The American journal of gastroenterology
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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.
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Am. J. Gastroenterol. · Jul 2019
Editorial CommentFecal Microbiota Transplant for Irritable Bowel Syndrome: Panacea or Placebo?
Irritable bowel syndrome (IBS) is a common disorder of heterogeneous pathogenesis, and alterations in the gut microbiome/dysbiosis play a role in the development of symptoms in a subset of individuals with IBS. Consequently, it stands to reason that modulation of the microbiome via fecal microbial transplant (FMT) may serve as an effective treatment strategy because this has proven effective for treating other illnesses such as Clostridium difficile colitis. Small studies completed to date have offered conflicting results and the strains used, route of administration, and IBS subtypes may all play a role in treatment outcomes. A better understanding of the altered microbiome of patients with IBS and more rigorous trials are warranted before the utility of fecal microbial transplant for IBS symptoms can be determined.
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Am. J. Gastroenterol. · Jul 2016
Editorial CommentEditorial: Magnetic Resonance Elastography and Non-Alcoholic Fatty Liver Disease: Time for an Upgrade?
Elastography techniques, such as two-dimensional magnetic resonance elastography (2D-MRE) are increasingly used for the non-invasive assessment of liver fibrosis in patients with nonalchoholic fatty liver disease (NAFLD). Loomba et al. demonstrate that 3D-MRE (shear wave frequency 40 Hz) had even greater diagnostic accuracy than the commercially available 2D-MRE (shear wave frequency 60 Hz) in diagnosing advanced fibrosis (area under the receiver operator curve, AUROC 0.981 vs. 0.921, P<0. 05) using liver biopsy as reference standard. Despite limitations, MRE serves as an important tool in risk stratification for patients with NAFLD.
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Am. J. Gastroenterol. · Dec 2012
Editorial CommentDoes the use of sedation, or the level of sedation, affect detection during colonoscopy?
There is limited and mixed evidence regarding whether the use of sedation affects detection during colonoscopy. There is no convincing evidence that the level of sedation (deep vs. moderate) affects detection.
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Am. J. Gastroenterol. · Feb 2011
Editorial CommentEditorial: consensus guidelines: method or madness?
Consensus development methodologies are used to develop evidence-based guidelines and include the Delphi process, the nominal group technique, and the National Institutes of Health (NIH) consensus process. Attention to methodology improves the outcomes of the consensus process and better guidelines.