The Natural History of Asymptomatic Gallstones: A Longitudinal Study and Prediction Model.

Background & Aims: Despite the high prevalence of asymptomatic gallstones (AGs), there are limited data on their natural history. We aimed to determine the rate of symptom development in a contemporary population, determine factors associated with progression to symptomatic gallstones (SGs), and develop a clinical prediction model.

Methods: We used a retrospective cohort design.

Patient and physician factors contributing to polypharmacy among older patients.

Objective: Polypharmacy, or use of multiple medications, is associated with patient factors. Less is known regarding variation in polypharmacy by individual physicians. The objective of this study was to assess patient and physician factors associated with polypharmacy among older patients.

Lyme Carditis: A Reversible Cause of Acquired Third-Degree AV Block.

BACKGROUND Lyme borreliosis, caused by spirochetes of the Borrelia burgdorferi genospecies complex, is the most commonly reported tickborne infection in North America and those infected may present with cutaneous, cardiac, articular, and neuropsychiatric abnormalities. The protean nature of many of its clinical manifestations presents a diagnostic conundrum. Lyme disease can affect the heart, albeit rarely, with cardiac abnormalities usually manifesting as varying degrees of heart block or arrhythmias.

Pneumonia and alcohol use disorder: Implications for treatment.

Patients with alcohol use disorder (AUD) are at higher risk of pneumonia and of poor outcomes. This article reviews the etiology of pneumonia in patients with AUD, its impact on mortality and resource utilization, and its implications for treatment.

Assessment of Physician Priorities in Delivery of Preventive Care.

Importance: Primary care physicians have limited time to discuss preventive care, but it is unknown how they prioritize recommended services.

Objective: To understand primary care physicians' prioritization of preventive services.

Design, Setting, And Participants: This online survey was administered to primary care physicians in a large health care system from March 17 to May 12, 2017.

Comparative Effectiveness of Commercial Bowel Preparations in Ambulatory Patients Presenting for Screening or Surveillance Colonoscopy.

Background: Inadequate bowel preparation (IBP) is associated with reduced adenoma detection. However, limited research has examined the impact of different commercial bowel preparations (CBPs) on IBP and adenoma detection. We aim to determine whether type of CBP used is associated with IBP or adenoma detection.

Weil's Disease: A Rare Cause of Jaundice.

Weil's disease is a complication of untreated leptospirosis and can be fatal. Awareness of leptospirosis and its hepatic manifestations are limited. We report the case of a 50-year-old man with gastrointestinal symptoms and a cholestatic pattern of liver injury diagnosed with Weil's disease.

Peroral endoscopic myotomy is highly effective for achalasia patients with recurrent symptoms after pneumatic dilatation.

Background: Previous interventions in achalasia such as pneumatic dilation (PD) might lead to difficulties with peroral endoscopic myotomy (POEM) along with sub-optimal outcomes. There are limited data in the literature on outcomes of POEM after PD, especially from the western hemisphere. Hence, we aimed to determine the safety and efficacy of POEM for recurrent symptoms after PD compared to treatment naïve achalasia patients.

National trends in healthcare outcomes and utilization of endoscopic and surgical interventions in patients hospitalized with esophageal foreign body and food impaction.

The incidence and number of emergency room visits for esophageal foreign body and food impaction (EFB) are on the rise. However, its impact on the rate of inpatient admissions, utilization of endoscopic and surgical interventions, and healthcare outcomes is poorly understood. We conducted a study to analyze these outcomes using the national inpatient sample (NIS) database.

Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database.

Introduction: Acute cholangitis (AC) can be associated with significant mortality and high risk of readmissions, if not managed promptly. We used national readmission database (NRD) to identify trends and risk factors associated with 30-day readmissions in patients with AC.

Methods: We conducted a retrospective cohort study of adult patients admitted with AC from 2010-2014 and Q1-Q3 of 2015 by extracting data from NRD.

The Effect of Starting the Protein-Sparing Modified Fast on Weight Change over 5 years.

Background: Ketogenic diets have been highlighted as a way to lose weight while experiencing reduced hunger. The protein-sparing modified fast (PSMF) induces ketosis but may be difficult to maintain.

Objective: To track weight loss for individuals initiating PSMF versus all other diets (e.

Management of Urinary Tract Infections in Direct to Consumer Telemedicine.

Background: Urinary tract infections (UTI) are a common reason for seeking care via direct to consumer (DTC) telemedicine, yet patterns of care, including antibiotic prescribing, have not been reported.

Objective: To describe management of UTI in a large nationwide DTC telemedicine platform.

Design: Cross-sectional observational study.

Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study.

Importance: Inappropriate antibiotic use for upper respiratory tract infections (URTIs) is an ongoing problem in primary care. There is extreme variation in the prescribing practices of individual physicians, which cannot be explained by clinical factors.

Objective: To identify factors associated with high and low prescriber status for management of URTIs in primary care practice.

Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia.

Background: Outcomes of laparoscopic Heller myotomy in obese patients with achalasia are suboptimal along with the increased risk of gastroesophageal reflux disease (GERD). The impact of obesity on treatment success and GERD after peroral endoscopic myotomy (POEM) are not well known. Hence, our study aims were to compare the clinical outcomes and rates of GERD after POEM in nonobese versus obese patients with achalasia.

The Colonic Single Stripe Sign: A Case of Ischemic Colitis.

Sudden, transient reduction in the blood flow especially in the "watershed" regions of the colon can lead to intestinal ischemia causing a decrease in the delivery of oxygen and nutrients to the intestinal wall. Patients with ischemic colitis often have elevated white blood cell counts, serum lactate, and serum amylase levels. Colonoscopy can confirm the diagnosis of ischemia and the findings include edematous, friable mucosa, erythema with interspersed pale areas, scattered hemorrhagic erosions or linear ulcerations.

Association Between Alcohol Use Disorders and Outcomes of Patients Hospitalized With Community-Acquired Pneumonia.

Importance: Patients with alcohol use disorder (AUD) are at elevated risk of developing pneumonia, but few studies have assessed the outcomes of pneumonia in patients with AUD.

Objectives: To compare the causes, treatment, and outcomes of pneumonia in patients with and without AUD and to understand the associations of comorbid illnesses, alcohol withdrawal, and any residual effects due to alcohol itself with patient outcomes.

Design, Setting, And Participants: A retrospective cohort study was conducted of 137 496 patients 18 years or older with pneumonia who were admitted to 177 US hospitals participating in the Premier Healthcare Database from July 1, 2010, to June 30, 2015.

Outcomes of endoscopic submucosal dissection in esophageal adenocarcinoma staged T1bN0 by endoscopic ultrasound in non-surgical patients.

Patients with esophageal adenocarcinoma (EAC) invading submucosa (T1b) are traditionally treated with esophagectomy and with chemoradiotherapy in poor surgical patients. Endoscopic submucosal dissection (ESD) has emerged as an alternative treatment in these patients. In this case series, we analyzed the outcomes of ESD in EAC staged T1bN0 by endoscopic ultrasound (EUS).

Esophageal Third Space Endoscopy: Recent Advances.

Purpose Of The Review: The novel concept of third space endoscopy was first applied to humans in 2008 for the management of achalasia through peroral endoscopic myotomy (POEM) procedure. Over the ensuing 10 years, this revolutionary procedure, which started in Japan, has been adopted and mastered by surgeons and gastroenterologists across the globe. In this article, we review the recent innovations and applications of third space endoscopy in the management of esophageal disorders.

Population-Based Trends in Prevalence of Nonalcoholic Fatty Liver Disease in US Adults With Type 2 Diabetes.

Type 2 diabetes (T2D) affects more than 9% of U.S. adults.