Fecal Incontinence: Prevalence, Severity, and Quality of Life Data from an Outpatient Gastroenterology Practice

Background. The prevalence of fecal incontinence varies tremendously as a result of inadequate data collection methods. Few office-based studies have assessed the prevalence of fecal incontinence and none have looked at modifiable risk factors or effect on quality of life. Design, Settings, Patients, and Main Outcome Measures. Five hundred patients who visited our inner city, university-based gastroenterology practice, were asked about symptoms of fecal incontinence. We also retrospectively reviewed 500 charts to identify the frequency of patient-physician reporting of fecal incontinence. Results. Of the 500 patients that were directly questioned, 58 (12%, 43 women, 15 men) admitted to fecal incontinence compared to 12 (2.4%) in the retrospective arm. Patients with fecal incontinence and loose/watery stool reported the lowest quality of life scores. While the average severity score was similar between men and women, women had a significantly lower average quality of life score (3.04 versus 2.51; P < 0.03). Conclusions. The identification of fecal incontinence increases when patients are directly questioned. Identifying and treating patients with loose stool is a potential strategy to improve quality of life in this patient population. In men and women with similar severity of fecal incontinence, women have a significantly lower quality of life

Association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study

BACKGROUND: Although recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients. METHODS: We performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI \u3c 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission. RESULTS: A total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P \u3c 0.001), more likely to be female (P \u3c 0.001) and African American (P \u3c 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07-1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04-1.80; P = 0.026). CONCLUSIONS: Obesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients

Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience

Background and study aims: Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods  This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results: A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5-13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3-17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions: G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx

Fecal Incontinence: Prevalence, Severity, and Quality of Life Data from an Outpatient Gastroenterology Practice

Background. The prevalence of fecal incontinence varies tremendously as a result of inadequate data collection methods. Few officebased studies have assessed the prevalence of fecal incontinence and none have looked at modifiable risk factors or effect on quality of life. Design, Settings, Patients, and Main Outcome Measures. Five hundred patients who visited our inner city, university-based gastroenterology practice, were asked about symptoms of fecal incontinence. We also retrospectively reviewed 500 charts to identify the frequency of patient-physician reporting of fecal incontinence. Results. Of the 500 patients that were directly questioned, 58 (12%, 43 women, 15 men) admitted to fecal incontinence compared to 12 (2.4%) in the retrospective arm. Patients with fecal incontinence and loose/watery stool reported the lowest quality of life scores. While the average severity score was similar between men and women, women had a significantly lower average quality of life score (3.04 versus 2.51; P &lt; 0.03). Conclusions. The identification of fecal incontinence increases when patients are directly questioned. Identifying and treating patients with loose stool is a potential strategy to improve quality of life in this patient population. In men and women with similar severity of fecal incontinence, women have a significantly lower quality of life

When Does the Timing of an Urgent Endoscopy for Foreign Body Extraction Matter?

Most cases of foreign body ingestion are managed by observation without the need for endoscopic intervention as these objects are expected to pass spontaneously. However, urgent endoscopy is indicated depending on the type and size of the ingested material to avoid the risk of perforation. We present a case of repeated foreign body ingestion in a patient with a developmental disability and illustrate the importance of patient selection for urgent endoscopy

Autoimmune Autonomic Ganglionopathy Presenting as Constipation

Autoimmune autonomic ganglionopathy (AAG) is a rare post-ganglionic disorder that causes a range of symptoms, often including gastrointestinal disorders. Patients may be seropositive or seronegative for antibodies against the nicotinic acetylcholine receptor. Here, we describe the case of a 56-year-old woman with a previous diagnosis of sensorimotor peripheral neuropathy who presented with severe constipation that was not responsive to laxative therapy. The evaluation showed diffuse colonic hypomotility, rectal hypersensitivity, and type IV pelvic floor dysfunction. The patient was diagnosed 10 months after the presentation as having seronegative AAG, and she responded well to treatment with intravenous methylprednisolone and apheresis

Attitudes of Gastroenterologists Regarding Delivery of Cancer Diagnoses: a Cross-Sectional Study

GOALS: To determine the attitudes and practices of gastroenterologists regarding the delivery of cancer diagnoses. BACKGROUND: Gastroenterologists frequently diagnose colorectal cancer. Receiving the news of a cancer diagnosis is difficult, and the delivery of the diagnosis can influence a patient\u27s understanding of their disease. No study to date has reported how gastroenterologists deliver cancer diagnoses to their patients. STUDY: An anonymous questionnaire was sent online to gastroenterologists of the American College of Gastroenterology to assess views regarding the delivery of cancer diagnoses. RESULTS: Of the 280 complete responses (response rate = 1.64%), most respondents were male (n = 205, 73.21%), in practice between 0 and 9 years (n = 133, 47.50%), and at the attending/faculty level (n = 69.53%, 194). Most responded that they would disclose a cancer diagnosis to the patient themselves if they had made the discovery on endoscopy/colonoscopy (n = 255, 94.80%), with the preferred methods being an in person discussion (n = 187, 71.65%). Most respondents were not familiar with any guidelines for delivering cancer diagnoses (n = 202, 75.94%) and would be open to receiving training on cancer diagnosis delivery (n = 207, 78.11%). CONCLUSIONS: Most gastroenterologists take personal responsibility in the delivery of cancer diagnoses. Many gastroenterologists receive no specific training on how to deliver this news and are unaware of any guidelines to follow that may be helpful in their practice. However, most displayed a willingness to learn these guidelines through some form of formal education. Future directions should consider the incorporation of education in cancer diagnosis delivery for gastroenterologists and gastroenterology fellows

Role of Functional Luminal Imaging Probe (FLIP) in the Management of post Myotomy Clinical Failure

INTRODUCTION: Small percentage of patients with esophageal dysmotility disorders (EDD) fail to improve or relapse following management by laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM). In this study, we aimed to describe the role of functional luminal imaging probe (FLIP) in identifying the patients who might benefit from LES-directed re-treatment. METHODS: This was a retrospective study at 6 tertiary care centers (4 USA, 1 Europe, 1 Asia) between 01/2015 and 04/2021 involving patients with prior failed myotomy. The primary outcome was the impact of FLIP utilization on the management of patients with prior failed myotomy. RESULTS: A total of 123 patients [F 62 (50%), mean age 53±21.1 years] who underwent LHM (n=53, 43%) or POEM (n=70, 57%) for the management of achalasia, (n=98) or other EDD (n=25) had clinical failure at a median time of 10.8 (IQR: 0.8-17.3) months post-procedure. A total of 29 patients had apposing abnormal diagnoses in terms of integrated relaxation pressure (IRP) \u3e 15mmHg on HRM and distensibility index (DI) \u3c 2.8 mm(2)/mmHg on FLIP, with ultimate change in management noted in 15 patients (10 directed towards conservative management, 5 directed towards LES directed re-treatment). The impact of FLIP on both the diagnosis and management was noted in 15/29 (52%) patients. In the subgroup analysis of patients who underwent LES-directed re-treatment (n=44), clinical success was highest among patients with both abnormal IRP and DI, 21/25 (84%) vs. patients with only abnormal IRP, 8/14 (57%), or only abnormal DI, 3/5 (60%), (p=0.04), with DI at 40 ml distension volume on FLIP identified as an independent predictor of clinical success, (OR 1.51; 95% CI 1.02-2.1, p=0.03). CONCLUSION: The finding of this study further suggests the important role of using FLIP in addition to HRM in evaluating patients with clinical failure post myotomy