Obeticholic Acid Decreases Intestinal Content of Enterococcus in Rats With Cirrhosis and Ascites.

The intestinal microbiome and bacterial translocation (BT), the passage of microorganisms from the gut lumen to mesenteric lymph nodes and other extra-intestinal sites, are main mechanisms implicated in liver injury and further decompensation in patients with cirrhosis. We hypothesized that obeticholic acid (OCA), a semisynthetic bile acid, would change the microbiome composition and reduce bacterial translocation in experimental cirrhosis. Rats with cirrhosis induced by carbon tetrachloride inhalation (a nonseptic model) with ascites present for at least 7 days were randomized to receive a 14-day course of OCA at a dose of 5 mg/kg/day (n = 34) or placebo (n = 34).

Acute kidney injury, but not sepsis, is associated with higher procedure-related bleeding in patients with decompensated cirrhosis.

Background: Bleeding after low-risk invasive procedures can be life-threatening or can lead to further complications in decompensated cirrhosis patients. In unstratified cohorts of hospitalized patients with cirrhosis, the rate of procedure-related bleeding is low despite abnormal coagulation parameters. Our objective was to identify patients with decompensated cirrhosis at a high risk of developing procedure-related bleeding in whom the value of pre-procedure transfusions could be assessed.

Systemic Mastocytosis Complicated by Non-Cirrhotic Portal Hypertension and Variceal Bleeding.

Systemic mastocytosis is a myeloproliferative disorder characterized by extracutaneous involvement of at least one organ. Although rare, infiltration of inflammatory mast cells within the portal vein may lead to obstruction of the sinusoids resulting in non-cirrhotic portal hypertension. We present a patient with known history of systemic mastocytosis with bone marrow involvement presenting with new-onset esophageal variceal bleeding.

Capnographic Monitoring of Moderate Sedation During Low-Risk Screening Colonoscopy Does Not Improve Safety or Patient Satisfaction: A Prospective Cohort Study.

Objectives: Appropriate monitoring during sedation has been recognized as vital to patient safety in procedures outside of the operating room. Capnography can identify hypoventilation prior to hypoxemia; however, it is not clear whether the addition of capnography improves safety or is cost effective during routine colonoscopy, a high volume, low-risk procedure. Our aim was to evaluate the value of EtCO2 monitoring during colonoscopy with moderate sedation.

Risk Factors and Outcomes of Reversal Agent Use in Moderate Sedation During Endoscopy and Colonoscopy.

Background: Moderate sedation has been standard for noninvasive gastrointestinal procedures for decades yet there are limited data on reversal agent use and outcomes associated with need for reversal of sedation.

Aim: To determine prevalence and clinical significance of reversal agent use during endoscopies and colonoscopies.

Methods: Individuals with adverse events requiring naloxone and/or flumazenil during endoscopy or colonoscopy from 2008 to 2013 were identified.

Complementary and Alternative Medicine Use Is Prevalent Among Patients with Gastrointestinal Diseases.

Introduction: Complementary and alternative medicine (CAM) use is reported to be higher among patients with irritable bowel syndrome and inflammatory bowel disease; however, demographic predictors and reasons for utilization for all GI conditions are less clear.

Aim: To determine prevalence, predictors, and reasons for CAM use among all patients attending a gastrointestinal (GI) clinic in a single academic center.

Methods: Adults attending outpatient GI clinics at Beth Israel Deaconess Medical Center completed a questionnaire to assess CAM utilization as well as perceived benefits, harms, and costs of CAM therapy.

Successful management of latent tuberculosis infection in an underserved community by a student-run free clinic.

The management of latent tuberculosis infection (LTBI) most commonly consists of a nine-month course of isoniazid (INH) therapy and is complicated by low adherence and completion rates. The Latent Tuberculosis Initiative at the HAVEN Free Clinic was developed to provide LTBI treatment to an underserved, high-risk, foreign-born population. We conducted a retrospective chart review to evaluate the program.

Carotid intima-media thickness provides evidence that ascending aortic aneurysm protects against systemic atherosclerosis.

Previous evaluation of total aortic calcium score suggests that mutations promoting ascending aortic aneurysm development may protect against atherosclerosis. However, calcium score is a late indicator of atherosclerosis. We evaluated carotid intima-media thickness (IMT), an earlier marker, to assess the degree of atherosclerosis in ascending aortic aneurysm patients compared to controls.