Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
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Clin. Gastroenterol. Hepatol. · Jul 2009
Characteristics of patients with cirrhosis who are discharged from the hospital against medical advice.
Patients discharged from hospital against medical advice are at risk of adverse health outcomes. The frequency and predictors of self-discharge in cirrhotic patients have not been examined. ⋯ Approximately 1 in 36 hospitalized cirrhotic patients leave hospital against medical advice. Self-discharge is most common among patients with alcoholic cirrhosis, lower socioeconomic status, psychiatric disorders, substance abuse, and less severe liver disease. These findings might assist in the prevention of self-discharge and, ultimately, improve health outcomes in patients with cirrhosis.
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Clin. Gastroenterol. Hepatol. · Jul 2009
Liver transplantation in patients with nonalcoholic steatohepatitis-related hepatocellular carcinoma.
The increasing incidence of hepatocellular carcinoma in the United States is only partially accounted for by hepatitis C virus (HCV) infections. The prevalence of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis (NASH) is not known; guidelines from the American Association for the Study of Liver Diseases do not recommend surveillance imaging. We sought to determine the prevalence of hepatocellular carcinoma among patients undergoing liver transplantation for NASH-related cirrhosis and their outcome after surgery, compared with controls. ⋯ Patients with NASH cirrhosis are at risk for developing hepatocellular carcinoma; patients with NASH cirrhosis, especially men older than 50 years, should undergo surveillance imaging. Patients with NASH and hepatocellular carcinoma have good outcomes after liver transplantation.
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Clin. Gastroenterol. Hepatol. · May 2009
Comparative StudyInvestigation of colonic and whole-gut transit with wireless motility capsule and radiopaque markers in constipation.
Colonic transit time (CTT) traditionally is assessed with radiopaque markers (ROMs), which requires radiation and is hindered by lack of standardization and compliance. We assessed regional and CTT with the SmartPill (SmartPill Corporation, Buffalo, NY), a new wireless pH and pressure recording capsule, in constipated and healthy subjects and compared this with ROM. ⋯ The SmartPill is a novel ambulatory technique of assessing regional (gastric, small bowel, colonic) and WGTT without radiation. It reveals hitherto unrecognized gender differences and upper-gut dysfunction in constipation. It correlates well with ROM and offers a standardized method of discriminating normal from slow colonic transit.