The American journal of gastroenterology
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Am. J. Gastroenterol. · Nov 2019
Is Dyssynergic Defecation an Unrecognized Cause of Chronic Constipation in Patients Using Opioids?
The impact of opioids on anorectal function is poorly understood but potentially relevant to the pathogenesis of opioid-induced constipation (OIC). To evaluate anorectal function testing (AFT) characteristics, symptom burden, and quality of life in chronically constipated patients prescribed an opioid (OIC) in comparison with constipated patients who are not on an opioid (NOIC). ⋯ Chronically constipated patients who use opioids are more likely to have DD and more severe constipation symptoms than NOIC.
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Am. J. Gastroenterol. · Oct 2019
Rethinking the Re-Prep: Attitudes Toward Noninvasive Colorectal Cancer Screening Tests After Inadequate Bowel Preparation.
To assess patient preferences for colorectal cancer screening with stool-based tests after initial colonoscopy with suboptimal bowel preparation. ⋯ Clinicians should consider offering stool-based screening tests as an alternative to repeat colonoscopy after suboptimal bowel preparation.
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Am. J. Gastroenterol. · Sep 2019
Incremental Cost-Effectiveness of Aspiration Therapy vs Bariatric Surgery and No Treatment for Morbid Obesity.
Despite its recent approval by the US Food and Drug Administration and Health Canada, aspiration therapy-one of the latest weight loss treatments-remains controversial. Critics have expressed concerns that the therapy could lead to bulimia and other binge eating disorders. Meanwhile, proponents argue that the therapy is less invasive, reversible, and cheaper than bariatric surgery. Cost-effectiveness of this therapy, however, is not yet established. ⋯ Given its high lifetime costs and its modest weight loss effects, aspiration therapy is not cost-effective relative to bariatric surgery. However, it is a cost-effective treatment option for patients who lack access to bariatric surgery.
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Am. J. Gastroenterol. · Sep 2019
Randomized Controlled Trial Multicenter StudyEfficacy and Safety of Eluxadoline in Patients With Irritable Bowel Syndrome With Diarrhea Who Report Inadequate Symptom Control With Loperamide: RELIEF Phase 4 Study.
Irritable bowel syndrome with diarrhea (IBS-D) is a functional gastrointestinal disorder with limited effective treatment options. We evaluated the efficacy and safety of eluxadoline in patients with IBS-D who reported inadequate symptom control with prior loperamide. ⋯ Eluxadoline appears safe and effective for treating IBS-D symptoms in patients with an intact gallbladder reporting inadequate relief with prior loperamide use.
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Am. J. Gastroenterol. · Sep 2019
Editorial CommentReadmissions for Cirrhosis Within the Healthcare Readmissions Reduction Program: A Hidden Challenge.
With the passage of the Affordable Care Act, the Healthcare Readmissions Reduction Program (HRRP) was implemented, leading to significant reductions in readmissions for congestive heart failure, pneumonia, and myocardial infarction. Patients with cirrhosis have a complex and difficult to manage underlying disease process and are often left out of large policy decisions such as the HRRP although they represent a population at high risk for readmission and other negative outcomes. In this editorial, hospital readmissions in patients with cirrhosis are discussed in the context of the HRRP and evolving models of care.