BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is currently considered as the most common cause of chronic liver disease worldwide.Risk factors for NAFLD have been well-described,including obesity,type 2 diabetes ...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is currently considered as the most common cause of chronic liver disease worldwide.Risk factors for NAFLD have been well-described,including obesity,type 2 diabetes mellites(T2DM),dyslipidemia(DLP)and metabolic syndrome.Hypothyroidism has been identified as an independent risk factor for the development of NAFLD,although the literature is inconsistent AIM To evaluate the prevalence of hypothyroidism in patients with NAFLD,assess if it is an independent risk factor and explore the effect of thyroxine replacement therapy.METHODS Our cohort’s data was obtained using a validated,large,multicenter database(Explorys Inc,Cleveland,OH,United States)aggregated from pooled outpatient and inpatient records of 26 different healthcare systems,consisting of a total of 360 hospitals in the United States,and utilizing Systematized Nomenclature of Medicine-Clinical Terms for coding.We evaluated a cohort of patients with hypothyroidism and NAFLD.Multivariate analysis was performed to adjust for confounding risk factors including hypertension(HTN),T2DM,DLP,obesity and metabolic syndrome.SPSS version 25,IBM Corp was used for statistical analysis,and for all analyses,a 2-sided P value of<0.05 was considered statistically significant.Exclusion criteria were limited to age<18 years.RESULTS Among the 37648180 included individuals in this database who are above the age of 18 years,there were a total of 2320 patients with NAFLD(6.16 per 100000)in the last five years(2015-2020),amongst which 520 patients(22.4%)had hypothyroidism.Baseline characteristics of patients in this database are described in Table 1.Patients with NAFLD were also more likely to have obesity,T2DM,DLP,HTN,and metabolic syndrome(Table 2).While males and females were equally affected,patients in the age group 18-65 years as well as Caucasians seem to be at a higher risk.There was an increased risk of NAFLD among patients with hypothyroidism(OR=1.587).Furthermore,thyroid hormone replacement was not associated with a decreased risk for developing NAFLD(OR=1.106,C=0.952-1.285,P=0.303).CONCLUSION Hypothyroidism seems to be an independent risk factor for the development of NAFLD.Thyroid hormone replacement did not provide a statistically significant risk reduction.Further studies are needed to evaluate the effect of thyroid hormone replacement and assess if being euthyroid while on thyroid replacement therapy affects development and/or progression of NAFLD.展开更多
BACKGROUND Clostridioides(formerly Clostridium)difficile infection(CDI)is an increasingly frequent cause of morbidity and mortality in hospitalized patients.Multiple risk factors are documented in the literature that ...BACKGROUND Clostridioides(formerly Clostridium)difficile infection(CDI)is an increasingly frequent cause of morbidity and mortality in hospitalized patients.Multiple risk factors are documented in the literature that includes,but are not limited to,antibiotics use,advanced age,and gastric acid suppression.Several epidemiological studies have reported an increased incidence of CDI in advanced liver disease patients.Some have also demonstrated a higher prevalence of nosocomial infections in cirrhotic patients.AIM To use a large nationwide database,we sought to determine CDI’s risk among liver cirrhosis patients in the United States.METHODS We queried a commercial database(Explorys Inc^(TM),Cleveland,OH,United States),and obtained an aggregate of electronic health record data from 26 major integrated United States healthcare systems comprising 360 hospitals in the United States from 2018 to 2021.Diagnoses were organized into the Systematized Nomenclature of Medicine Clinical Terms(SNOMED–CT)hierarchy.Statistical analysis for the multivariable model was performed using Statistical Package for Social Sciences(SPSS version 25,IBM CorpTM).For all analyses,a two-sided P value of<0.05 was considered statistically significant.RESULTS There were a total of 19387760 patients in the database who were above 20 years of age between the years 2018-2021.Of those,133400 were diagnosed with liver cirrhosis.The prevalence of CDI amongst the liver cirrhosis population was 134.93 per 100.000 vs 19.06 per 100.000 in non-cirrhotic patients(P<0.0001).The multivariate analysis model uncovered that cirrhotic patients were more likely to develop CDI(OR:1.857;95%CI:1.665-2.113,P<0.0001)compared to those without any prior history of liver cirrhosis.CONCLUSION In this large database study,we uncovered that cirrhotic patients have a significantly higher CDI prevalence than those without cirrhosis.Liver cirrhosis may be an independent risk factor for CDI.Further prospective studies are needed to clarify this possible risk association that may lead to the implementation of screening methods in this high-risk population.展开更多
BACKGROUND Sickle cell hepatopathy(SCH)is an inclusive term referring to any liver dysfunction among patients with sickle cell disease.Acute sickle cell intrahepatic cholestasis is one of the rarest and most fatal pre...BACKGROUND Sickle cell hepatopathy(SCH)is an inclusive term referring to any liver dysfunction among patients with sickle cell disease.Acute sickle cell intrahepatic cholestasis is one of the rarest and most fatal presentations of SCH.We present the 23rd reported case of liver transplantation(LT)for SCH;a rare case of acute sickle cell intrahepatic cholestasis managed with LT from a hepatitis C virus(HCV)nucleic acid amplification test positive donor.CASE SUMMARY A 29-year-old male with a past medical history of sickle cell disease presented with vaso-occlusive pain crisis.On examination,he had jaundice and a soft,nontender abdomen.Initially he was alert and fully oriented;within 24 h he developed new-onset confusion.Laboratory evaluation was notable for hyperbilirubinemia,leukocytosis,anemia,thrombocytopenia,acute kidney injury and elevated international normalized ratio(INR).Imaging by ultrasound and computed tomography scan suggested a cirrhotic liver morphology with no evidence of biliary ductal dilatation.The patient was diagnosed with acute sickle cell intrahepatic cholestasis after excluding competing etiologies of acute liver injury.He underwent LT from an HCV nucleic acid amplification test positive donor 9 d after initial presentation.The liver explant was notable for widespread sinusoidal dilatation with innumerable clusters of sickled red blood cells and cholestasis.On postoperative day 3,HCV RNA was detectable in the patient's peripheral blood and anti-HCV therapy with glecaprevir/pibrentasvir was initiated on postoperative day 23.He subsequently achieved sustained virologic response after completing 3 mo of therapy and has been followed clinically for 12 mo post-transplant.CONCLUSION This case highlights the utility of LT as a viable treatment option for acute sickle cell intrahepatic cholestasis.展开更多
BACKGROUND Takotsubo cardiomyopathy(TCM),or stress-induced cardiomyopathy,is associated with adverse prognosis.Limited data suggest that TCM occurring in orthotopic liver transplant(OLT)recipients is associated with e...BACKGROUND Takotsubo cardiomyopathy(TCM),or stress-induced cardiomyopathy,is associated with adverse prognosis.Limited data suggest that TCM occurring in orthotopic liver transplant(OLT)recipients is associated with elevated perioperative risk.AIM To characterize the predictors of TCM in OLT recipients,using a large,multicenter pooled electronic health database.METHODS A multi-institutional database(Explorys Inc,Cleveland,OH,USA),an aggregate of de-identified electronic health record data from 26 United States healthcare systems was surveyed.A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of“liver transplant”between 09/2015 and 09/2020 was identified.Subsequently,individuals who developed a new diagnosis of TCM following OLT were identified.Furthermore,the risk associations with TCM among this patient population were characterized using linear regression.RESULTS Between 09/2015 and 09/2020,of 37718540 patients in the database,38740(0.10%)had a history of OLT(60.6%had an age between 18-65 years,58.1%female).A new diagnosis of TCM was identified in 0.3%of OLT recipients(45.5%had an age between 18-65 years,72.7%female),compared to 0.04%in non-OLT patients[odds ratio(OR):7.98,95%confidence intervals:6.62-9.63,(P<0.0001)].OLT recipients who developed TCM,compared to those who did not,were more likely to be greater than 65 years of age,Caucasian,and female(P<0.05).There was also a significant association with cardiac arrhythmias,especially ventricular arrhythmias(P<0.0001).CONCLUSION TCM was significantly more likely to occur in LT recipients vs non-recipients.Older age,Caucasian ethnicity,female gender,and presence of arrhythmias were significantly associated with TCM in LT recipients.展开更多
Driven by the tremendous availability of data,artificial intelligence(AI)using deep learning has emerged as a breakthrough computer technology in the last few decades and has recently been acknowledged by the Task For...Driven by the tremendous availability of data,artificial intelligence(AI)using deep learning has emerged as a breakthrough computer technology in the last few decades and has recently been acknowledged by the Task Force on AI as a golden opportunity for research.With its ability to understand,learn from and build on non-linear relationships,AI aims to individualize medical care in an attempt to save time,cost,effort and improve patient’s safety.AI has been applied in multiple medical fields with substantial progress made in gastroenterology mainly to facilitate accurate detection of pathology in different disease processes,among which inflammatory bowel disease(IBD)seems to drag significant attention,specifically by interpreting imaging studies,endoscopic images and videos and-to a lesser extent-disease genomics.Moreover,models have been built to predict IBD occurrence,flare ups,persistence of histological inflammation,disease-related structural abnormalities as well as disease remission.In this article,we will review the applications of AI in IBD in the present medical literature at multiple points of IBD timeline,starting from disease prediction via genomic assessment,diagnostic phase via interpretation of radiological studies and AI-assisted endoscopy,and the role of AI in the evaluation of therapy response and prognosis of IBD patients.展开更多
Systemic sclerosis(SSc)is a multisystem connective-tissue disorder of unknown etiology affecting various internal organs and skin.Esophageal involvement is present in≤70%–90%of the patients and is manifested by seve...Systemic sclerosis(SSc)is a multisystem connective-tissue disorder of unknown etiology affecting various internal organs and skin.Esophageal involvement is present in≤70%–90%of the patients and is manifested by severe gastroesophageal-reflux disease and dysmotility.Although Barrett’s esophagus(BE)has been reported in patients with SSc[1,2],the risk of neoplastic progression has not been reported before in the USA.Therefore,we aimed to study the prevalence of BE in SSc and incidence of neoplastic progression.展开更多
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is currently considered as the most common cause of chronic liver disease worldwide.Risk factors for NAFLD have been well-described,including obesity,type 2 diabetes mellites(T2DM),dyslipidemia(DLP)and metabolic syndrome.Hypothyroidism has been identified as an independent risk factor for the development of NAFLD,although the literature is inconsistent AIM To evaluate the prevalence of hypothyroidism in patients with NAFLD,assess if it is an independent risk factor and explore the effect of thyroxine replacement therapy.METHODS Our cohort’s data was obtained using a validated,large,multicenter database(Explorys Inc,Cleveland,OH,United States)aggregated from pooled outpatient and inpatient records of 26 different healthcare systems,consisting of a total of 360 hospitals in the United States,and utilizing Systematized Nomenclature of Medicine-Clinical Terms for coding.We evaluated a cohort of patients with hypothyroidism and NAFLD.Multivariate analysis was performed to adjust for confounding risk factors including hypertension(HTN),T2DM,DLP,obesity and metabolic syndrome.SPSS version 25,IBM Corp was used for statistical analysis,and for all analyses,a 2-sided P value of<0.05 was considered statistically significant.Exclusion criteria were limited to age<18 years.RESULTS Among the 37648180 included individuals in this database who are above the age of 18 years,there were a total of 2320 patients with NAFLD(6.16 per 100000)in the last five years(2015-2020),amongst which 520 patients(22.4%)had hypothyroidism.Baseline characteristics of patients in this database are described in Table 1.Patients with NAFLD were also more likely to have obesity,T2DM,DLP,HTN,and metabolic syndrome(Table 2).While males and females were equally affected,patients in the age group 18-65 years as well as Caucasians seem to be at a higher risk.There was an increased risk of NAFLD among patients with hypothyroidism(OR=1.587).Furthermore,thyroid hormone replacement was not associated with a decreased risk for developing NAFLD(OR=1.106,C=0.952-1.285,P=0.303).CONCLUSION Hypothyroidism seems to be an independent risk factor for the development of NAFLD.Thyroid hormone replacement did not provide a statistically significant risk reduction.Further studies are needed to evaluate the effect of thyroid hormone replacement and assess if being euthyroid while on thyroid replacement therapy affects development and/or progression of NAFLD.
文摘BACKGROUND Clostridioides(formerly Clostridium)difficile infection(CDI)is an increasingly frequent cause of morbidity and mortality in hospitalized patients.Multiple risk factors are documented in the literature that includes,but are not limited to,antibiotics use,advanced age,and gastric acid suppression.Several epidemiological studies have reported an increased incidence of CDI in advanced liver disease patients.Some have also demonstrated a higher prevalence of nosocomial infections in cirrhotic patients.AIM To use a large nationwide database,we sought to determine CDI’s risk among liver cirrhosis patients in the United States.METHODS We queried a commercial database(Explorys Inc^(TM),Cleveland,OH,United States),and obtained an aggregate of electronic health record data from 26 major integrated United States healthcare systems comprising 360 hospitals in the United States from 2018 to 2021.Diagnoses were organized into the Systematized Nomenclature of Medicine Clinical Terms(SNOMED–CT)hierarchy.Statistical analysis for the multivariable model was performed using Statistical Package for Social Sciences(SPSS version 25,IBM CorpTM).For all analyses,a two-sided P value of<0.05 was considered statistically significant.RESULTS There were a total of 19387760 patients in the database who were above 20 years of age between the years 2018-2021.Of those,133400 were diagnosed with liver cirrhosis.The prevalence of CDI amongst the liver cirrhosis population was 134.93 per 100.000 vs 19.06 per 100.000 in non-cirrhotic patients(P<0.0001).The multivariate analysis model uncovered that cirrhotic patients were more likely to develop CDI(OR:1.857;95%CI:1.665-2.113,P<0.0001)compared to those without any prior history of liver cirrhosis.CONCLUSION In this large database study,we uncovered that cirrhotic patients have a significantly higher CDI prevalence than those without cirrhosis.Liver cirrhosis may be an independent risk factor for CDI.Further prospective studies are needed to clarify this possible risk association that may lead to the implementation of screening methods in this high-risk population.
文摘BACKGROUND Sickle cell hepatopathy(SCH)is an inclusive term referring to any liver dysfunction among patients with sickle cell disease.Acute sickle cell intrahepatic cholestasis is one of the rarest and most fatal presentations of SCH.We present the 23rd reported case of liver transplantation(LT)for SCH;a rare case of acute sickle cell intrahepatic cholestasis managed with LT from a hepatitis C virus(HCV)nucleic acid amplification test positive donor.CASE SUMMARY A 29-year-old male with a past medical history of sickle cell disease presented with vaso-occlusive pain crisis.On examination,he had jaundice and a soft,nontender abdomen.Initially he was alert and fully oriented;within 24 h he developed new-onset confusion.Laboratory evaluation was notable for hyperbilirubinemia,leukocytosis,anemia,thrombocytopenia,acute kidney injury and elevated international normalized ratio(INR).Imaging by ultrasound and computed tomography scan suggested a cirrhotic liver morphology with no evidence of biliary ductal dilatation.The patient was diagnosed with acute sickle cell intrahepatic cholestasis after excluding competing etiologies of acute liver injury.He underwent LT from an HCV nucleic acid amplification test positive donor 9 d after initial presentation.The liver explant was notable for widespread sinusoidal dilatation with innumerable clusters of sickled red blood cells and cholestasis.On postoperative day 3,HCV RNA was detectable in the patient's peripheral blood and anti-HCV therapy with glecaprevir/pibrentasvir was initiated on postoperative day 23.He subsequently achieved sustained virologic response after completing 3 mo of therapy and has been followed clinically for 12 mo post-transplant.CONCLUSION This case highlights the utility of LT as a viable treatment option for acute sickle cell intrahepatic cholestasis.
文摘BACKGROUND Takotsubo cardiomyopathy(TCM),or stress-induced cardiomyopathy,is associated with adverse prognosis.Limited data suggest that TCM occurring in orthotopic liver transplant(OLT)recipients is associated with elevated perioperative risk.AIM To characterize the predictors of TCM in OLT recipients,using a large,multicenter pooled electronic health database.METHODS A multi-institutional database(Explorys Inc,Cleveland,OH,USA),an aggregate of de-identified electronic health record data from 26 United States healthcare systems was surveyed.A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of“liver transplant”between 09/2015 and 09/2020 was identified.Subsequently,individuals who developed a new diagnosis of TCM following OLT were identified.Furthermore,the risk associations with TCM among this patient population were characterized using linear regression.RESULTS Between 09/2015 and 09/2020,of 37718540 patients in the database,38740(0.10%)had a history of OLT(60.6%had an age between 18-65 years,58.1%female).A new diagnosis of TCM was identified in 0.3%of OLT recipients(45.5%had an age between 18-65 years,72.7%female),compared to 0.04%in non-OLT patients[odds ratio(OR):7.98,95%confidence intervals:6.62-9.63,(P<0.0001)].OLT recipients who developed TCM,compared to those who did not,were more likely to be greater than 65 years of age,Caucasian,and female(P<0.05).There was also a significant association with cardiac arrhythmias,especially ventricular arrhythmias(P<0.0001).CONCLUSION TCM was significantly more likely to occur in LT recipients vs non-recipients.Older age,Caucasian ethnicity,female gender,and presence of arrhythmias were significantly associated with TCM in LT recipients.
文摘Driven by the tremendous availability of data,artificial intelligence(AI)using deep learning has emerged as a breakthrough computer technology in the last few decades and has recently been acknowledged by the Task Force on AI as a golden opportunity for research.With its ability to understand,learn from and build on non-linear relationships,AI aims to individualize medical care in an attempt to save time,cost,effort and improve patient’s safety.AI has been applied in multiple medical fields with substantial progress made in gastroenterology mainly to facilitate accurate detection of pathology in different disease processes,among which inflammatory bowel disease(IBD)seems to drag significant attention,specifically by interpreting imaging studies,endoscopic images and videos and-to a lesser extent-disease genomics.Moreover,models have been built to predict IBD occurrence,flare ups,persistence of histological inflammation,disease-related structural abnormalities as well as disease remission.In this article,we will review the applications of AI in IBD in the present medical literature at multiple points of IBD timeline,starting from disease prediction via genomic assessment,diagnostic phase via interpretation of radiological studies and AI-assisted endoscopy,and the role of AI in the evaluation of therapy response and prognosis of IBD patients.
基金supported by NIH grants[U54CA163060,P50CA150964].
文摘Systemic sclerosis(SSc)is a multisystem connective-tissue disorder of unknown etiology affecting various internal organs and skin.Esophageal involvement is present in≤70%–90%of the patients and is manifested by severe gastroesophageal-reflux disease and dysmotility.Although Barrett’s esophagus(BE)has been reported in patients with SSc[1,2],the risk of neoplastic progression has not been reported before in the USA.Therefore,we aimed to study the prevalence of BE in SSc and incidence of neoplastic progression.
