Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
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Clin. Gastroenterol. Hepatol. · Oct 2014
Effects of Clostridium difficile infection in patients with alcoholic hepatitis.
Infection increases mortality in patients with alcoholic hepatitis (AH). Little is known about the association between Clostridium difficile infection (CDI) and AH. We examined the prevalence and effects of CDI in patients with AH, compared with those of other infections. ⋯ In patients with AH, CDI is associated with greater mortality and health care use. These effects appear similar to those for UTI and SBP. We propose further studies to determine the cost effectiveness of screening for CDI among patients with AH.
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Abuse of ketamine leads to liver injury. We investigated the histopathologic and radiologic features of ketamine abusers with significant liver injury in a cross-sectional survey of 297 consecutive chronic abusers of ketamine with urinary tract dysfunction. Liver biopsy and magnetic resonance cholangiopancreatography were performed in patients with liver injury (concentrations of bilirubin, alkaline phosphatase, and/or alanine aminotransferase >2-fold the upper limit of normal). ⋯ Two patients had bridging fibrosis despite their young age. Three of 6 patients who underwent magnetic resonance cholangiopancreatography examination were found to have prominent or dilated common bile ducts without obstructions or extrinsic compressions. Ketamine abuse therefore appears to lead to common bile duct dilatation, microscopic bile duct injury, and even significant liver fibrosis.
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Clin. Gastroenterol. Hepatol. · Sep 2014
Randomized Controlled Trial Multicenter StudyA phase 2 study of tofacitinib, an oral Janus kinase inhibitor, in patients with Crohn's disease.
Tofacitinib, an orally administered Janus kinase inhibitor, blocks signaling through γ-chain-containing cytokines (interleukins 2, 4, 7, 9, 15, and 21). We performed a phase 2 trial to measure its efficacy in patients with moderate-to-severe active Crohn's disease. ⋯ There were no significant differences in the percentage of patients with moderate-to-severe active Crohn's disease who achieved clinical responses (Response-70) or clinical remission after 4 weeks' administration of tofacitinib (1, 5, or 15 mg) or placebo twice daily. However, a large percentage of patients given placebo achieved Response-70 or remission. Reductions in C-reactive protein and fecal calprotectin levels among patients given the 15-mg dose of tofacitinib indicate its biologic activity. ClinicalTrials.gov number: NCT00615199.
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Clin. Gastroenterol. Hepatol. · Jul 2014
Clinical decision support with natural language processing facilitates determination of colonoscopy surveillance intervals.
With an increased emphasis on improving quality and decreasing costs, new tools are needed to improve adherence to evidence-based practices and guidelines in endoscopy. We investigated the ability of an automated system that uses natural language processing (NLP) and clinical decision support (CDS) to facilitate determination of colonoscopy surveillance intervals. ⋯ A fully automated system that uses NLP and a guideline-based CSD system can accurately facilitate guideline-recommended adherence surveillance for colonoscopy.
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Clin. Gastroenterol. Hepatol. · Jun 2014
Randomized Controlled TrialEffect of ramosetron on stool consistency in male patients with irritable bowel syndrome with diarrhea.
Ramosetron, a serotonin (5-hydroxytryptamine)-3 receptor antagonist with high selectivity, reduced stress-induced diarrhea and defecation caused by corticotropin-releasing hormone in rats. However, there have been no clinical trials of its effect in patients with diarrhea and irritable bowel syndrome (IBS-D). We performed a randomized, double-blind, placebo-controlled trial to determine whether ramosetron reduces diarrhea in these patients. ⋯ Ramosetron (5 μg oral, once daily for 12 weeks) improved stool consistency in male patients with IBS-D, compared with placebo. These study results, along with the pharmacologic profile of ramosetron, indicate that increased stool consistency is the best end point for studies of ramosetron in patients with IBS-D. Clinicaltrials.gov No, NCT01225237.