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Endocrinology, Computer Science, Biology, Immunohistochemistry, Medicine, and 14 moreCanadian, Internal Medicine, Female, Animals, Jejunum, Medical Physiology, Colitis, Rats, Time Factors, Colon, Severity of Illness Index, maltase, reverse transcriptase polymerase chain reaction, and Pharmacology and pharmaceutical sciences
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DOMELLOF L, 1983, SCAND J GASTROENTERO, V18, P951; Parra-Blanco A, 2000, GASTROINTEST ENDOSC, V51, P37, DOI 10.1016-S0016-5107(00)70384-1; Repici A, 2012, ENDOSCOPY, V44, P27, DOI 10.1055-s-0031-1291387; ROGERS BHG, 1975, GASTROINTEST... more
DOMELLOF L, 1983, SCAND J GASTROENTERO, V18, P951; Parra-Blanco A, 2000, GASTROINTEST ENDOSC, V51, P37, DOI 10.1016-S0016-5107(00)70384-1; Repici A, 2012, ENDOSCOPY, V44, P27, DOI 10.1055-s-0031-1291387; ROGERS BHG, 1975, GASTROINTEST ENDOSC, V22, P73; Whitson MJ, 2011, J CLIN GASTROENTEROL, V45, P228, DOI 10.1097-MCG.0b013e3181eb5efd; Yao MD, 2009, GASTROINTEST ENDOSC, V69, P906, DOI 10.1016-j.gie.2008.05.015; Yousfi M, 2004, AM J GASTROENTEROL, V99, P1785, DOI 10.1111-j.1572-0241.2004.30368.x
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CLINICAL PRESENTATION A 51yearold man presented to our gastroenterology clinic complaining of bloating and belching. His medical history was significant for diabetes mellitus and thyroidectomy for papillary thyroid cancer. He reported... more
CLINICAL PRESENTATION A 51yearold man presented to our gastroenterology clinic complaining of bloating and belching. His medical history was significant for diabetes mellitus and thyroidectomy for papillary thyroid cancer. He reported occasional heartburn but denied any abdominal pain, change in bowel habits, weight loss or family history of malignancy. One of his children had autism. Physical examination was noted for asymptomatic skincoloured lesions over the feet (figure 1A) but was otherwise negative. Upper gastrointestinal endoscopy showed numerous whitish plaques in the oesophagus (figure 1B), along with multiple small polyps in the stomach (figure 1C) and duodenum. Colonoscopy revealed numerous polyps scattered throughout the colon (figure 1D) and multiple polyps in the terminal ileum. Biopsies from the stomach, duodenum and colon were all consistent with hyperplastic polyps (figure 1E).
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Gastroenterology, Medicine, Colorectal cancer, Humans, Internal Medicine, and 15 moreFemale, Male, Mucin, Clinical Sciences, Aged, Middle Aged, Adult, Survival Rate, Retrospective Studies, Disease Progression, Mucins, Adenocarcinoma, Case Control Studies, Colorectal Neoplasms, and Combined Modality Therapy
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Liver cystic echinococcosis (CE) is one of the important neglected tropical diseases that have a global distribution and significant implications on public health outcomes. The World Health Organization (WHO) has played an essential role... more
Liver cystic echinococcosis (CE) is one of the important neglected tropical diseases that have a global distribution and significant implications on public health outcomes. The World Health Organization (WHO) has played an essential role in raising awareness about this chronic parasitic disease and has set the stage for a unified diagnostic and treatment approach. Currently, the management of CE should follow the stage-specific WHO recommendations. Therapeutic options include surgery, percutaneous treatment, drug therapy, and observation. Despite the availability of multiple treatment options, it is necessary to recognize that the evidence to support the best treatment approach is insufficient. Determining the ideal individualized treatment strategy remains controversial, in particular on how best to manage asymptomatic individuals. Invasive treatment options such as surgery or PAIR (puncture, aspiration, injection, reaspiration) have considerable risks as well as risk of relapse. Given that the majority of liver hydatid cysts have a good prognosis, two treatment strategies should be highlighted. First, the “watch and wait” strategy is a safe option to consider in inactive uncomplicated cysts classified as WHO stage CE4 and CE5. Second, medical drug therapy with benzimidazoles is another noninvasive treatment option with an expected favorable outcome in the majority of cases. Antiparasitic drugs work best for small (less than 5 cm) CE1 and CE3a cysts. Both noninvasive treatment strategies should be followed up closely with regular ultrasound monitoring. Patients should be informed about the risks and benefits including the risk of relapse. Evidence from randomized trials comparing different options is needed for better guidance.
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Gastroenterology, Lebanon, Chemotherapy, Medicine, Multivariate Analysis, and 15 moreHumans, Internal Medicine, Female, Male, Bilirubin, Body Mass Index, Clinical Sciences, Aged, Middle Aged, Adult, Cholangiocarcinoma, Retrospective Studies, Antineoplastic Agents, Proportional Hazards Models, and Malignancy
Background and Aims: Gross non-variceal upper gastrointestinal bleeding (NVUGIB) is a serious complication of antiplatelet (AP) and anticoagulant (AC) therapy. However, there is paucity of information on the effect of such therapy on... more
Background and Aims: Gross non-variceal upper gastrointestinal bleeding (NVUGIB) is a serious complication of antiplatelet (AP) and anticoagulant (AC) therapy. However, there is paucity of information on the effect of such therapy on clinical outcomes. We compared mortality and morbidity of patients hospitalized with peptic disease related NVUGIB while taking AP and/or AC therapy with those of patients not using them. Methods: A retrospective cohort study of patients admitted with NVUGIB between 1993 and 2010 was conducted. Only patients with peptic disease [gastric ulcer (GU), duodenal ulcer (DU), or erosive duodenitis, gastritis, or esophagitis) as a cause of bleeding were included. The patients' characteristics and clinical outcomes were compared between different medication groups: (a) any one or more AP/AC (aspirin, clopidogrel, ticlopidine, dypiridamole, heparin, and warfarin), (b) AP therapy, (c) aspirin only, (d) AC therapy, (e) heparin only, and (f) no AP/ AC drugs (controls). Outcomes included in-hospital mortality, length of hospital stay, and the frequency of severe bleeding, rebleeding, surgery, endoscopic therapy, blood transfusion, and in-hospital complications. Criteria for severe bleeding were: Bp 120 b/min, Hb 3 units of blood. Independent t test, chi-squared test, and Fisher's exact test were used for statistical analysis, as appropriate. Results: 386 patients were included: 231 (60%) were on any one or more AP/AC [171 AP (137 on aspirin only), 35 AC (9 on heparin only), and 25 on AP+AC combinations] and 155 (40%) served as the control group. DU was present in 43%, GU in 35%, and erosive disease in 57% of the patient population. In total, in-hospital mortality occurred in 3.6%, surgery in 5.7%, re-bleeding in 16.6%, severe bleeding in 40.4%, in-hospital complications in 50.5%, and endoscopic therapy in 24.4% of the patients. Patients on any AP/AC were significantly older (P<0.0001) and had more comorbidities (P<0.0001) than controls. Compared to the control group, patients on aspirin alone had less mortality (5.8% vs. 0.73%, P=0.02), less surgeries (8.4% vs. 2.9%, P=0.077), and shorter hospital stay (7.3 ± 11 vs. 5 ± 3 days, P=0.01), but were more likely to require transfusion (64% vs. 78%, P=0.008). Patients on AP therapy had similar results. However, patients on AC therapy had more rebleeding (18.1% vs. 34.3%, P=0.034), severe bleeding (35.5% vs. 65.7%, P=0.001), in-hospital complications (45.8% vs. 80%, P=0.0003), and longer hospital stay (7.3 ± 11 vs. 12.3 ± 16 days, P=0.08), and were more likely to require transfusion (64% vs. 94%, P=0.0004), but mortality was 8.6% (vs. 5.8%, P=0.47). Conclusion: Use of aspirin or AP drugs is associated with lower mortality and morbidity, while use of AC drugs is associated with increased morbidity in patients with peptic disease related NVUGIB.
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Medicine, Comorbidity, Humans, Internal Medicine, Female, and 15 moreMale, Anticoagulant, Anticoagulants, Length of Stay, Colonoscopy, Clinical Sciences, Aged, Middle Aged, Adult, Age Factors, Antiplatelet Therapy, Gastrointestinal bleeding, Clinical Gastroenterology, Platelet Aggregation Inhibitors, and Diverticulum
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Dear Editor, Patients with thalassemia receive their first blood trans-fusions within 2 years of birth, and hepatitis C virus (HCV) infection is acquired around the age of 4 years. We have previously reported that the combination of... more
Dear Editor, Patients with thalassemia receive their first blood trans-fusions within 2 years of birth, and hepatitis C virus (HCV) infection is acquired around the age of 4 years. We have previously reported that the combination of peginterferon alpha-2a and ribavirin is effective and ...
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Hematology, Hepatitis C, Hepatitis B, Humans, Internal Medicine, and 15 moreLiver, Male, Hepatitis C Virus, Hepatitis, Iron, Hiv Infection, Combination drug therapy, Blood Transfusion, Liver Disease, chronic hepatitis C, Antiviral Agents, Combination Therapy, Antiviral Therapy, Liver biopsy, and Cardiovascular medicine and haematology
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Geography, Developing Countries, Adolescent, Medicine, Middle East, and 15 moreLiterature Review, Humans, Child, Celiac Disease, Disease, Clinical Sciences, Adult, Low Risk, Clinical Presentation, Iron Deficiency Anemia, Predictive value of tests, Gluten Free Diet, High risk, Insulin dependent diabetes mellitus, and Genetic predisposition to disease
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Background/Aim The ABC score is a new pre-endoscopic scoring system that was recently developed to accurately predict one-month mortality in upper and lower gastrointestinal bleeding (GIB). We aim to validate this new score on a cohort of... more
Background/Aim The ABC score is a new pre-endoscopic scoring system that was recently developed to accurately predict one-month mortality in upper and lower gastrointestinal bleeding (GIB). We aim to validate this new score on a cohort of Lebanese patients treated in a tertiary care center and to compare it to currently existing scores. Methods Adult patients admitted to the American University of Beirut Medical Center (AUBMC) with overt GIB between January 2013 and August 2020 were included. The area under receiver operating characteristic (AUROC) curves of the ABC score in predicting 30-day mortality was calculated using the SPSS software. Other optimal existing scores for predicting mortality (the Oakland score for lower GIB, the AIMS-65 and the Rockall scores for upper GIB)s were also assessed and compared to the ABC score. Results A total of 310 patients were included in our study. For upper GIB, the ABC score showed good performance in predicting 30-day mortality (AUROC: 0.79)...
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Gastroenterology, Adolescent, Endoscopy, Biopsy, Humans, and 15 moreInternal Medicine, Intestinal Mucosa, Celiac Disease, Female, Disease, Clinical Sciences, Aged, Adult, Cross Sectional Studies, Logistic Models, Confidence Interval, Duodenum, Esophagogastroduodenoscopy, Decision Support Techniques, and Diagnostic errors
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Endocrinology, Nutrition, Diabetes, Medicine, Humans, and 15 moreInternal Medicine, Diabetes mellitus, Female, Male, Body Mass Index, Intestinal absorption, Middle Aged, Pilot study, Adult, Pilot Projects, Reference Values, Diabetes Care, Ectoine Excretion, excretion, and Medical and Health Sciences
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Helicobacter pylori, Medicine, Endoscopy, Humans, Internal Medicine, and 10 moreAnticoagulants, Risk factors, Clinical Sciences, Antiplatelet Therapy, Risk Factors, Gastrointestinal bleeding, Proton Pump Inhibitors, Clinical Trials as Topic, Clinical Gastroenterology, and Platelet Aggregation Inhibitors
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The aim of this study was to determine the prevalence of antimicrobial resistance amongst Helicobacter pylori isolates cultured from gastric biopsies taken during routine endoscopies at the American University of Beirut Medical Center in... more
The aim of this study was to determine the prevalence of antimicrobial resistance amongst Helicobacter pylori isolates cultured from gastric biopsies taken during routine endoscopies at the American University of Beirut Medical Center in Lebanon. Fifty-four consecutively recovered H. pylori isolates were tested against metronidazole, clarithromycin, tetracycline and amoxycillin using the epsilometer test. Resistance to metronidazole (MIC&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;8 mg/l) was found
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Background/Aim We determined the effect of antiplatelet and anticoagulant agents on rebleeding and mortality in patients with gastrointestinal bleeding. Methods This was a prospective study of patients admitted with gastrointestinal... more
Background/Aim We determined the effect of antiplatelet and anticoagulant agents on rebleeding and mortality in patients with gastrointestinal bleeding. Methods This was a prospective study of patients admitted with gastrointestinal bleeding between 2013 and 2018. Outcomes were compared among patients on antiplatelet agents only, anticoagulant drugs only, combination therapy, and none. The association between mortality, rebleeding, and type of antithrombotic medication on admission and discharge was determined using multivariate analysis. Results A total of 509 patients were followed up for a median of 19 months. End of follow-up rebleeding and mortality rates were 19.4% and 23.0%, respectively. Independent predictors of mortality were age [hazard ratio (HR) = 1.025 per year increase, P = 0.002], higher Charlson Comorbidity Index (HR = 1.4, P &lt; 0.0001), severe bleeding (HR = 2.1, P &lt; 0.0001), and being on anticoagulants (HR = 2.3, P = 0.002). Being on antiplatelets was protective against rebleeding (HR = 0.6, P = 0.047). Those on anticoagulants were more likely to die (HR = 2.5, P &lt; 0.0001) and to rebleed (HR = 2.1, P = 0.01) than those on antiplatelets. Antithrombotic drug discontinuation upon discharge was associated with increased mortality in patients with cardiovascular disease. Conclusion In gastrointestinal bleeding, rebleeding and mortality were associated with being on anticoagulant drugs, while being on antiplatelet agents was protective against rebleeding. Discontinuation of antithrombotics upon discharge increased the risk of death. The findings inform risk stratification and decisions regarding continuation or discontinuation of antithrombotics.
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We aimed to determine the effect of antithrombotics on in-hospital mortality and morbidity in patients with peptic ulcer disease-related upper gastrointestinal bleeding (PUD-related UGIB). The study cohort was retrospectively selected... more
We aimed to determine the effect of antithrombotics on in-hospital mortality and morbidity in patients with peptic ulcer disease-related upper gastrointestinal bleeding (PUD-related UGIB). The study cohort was retrospectively selected from a tertiary center database of patients with PUD-related UGIB, defined as bleeding due to gastric or duodenal ulcers, or erosive duodenitis, gastritis or esophagitis. Outcomes were compared among patient groups based on their antithrombotic medications before admission. Patients on no antithrombotics served as controls. The composite adverse outcomes, in-hospital mortality, rebleeding and/or need for surgery were measured. Severe bleeding and in-hospital complications were also recorded. Of 398 patients with PUD-related UGIB, 44.5% were on aspirin or anticoagulants only. The composite adverse outcome was most common in patients taking anticoagulants only (40.5%), intermediate in controls (23.1%) and least in those taking aspirin only (12.1%). On multivariate analysis, patients taking aspirin alone had a significantly lower risk of adverse outcome events (odds ratio [OR] 0.4, 95% CI 0.2-0.8) and a shorter length of hospital stay (regression coefficient = -3.4, 95% CI [-6.6, -0.6]). In contrast, taking anticoagulants was associated with a greater risk of adverse outcome events (OR 2.3, 95% CI 1.0-5.3), severe bleeding (OR 2.6, 95% CI 1.2-5.8) and in-hospital complications (OR 2.9, 95% CI 1.3-6.6). Patients with PUB-related UGIB while taking aspirin had fewer adverse outcomes compared with those taking anticoagulants. Aspirin may have beneficial effects in this population.