralateral mesentery at 40cm from the terminal ileum. It was diagnosed as Meckel's diverticulum, but Tc scintigraphy did not visualize the diverticulum. Angiography confirmed abnormal vessels distributed in the diverticulum. It was determined that massive anal bleeding was originated from the Meckel's diverticulum. On November 15, 1996, a partial resection of the ileum including the diverticulum was performed under laparoscopy. Histological examination of the resected material revealed regeneration of epithelia at the top of the diverticulum which appeared to be a repairing process of acute mucosal lesion. Differing from usual bleeding from Meckel's diverticulum, massive bleeding in this case was thought to occur from the acute mucosal lesion of the diverticulum.

Clinical applications of nuclear medicine in gastroenterology.

Nuclear medicine (NM) has traditionally been a non-nursing field. This specialty has grown rapidly and continues to expand. Most nurses have had very limited exposure to nuclear medicine, except in the area of patient preparation for the nuclear medicine department. Because this specialty has had significant advances that require patient monitoring in many diagnostic and therapeutic procedures, nurses will benefit by learning more about this field and by equipping themselves to care for pre- and postprocedural patients. This article is an overview of the nuclear medicine process and its most common clinical applications in the GI field as they relate to nursing practice.