83 research outputs found
Imaging of intestinal fibrosis: current challenges and future methods
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166213/1/ueg2bf00613.pd
Letter: immune checkpoint inhibitorâinduced colitisâshouldnât we be checking more often? Authorsâ reply
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151368/1/apt15448_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151368/2/apt15448.pd
Increasing ultraviolet light exposure is associated with reduced mortality from Clostridium difficile infection
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166256/1/ueg2bf00112.pd
Nuances of the psychogastroenterology patient: A predictive model for gastrointestinal quality of life improvement
BackgroundGastrointestinal conditions are multifactorial in nature, and certain patients can benefit greatly from brainâgut psychotherapies delivered by mental health professionals who specialize in psychogastroenterology. This study aimed to identify features associated with improvements in GIâspecific quality of life scores following behavioral health interventions (BHI). The second aim was to create a psychogastroenterology referral care pathway incorporating identified characteristics for greatest benefit from GIâspecific behavioral therapy.MethodsWe performed a prospective observational study of 101 (63 women; median age, 45Â years) gastroenterology patients referred for psychogastroenterology consultation at a single center. Patients attended an average of seven sessions with a single GI psychologist where evidenceâbased brainâgut psychotherapies were employed. GIâspecific quality of life (IBSâQOL) and psychological distress (BSIâ18) were assessed before and after BHI. Patients completed selfâreported questionnaires. We performed a multivariable analysis to determine predictors associated with IBSâQOL score improvement.Key ResultsA total of 53 (52.5%) patients experienced improvement in IBSâQOL score. Patients with improved IBSâQOL scores had significantly higher baseline BSI general domain Tâscores (61.9 vs. 56.9, PÂ =Â 0.002). Female gender (odds ratio [OR], 3.2), pretreatment BSI somatization Tâscore â„63 (OR, 3.7), and a diagnosis of depression (OR, 4.2) were associated with greater odds of IBSâQOL score improvement following BHI.Conclusions and InferencesWe identified factors associated with response to GIâspecific BHI to aid in optimizing the utilization of psychogastroenterology services and provide referring providers with information to inform treatment recommendations. Female patients with disorders of gutâbrain interaction (DGBIs), high somatization, and depression should be considered a priority for brainâgut psychotherapies.Gastrointestinal conditions are multifactorial in nature, and certain patients can benefit greatly from brainâgut psychotherapies delivered by mental health professionals who specialize in psychogastroenterology. Females with disorders of gutâbrain interaction, high somatization, and depression should be considered priority for brainâgut psychotherapies. Behavioral health outcomes were not limited to disease; patients with IBD should be routinely considered for referral. Optimizing utilization of GIâspecific behavioral health specialists for the best outcomes can maximize quality of life and disease experience, but also improve valueâbased care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151345/1/nmo13663.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151345/2/nmo13663_am.pd
Cold snare piecemeal resection of colonic and duodenal polyps â„1âcm
BACKGROUND: Endoscopic removal of duodenal and colorectal adenomas is currently considered to be the standard of care for prevention of adenocarcinoma. The use of cautery carries a risk of delayed bleeding, post-polypectomy syndrome, and perforation. We examined the safety and feasibility of removing colonic and duodenal polyps â„â1âcm using a piecemeal cold snare polypectomy technique.
PATIENTS: The study included 15 patients with duodenal polyps â„â1âcm and 15 patients with colonic polyps â„â1âcm.
MAIN OUTCOME MEASUREMENTS: Bleeding, perforation, abdominal pain, or hospitalization occurring within 2 weeks of polypectomy.
RESULTS: Between 24 August 2011 and 29 April 2013, 15 patients had removal of duodenal polyps â„â1âcm. Mean patient age was 64 years and 9/15 patients were male. The mean polyp size was 24âmm (10â-â60âmm). All polyps were removed with a cold snare and some required cold biopsy forceps. One patient required hospitalization for gastrointestinal blood loss 7 days post-polypectomy; this patient was using Coumadin. Between 27 February 2012 and 30 May 2013, 15 patients underwent resection of a â„â1âcm colonic polyp.âMean patient age was 68 years and 9/15 were male. The mean polyp size was 20âmm (10â-â45âmm). All polyps were primarily removed with a cold snare. None of the patients required hemostatic clips for control of immediate bleeding. One patient presented to the emergency department with abdominal pain 1 day after initial endoscopy. CT scan showed no abnormalities and the patient was discharged.
CONCLUSIONS: Cold snare polypectomy for large duodenal and colonic polyps is technically feasible and may have a favorable safety profile compared to standard electrocautery-based endoscopic resection. Comparative trials are required to determine the relative safety and efficacy of cold snare techniques for complete and durable resection of large polyps compared to standard hot snare methods
Cold snare polypectomy for non-pedunculated colon polyps greater than 1âcm
Background and study aimsâColonic polypsâ>â1âcm in size are commonly managed using hot polypectomy techniques. The most frequent adverse events (delayed bleeding, post-polypectomy syndrome, and perforation) are related to electrocautery-induced injury. We hypothesized that cold resection of large polyps may have similar efficacy and improved safety compared to hot polypectomy. Our aims were to evaluate efficacy and safety of piecemeal cold snare resection of colonic polypsâ>â1âcm. Patients and methodsâPatients undergoing lift and piecemeal cold snare polypectomy of non-pedunculated colon polyps >â1âcm from October 2013 to September 2015 were identified retrospectively. Efficacy was defined by the absence of residual adenomatous tissue at endoscopic follow-up.âAdverse events (AEs), including post-procedural bleeding, bowel perforation, or post-procedural pain requiring hospitalization were assessed by chart review and telephone follow-up.â ResultsâSeventy-three patients underwent piecemeal cold snare polypectomy for 94 colon polypsâ>â1âcm with 56 of 73 patients completing follow-up on 72 polyps. Residual or recurrent adenoma was found in 7 cases (9.7â%). Median polyp size was significantly greater in those with residual/recurrent adenoma (37.1 vs. 19.1âmm, Pâ<â.0001). There were no AEs among all 73 patients enrolled. ConclusionsâPiecemeal cold snare resection of colon polyps >â1âcm is feasible, safe and efficacious when compared to published hot polypectomy data. Additional observational and randomized comparative effectiveness studies are necessary to demonstrate comparable adenoma eradication and improved safety advantage over existing hot snare polypectomy techniques
Comparison of noncontrast MRI magnetization transfer and T2âWeighted signal intensity ratios for detection of bowel wall fibrosis in a Crohn's disease animal model
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113105/1/jmri24815.pd
Ultrasound Shear Wave Elastography Helps Discriminate Lowâgrade From Highâgrade Bowel Wall Fibrosis in Ex Vivo Human Intestinal Specimens
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135467/1/jum201433122115.pd
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