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Efficacy and Tolerability of Oral Iron Protein Succinylate in the Treatment of Iron Deficiency Anemia in Adults with Gastrointestinal Diseases
Issue:
Volume 5, Issue 2, December 2021
Pages:
40-47
Received:
20 June 2021
Accepted:
5 July 2021
Published:
16 July 2021
Abstract: Iron deficiency anemia (IDA) is commonly associated with several pathological gastrointestinal (GI) conditions in adults, being induced through different mechanisms, such as chronic bleeding, chronic inflammation, malabsorption, autoimmune re-actions, or, quite frequently, as a combination of different mechanisms. All patients must be treated with iron supplementation with the aim of restoring normal hemoglobin levels and iron status. Oral iron compounds are the first line treatment options for ID clinical conditions, according to International Guidelines, as they have proven to be efficacious, safe, and relatively inexpensive. However, ferric salts are scarcely absorbed, and ferrous compounds present a poor GI tolerability. Iron-protein succinylate (IPS), an iron complex that keeps ferric iron bonded to the protein content of a succinylated casein shell at acid pH values, has been shown to release gradually iron into the intestinal lumen, protecting the gastrointestinal mucosa from eventual damage, an ensuring an optimal intestinal iron absorption. This review focuses on IPS in the treatment of IDA associated to a variety of GI medical conditions in adults. Results from diverse studies including IDA due to acute and chronic GI conditions, as well as IDA associated to gastric surgery, confirm a consistent improvement in hematologic parameters and clinical symptoms, and an optimal tolerability profile.
Abstract: Iron deficiency anemia (IDA) is commonly associated with several pathological gastrointestinal (GI) conditions in adults, being induced through different mechanisms, such as chronic bleeding, chronic inflammation, malabsorption, autoimmune re-actions, or, quite frequently, as a combination of different mechanisms. All patients must be treated with ...
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Incidence of Gastric Cancer in the Patients with Schizophrenia: A Meta-analysis
Jiacheng Gao,
Yuhang Wang,
Zirui Jia,
Tingting Zhou,
Xiangwen Zhang,
Guo Zu
Issue:
Volume 5, Issue 2, December 2021
Pages:
48-52
Received:
9 July 2021
Accepted:
26 July 2021
Published:
2 August 2021
Abstract: Background: Several studies have reported the incidence of gastric cancer (GC) in the patients with schizophrenia, but the incidence of GC in schizophrenia patients remains controversy. It is necessary to perform a meta-analysis to detect the incidence of GC in schizophrenia patients. Methods: We search the relevant articles from PubMed, EMBASE, Web of Science, the Cochrane Library and Chinese electronic databases. The incidence of GC in schizophrenia patients and heterogeneity were analyzed with STATA10.0 software. Results: Our meta-analysis included total 283,422 patients with schizophrenia and 1,024 patients with GC in nine articles. The incidence of GC in schizophrenia patients was 0.62% (95%CI: 0.005-0.008; P<0.001), but there is obvious heterogeneity (I2=98.7%). We next performed subgroup analysis to explore the incidence of GC in schizophrenia patients by gender and region. The GC incidence in male schizophrenia patients (0.28%, 95%CI: 0.001-0.003; P<0.001) was higher than that in female patients (0.23%, 95%CI: 0.002-0.004). In European countries, the GC incidence in schizophrenia patients (0.98%, 95%CI: 0.005-0.008) was higher than that in Asian countries (0.13%, 95%CI: 0.000-0.002; P<0.001). Conclusion: The incidence of GC in patients with schizophrenia was 0.62%. The GC incidence was higher in male and European countries schizophrenia patients, but large cohort studies are needed to confirm further.
Abstract: Background: Several studies have reported the incidence of gastric cancer (GC) in the patients with schizophrenia, but the incidence of GC in schizophrenia patients remains controversy. It is necessary to perform a meta-analysis to detect the incidence of GC in schizophrenia patients. Methods: We search the relevant articles from PubMed, EMBASE, We...
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An Emerging Clinical Form of Acute Pancreatitis in Covid-19
Meriem Atrassi,
Karima Ryouni,
Dalal Ben Sabbahia,
Abdelhak Abkari
Issue:
Volume 5, Issue 2, December 2021
Pages:
53-56
Received:
4 July 2021
Accepted:
27 July 2021
Published:
4 August 2021
Abstract: Background: As the global severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic continues, new clinical forms of the disease continue to emerge. While the coronavirus is responsible for gastrointestinal symptoms and acute hepatitis, researchers at the Royal University Hospital of Liverpool say they have identified cases of COVID-19-linked pancreatitis in young patients with COVID-19. Objectives: To establish influence of concomitant COVID-19 on clinical presentation and treatment strategy of patients with AP. Methods: This is a case report of pediatric patient admitted to a Pediatric Gastroenterology Unit, A. Harouchi Hospital, CHU Ibn Rochd, Casablanca, Morocco in October 2020 during the COVID-19 pandemic. Results: We report the observation of a 16-year-old girl, who received symptomatic outpatient treatment for influenza-like illness with a fever of 38.5°C before rapidly evolving in 1 week to stage E pancreatitis, where a SARS-COV2 IgG and IgM viral serology was requested coming back positive with a negative nasopharyngeal PCR covid. Conclusion: In conclusion, pancreatitis caused by SARS-CoV-2 is a real but rare entity; in fact COVID-19 can present as pancreatitis. This case highlights acute pancreatitis as a complication associated with COVID-19 and underlines the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain. This diagnosis is important for adequate treatment and better management of systemic repercussions, such as SIRS, decreasing SARS-CoV-2 mortality.
Abstract: Background: As the global severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic continues, new clinical forms of the disease continue to emerge. While the coronavirus is responsible for gastrointestinal symptoms and acute hepatitis, researchers at the Royal University Hospital of Liverpool say they have identified cases of COVID-19-li...
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Progress in the Application of Interventional Technique in Malignant Obstructive Jaundice
Lipeng Yang,
Xingyuan Zhang,
Songsong Fan,
Xuefeng Cao
Issue:
Volume 5, Issue 2, December 2021
Pages:
57-61
Received:
7 August 2021
Accepted:
17 August 2021
Published:
31 August 2021
Abstract: Malignant obstructive jaundice (MOJ) is usually due to the terminal stages of tumor, so there is no time for curative surgery. Hyperbilirubinemia caused by MOJ can cause damage to systems throughout the body and affect the survival prognosis. Symptomatic treatment is needed even in the advanced stage of the disease. Interventional therapy and surgery are the main means to relieve biliary obstruction, but patients have poor tolerance to surgery at this time, and the risk of surgery is high. At this time, the focus of treatment is to remove the obstruction of the biliary tract as early as possible to avoid the further aggravation of jaundice, progressive deterioration of liver function and other serious complications. Biliary interventional therapy has the special advantage of minimally invasive, and is an effective treatment for patients with advanced MOJ. Currently, bile duct interventional therapy mainly includes bile duct interventional drainage, biliary stent implantation, iodine-125 (125 I) seed strand implantation, biliary radiofrequency ablation（RFA）and Intraluminal brachytherapy (ILBT), etc. Each of which has its own advantages and disadvantages in clinical application. With the progress of medical technology and the improvement and perfection of hardware equipment, the combination of multiple clinical departments and multiple operation methods will become a new trend of MOJ interventional therapy.
Abstract: Malignant obstructive jaundice (MOJ) is usually due to the terminal stages of tumor, so there is no time for curative surgery. Hyperbilirubinemia caused by MOJ can cause damage to systems throughout the body and affect the survival prognosis. Symptomatic treatment is needed even in the advanced stage of the disease. Interventional therapy and surge...
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Risk Factors for Delayed Post Polypectomy Bleeding Following Colonoscopic Polypectomy: A Study of 1073 Cases
Khan Mohammad Nazmus Saqeb,
Mohammad Shamsul Arfin
Issue:
Volume 5, Issue 2, December 2021
Pages:
62-67
Received:
9 August 2021
Accepted:
27 August 2021
Published:
30 September 2021
Abstract: Background: Bleeding occurs in approximately 1.0−6.1% cases of endoscopic polypectomy. Bleeding can be immediate or delayed. The incidence of delayed post polypectomy bleeding ranges from 0.4% to 1.1%. This study aims at identifying risk factors for delayed post polypectomy bleeding. Methods: A retrospective study was carried out to evaluate the risk factors of delayed Post Polypectomy Bleeding following colonoscopic polypectomy. Patient who had post polypectomy bleeding were assigned to the case group. These patients were age and sex-matched to 57 randomly selected control patients who didn’t have post polypectomy bleeding after colonoscopic polypectomy. The baseline characteristics of the case and control groups were similar. No significant differences were identified between the two groups of patients in terms of demographic characteristics, laboratory findings, and comorbidities. Different characteristics of the patients and their polyps (size, location, shape, and histopathological findings) were compared between the case and control group using Chi-square(X2) test. Odds ratio (OR) was calculated for each risk factor to be evaluated. A p-value <0.05 was considered as significant. Statistical analysis was done with SPSS v22. Result: Among the 1073 patients who underwent colonoscopic polypectomy during the study period, 19 (1.77%) experienced delayed PPB. A polyp size of more than 10mm showed significant association with occurrence of delayed PPB with an OR of 6.7. Sessile polyps were more likely to be associated with delayed PPB with an OR of 4.4. Polyps located at the right colon were more prone to delayed PPB with an OR of 4.7. Obese patients with a BMI of more than 25 were more likely to have delayed PPB with an OR of 6.6. Patients aged more than 65 years, patients having cardiovascular disease & patients having CKD were more likely to have delayed PPB in comparison with those who didn’t have these comorbidities. Conclusion: The incidence of delayed PPB was 1.77% in our study, and patients with large polyps (>10mm), sessile polyps & polyps located in the right hemi colon showed an increased risk of delayed PPB. In addition, patients with higher BMI (>25) also showed a higher risk of delayed PPB. Patients aged more than 65 years, patients having cardiovascular disease & patients having CKD were more likely to have delayed PPB in comparison with those who didn’t have these comorbidities. Polypectomies in patients with these risk factors carry high risk of delayed PPB and should always be delt with extra precaution.
Abstract: Background: Bleeding occurs in approximately 1.0−6.1% cases of endoscopic polypectomy. Bleeding can be immediate or delayed. The incidence of delayed post polypectomy bleeding ranges from 0.4% to 1.1%. This study aims at identifying risk factors for delayed post polypectomy bleeding. Methods: A retrospective study was carried out to evaluate the ri...
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Phase 1 Study of EDP-305, a Novel Once-Daily Oral Farnesoid X Receptor Agonist, in Healthy Subjects and Those with Presumptive Nonalcoholic Fatty Liver Disease
Alaa Ahmad,
Kristin Sanderson,
Daniel Dickerson,
Nathalie Adda
Issue:
Volume 5, Issue 2, December 2021
Pages:
68-79
Received:
21 October 2021
Accepted:
9 November 2021
Published:
17 November 2021
Abstract: Introduction: EDP-305 is a farnesoid X Receptor (FXR) agonist that selectively activates FXR and is currently under investigation for with the treatment of nonalcoholic steatohepatitis (NASH). The primary objective was to assess the safety of EDP-305 in healthy subjects and subjects with presumptive NAFLD. Methods: In this placebo-controlled double-blind Phase 1 study, healthy subjects (aged 20-55 years) were randomized to single or multiple oral doses of once daily EDP-305 or placebo and subjects with presumptive NAFLD (aged 25-52 years) were randomized to multiple oral doses of once daily EDP-305 or placebo for 14 days. Six cohorts received EDP-305 1 mg, 5 mg, 10 mg, 20 mg, 40 mg or 80 mg in the SAD phase including a food effect cohort that received EDP-305 10 mg. In the MAD phase, 12 cohorts received EDP-305 0.5 mg, 1 mg, 2.5 mg, 5 mg, 10 mg or 20 mg (six cohorts in healthy subjects and six in presumptive NAFLD). Results: In the SAD phase, 38 subjects received EDP-305 and 12 subjects received placebo, and in the MAD phase, 72 subjects received EDP-305 and 24 subjects received placebo. No serious adverse events were reported, and the most common treatment-emergent adverse events (TEAEs) in EDP-305 treated subjects were constipation, headache, and pruritus. The majority of TEAEs were mild to moderate in severity. EDP-305 exposure increased with single and multiple doses in both healthy subjects and those with presumptive NAFLD. EDP-305 exposure was approximately 3-fold higher in fed vs. fasted subjects. Strong FXR target engagement was demonstrated in both healthy and presumptive NAFLD subjects in the MAD phase with FGF19 increases and C4 reductions compared with placebo. Conclusion: EDP-305 was well tolerated, with pruritus the most common treatment-emergent adverse event at EDP-305 doses ≥10 mg and with minimal effects on lipids. Dose proportional PK support once daily dosing. Significant elevations of FGF19 and diminutions in C4 demonstrated potent engagement of the FXR receptor at doses that neither elicit adverse effects on lipids nor result in pruritus. These results supported further evaluation of EDP-305 in patients with NASH.
Abstract: Introduction: EDP-305 is a farnesoid X Receptor (FXR) agonist that selectively activates FXR and is currently under investigation for with the treatment of nonalcoholic steatohepatitis (NASH). The primary objective was to assess the safety of EDP-305 in healthy subjects and subjects with presumptive NAFLD. Methods: In this placebo-controlled double...
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A Case Report on Chronic Xanthogranulomatous Cholecystitis
James Crisfil Fructuoso Montesa,
Jacklyn Manaog So-Cabahug
Issue:
Volume 5, Issue 2, December 2021
Pages:
80-85
Received:
20 October 2021
Accepted:
12 November 2021
Published:
23 November 2021
Abstract: Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis often being misdiagnosed as gallbladder carcinoma, hence poses as a diagnostic challenge for physicians. The proposed mechanism of the formation of this lesion is through mucosal ulceration or the rupture of Rokitansky-Aschoff sinuses due to increased intraluminal pressure. This causes granulomatous changes that lead to the formation of intramural nodules. Due to its nature of presenting as a gallbladder mass, certain surgical interventions can become unwarranted, which may diminish the patient’s quality of life. This paper presents a case of a 59-year-old male who presented with epigastric pain, initially treated as reflux disease, relieved by antacids, antispasmodics and opioid analgesics. The imaging studies revealed a mass in the gallbladder with signs of cholecystitis. The patient underwent intra-operative ultrasound, extended cholecystectomy and lymph node dissection with an unremarkable postoperative course. The final histopathology revealed chronic xanthogranulomatous cholecystitis and was negative for malignancy. This paper further reviews the presentation of the lesion under different imaging modalities. On ultrasound, it appears as a hypoechoic focus and marked or focal thickening of the gallbladder wall, while on computed tomography, it presents with hypoattenuating nodules in thickened walls, luminal surface enhancement with continuous mucosal lines. While on magnetic resonance imaging, it may appear as either a reduced signal intensity on out of phase images or slightly high signal intensity and slight enhancement on early phase and strong enhancement on the late phase. In general, the recommended treatment approach is through open cholecystectomy.
Abstract: Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis often being misdiagnosed as gallbladder carcinoma, hence poses as a diagnostic challenge for physicians. The proposed mechanism of the formation of this lesion is through mucosal ulceration or the rupture of Rokitansky-Aschoff sinuses due to increased intraluminal pressure. This...
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Elevated AFP in the Absence of Hepatic Malignancy in a Patient with Acute Hepatitis
Jacklyn Manaog So-Cabahug,
Rafael Chan,
Marc Lustre,
Janus Ong
Issue:
Volume 5, Issue 2, December 2021
Pages:
86-90
Received:
25 October 2021
Accepted:
12 November 2021
Published:
23 November 2021
Abstract: Alpha-fetoprotein is a tumor marker used in the clinical diagnosis and monitoring of treatment response in hepatocellular carcinoma (HCC). However, elevated levels are not specific for malignancy as it has been reported in other chronic liver diseases. This paper aims to describe such a case of elevated AFP in a case of acute hepatitis and its pathophysiology. Herein presents a 26-year-old Asian male with jaundice; who had no personal or family history of liver disease, drug or supplement use. The reported alcohol intake was not significant. The laboratory workup revealed hepatocellular type of liver injury (total bilirubin of 478 umol/L, direct bilirubin 401 umol/L, indirect bilirubin 77 umol/L, AST 1135 U/L, ALT 1592 U/L, LDH 53 U/L, ALP 139 u/L), elevated AFP (3337 IU/mL), elevated INR, positive autoimmune panel (ANA, Anti-Sm, Anti-TPO, Anti-TG). The serological examinations revealed a past infection with EBV and CMV, while imaging tests did not show ductal obstruction or the presence of mass lesions. A subsequent liver biopsy demonstrated interface hepatitis. The patient was then treated as a case of autoimmune hepatitis and was started on glucocorticoids with clinical and biochemical improvement including normalization of AFP levels.
Abstract: Alpha-fetoprotein is a tumor marker used in the clinical diagnosis and monitoring of treatment response in hepatocellular carcinoma (HCC). However, elevated levels are not specific for malignancy as it has been reported in other chronic liver diseases. This paper aims to describe such a case of elevated AFP in a case of acute hepatitis and its path...
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Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement
Indira Chandrasekar,
Erica Ortiz,
Jennifer Norgaard,
Mario Augusto Rojas
Issue:
Volume 5, Issue 2, December 2021
Pages:
91-95
Received:
1 October 2021
Accepted:
26 October 2021
Published:
3 December 2021
Abstract: Background: Gastrostomy tube placement (GTP) has become standard of care in infants with esophageal atresia, severe neurologic impairment, evidence of severe dysphagia with aspiration, and tracheostomy; all other indications are considered non-traditional indications with little evidence of benefit. Objective: The aim of the study is to identify a select group of infants with non- traditional indications for GTP who may benefit from home nasogastric feeds (HNGF) with a pre-established protocol and algorithm. Methods: We performed a retrospective study of all infants who underwent GTP between January 2015 and December 2017. Infants were categorized as having traditional or non-traditional indications for GTP. Parents or designated caregivers were prospectively contacted by phone and interviewed to determine gastrostomy tube (GT) use status, time to full per oral (PO) feeds, and related complications after discharge. Results: 111 infants had GTP during the study period and 51 (46%) of these were classified as non-traditional indications: term infants with chronic oral aversion, preterm infants with mild to moderate dysphagia, infants of diabetic mothers with feeding problems, post-op cardiac patients with oral aversion, and patients with isolated Pierre Robin sequence. The average days of PO trial before GTP in this group was 41 (±30.5) days, average oral intake and average age at GTP was 32% and 75±42.4 days respectively. Average duration of GT use was 403.4±390.7 days. After discharge, 100% of preterm infants with oral aversion or dysphagia, 100% of infants with isolated Pierre Robin sequence, and 75% of infants of diabetic mothers reached full feeds by mouth in less than 90 days. Only 30% of infants with complex congenital heart defects met this goal. Thirty percent of infants with mild to moderate aspiration reached full PO feeds on average at 22.5 months post-conception age. All infants with neurodevelopmental abnormalities and feeding problems were still on GT feeds at the time of parental interview. Conclusion: We identified a cohort of infants with non-traditional indications for GTP who may benefit from HNGF. Future quality improvement initiatives and randomized controlled studies with HNGF should include infants with the probability of reaching full feeds before 6 months of life to avoid the complications and costs associated with GT placement.
Abstract: Background: Gastrostomy tube placement (GTP) has become standard of care in infants with esophageal atresia, severe neurologic impairment, evidence of severe dysphagia with aspiration, and tracheostomy; all other indications are considered non-traditional indications with little evidence of benefit. Objective: The aim of the study is to identify a ...
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