The Wireless Motility Capsule: a One-Stop Shop for the Evaluation of GI Motility Disorders.

The wireless motility and pH capsule (WMC) provides an office-based test to simultaneously assess both regional and whole gut transit. Ingestion of this non-digestible capsule capable of measuring temperature, pH, and the pressure of its immediate surroundings allows for the measurement of gastric, small bowel, and colonic transit times in an ambulatory setting. Approved by the US Food and Drug Administration for the evaluation of suspected conditions of delayed gastric emptying and the evaluation of colonic transit in chronic idiopathic constipation, WMC should be considered in suspected gastrointestinal motility disorders as it provides a single study capable of simultaneously assessing for regional, multiregional, or generalized motility disorders.

A Text Searching Tool to Identify Patients with Idiosyncratic Drug-Induced Liver Injury.

Background: Idiosyncratic drug-induced liver injury (DILI) is an uncommon but important cause of liver disease that is challenging to diagnose and identify in the electronic medical record (EMR).

Aim: To develop an accurate, reliable, and efficient method of identifying patients with bonafide DILI in an EMR system.

Methods: In total, 527,000 outpatient and ER encounters in an EPIC-based EMR were searched for potential DILI cases attributed to eight drugs.

Admissions for hepatitis B reactivation in patients receiving immunosuppressive therapy remain unchanged from 1999 to 2014.

Background: Reactivation of hepatitis B virus (HBV) replication in patients with chronic or past HBV infection receiving immunosuppressive therapy (IST) can be prevented through HBV screening and prophylactic antiviral therapy. We aimed to determine the occurrence of severe HBV reactivation secondary to IST in the era of HBV nucleos/tide analogs, the implicated IST, and outcomes.

Methods: We conducted a retrospective chart review of adult patients who were HBsAg+ and HBV DNA+ and had received IST within 90 days of admission to our hospital.

EUS Diagnostic Criteria for Chronic Pancreatitis: A Comparison of Conventional Versus Rosemont Criteria.

Objective: To compare the Rosemont criteria, which are graded features chosen by experts in 2007, versus the conventional criteria, which require ≥ 3-5 of the 9 features that are "counted as equal," for the diagnosis of chronic pancreatitis by EUS.

Methods: This is a retrospective cohort study. EUS examinations were scored using both criteria, and the following categories compared: 3-CC versus "consistent with" chronic pancreatitis by RC; 3-CC versus "consistent with" and "suggestive of" chronic pancreatitis by RC; 5-CC versus "consistent with" chronic pancreatitis by RC; and 5-CC versus "consistent with" and "suggestive of" chronic pancreatitis by RC.

Predictors of Early Hospitalization After Deceased Donor Liver Transplantation.

Unlabelled: Hospitalizations after solid organ transplantation may affect patient outcomes. Identification of the factors attributed to them may decrease hospitalization rates, reduce overall cost, and improve post-transplant outcomes. We examined the risk factors for early hospitalization within 30 and 90 days after liver transplantation (LT).

Surveillance in Barrett's Esophagus: Utility and Current Recommendations.

Surveillance of Barrett's esophagus for preventing death from esophageal adenocarcinoma is attractive and widely practiced. However, empirical evidence supporting its effectiveness is weak. Longer intervals between surveillance examinations are being recommended, supported by computer simulation analyses.

A comparative study of patients' knowledge about hepatitis C in the United States and in urban and rural China.

Background: Hepatitis C (HCV) is the predominant cause of chronic liver disease in the USA and is increasingly recognized as a common cause of liver disease in China. Studies of HCV patients in the US found major gaps in knowledge but little is known about HCV knowledge among patients in China.

Methods: We conducted a survey in three cohorts of HCV patients in Ann Arbor, MI, US, and in Beijing and Hebei, China, between April and November 2012 to compare patient knowledge about HCV in the US and in urban and rural China.

Symptomatic management for gastroparesis: antiemetics, analgesics, and symptom modulators.

Although prokinetic agents typically are used for gastroparesis, antiemetic, analgesic, and neuromodulatory medications may help manage nausea, vomiting, pain, or discomfort. Antiemetic benefits are supported by few case reports. An open series reported symptom reductions with transdermal granisetron in gastroparesis.

Endoscopic Transpapillary Gallbladder Stent Placement Is Safe and Effective in High-Risk Patients Without Cirrhosis.

Background: Endoscopic transpapillary gallbladder stent (ETGS) placement is a proposed minimally invasive alternative to cholecystectomy in high-risk patients with symptomatic gallbladder disease.

Aims: To describe the safety and efficacy of ETGS placement in 29 consecutive patients without cirrhosis.

Methods: A retrospective analysis of consecutive ETGS cases from 2005 to 2013 at a referral center was undertaken.

Dietary Renaissance in IBS: Has Food Replaced Medications as a Primary Treatment Strategy?

The medical community has only recently started to focus attention on the role of food in the pathogenesis of irritable bowel syndrome (IBS), though the association between food and gastrointestinal (GI) symptoms has been recognized by patients for decades. Health care providers receive little formal training in the dietary management of IBS and have traditionally viewed dietary interventions with skepticism. There is mounting evidence that links food to changes in motility, visceral sensation, microbiome, permeability, immune activation, and brain-gut interactions-all key elements in the pathogenesis of IBS.

Randomized, controlled pilot study comparing large-volume paracentesis using wall suction and traditional glass vacuum bottle methods.

Objectives: Large-volume paracentesis (LVP) can be time and labor intensive depending on the amount of ascites removed and the method of drainage. Wall suction has been adopted as the preferred method of drainage at many centers, though the safety and benefits of this technique have not been formally evaluated. The primary objective of this study was to define the cost and time savings of wall suction over the traditional glass vacuum bottle method for ascites drainage.

The use of SmartPill for gastric monitoring.

Testing to define delayed gastric emptying is required to diagnose gastroparesis; rapid emptying is found in other patients. Commonly performed methods of gastric emptying testing include scintigraphy and breath testing. The SmartPill wireless motility capsule (WMC) system is US FDA-approved for evaluating suspected delayed emptying in gastroparesis and functional dyspepsia.

Does stress induce bowel dysfunction?

Psychological stress is known to induce somatic symptoms. Classically, many gut physiological responses to stress are mediated by the hypothalamus-pituitary-adrenal axis. There is, however, a growing body of evidence of stress-induced corticotrophin-releasing factor (CRF) release causing bowel dysfunction through multiple pathways, either through the HPA axis, the autonomic nervous systems, or directly on the bowel itself.

Emerging drugs for the treatment of gastroparesis.

Introduction: Gastroparesis presents with symptoms of gastric retention with findings of delayed gastric emptying on diagnostic testing. Manifestations of gastroparesis are disabling in severe cases and lead to significant health resource utilization. Current therapies often are ineffective, may exhibit tolerance on chronic administration or produce prominent side effects in large patient subsets.

Epstein-Barr virus (EBV) related acute liver failure: a case series from the US Acute Liver Failure Study Group.

Purpose: Acute liver failure (ALF) is a rare clinical syndrome associated with a high case fatality rate. Asymptomatic primary infection with Epstein-Barr virus (EBV) is common in the general population while acute hepatitis and jaundice are much less common and ALF has been rarely reported. We reviewed the presenting features as well as clinical outcomes amongst consecutive adults with EBV-related ALF.

Preventing pancreatitis after endoscopic retrograde cholangiopancreatography.

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a common and potentially devastating complication of ERCP. Advances in risk stratification, patient selection, procedure technique, and prophylactic interventions have substantially improved the endoscopists' ability to prevent this complication. This article presents the evidence-based approaches to preventing post-ERCP pancreatitis and suggests timely research questions in this important area.

Peritoneal fluid bilirubin to serum bilirubin ratio for the diagnosis of bile leaks in orthotopic liver transplant recipients.

Background: A peritoneal fluid-to-serum bilirubin ratio (FSBR) of >5 has been shown to be accurate for the detection of bile leaks in post-cholecystectomy and trauma patients; however, there are no studies evaluating the accuracy of this threshold ratio in orthotopic liver transplant (OLT) recipients.

Methods: We performed a nested case-control analysis to determine the optimal FSBR threshold for diagnosing bile leaks in OLT recipients and the relationship between FSBR and likelihood of bile leak. Adult OLT patients undergoing ERCP for suspected bile leak were divided into 2 groups: those with cholangiographic evidence of a bile leak and those without evidence of leak.

Presentation and outcomes with clinically apparent interferon beta hepatotoxicity.

Aims: The aim of this study was to describe the presenting features and outcomes of consecutive patients with liver injury attributed to interferon beta.

Methods: The presenting features of eight subjects with clinically apparent liver injury attributed to interferon beta enrolled in the U.S.

Essential elements for glucosensing by gastric vagal afferents: immunocytochemistry and electrophysiology studies in the rat.

Glucosensing nodose ganglia neurons mediate the effects of hyperglycemia on gastrointestinal motility. We hypothesized that the glucose-sensing mechanisms in the nodose ganglia are similar to those of hypothalamic glucose excited neurons, which sense glucose through glycolysis. Glucose metabolism leads to ATP-sensitive potassium channel (K(ATP)) channel closure and membrane depolarization.

Agents that act luminally to treat diarrhoea and constipation.

Diarrhoea and constipation are common clinical complaints that negatively affect quality of life, reduce work productivity and lead to considerable health-care expenditure. A variety of therapies have been used to treat these conditions. Unlike drugs that require systemic absorption to exert their effects, luminally acting agents improve diarrhoea and constipation by altering intestinal and/or colonic motility, as well as mucosal absorption and secretion, through a variety of mechanisms.

New vision in video capsule endoscopy: current status and future directions.

Now, more than 10 years after the approval of video capsule endoscopy (VCE), the technology has become an essential component in the management of several clinical conditions. Currently, two capsules are approved in the USA for visualizing the small bowel mucosa, one capsule is authorized for oesophageal assessment and several others are in use or under evaluation worldwide. New investigations have focused on optical improvements, advances in intestinal cleansing and risk reduction strategies to optimize VCE methodologies in clinical care.

Preliminary study of two antiviral agents for hepatitis C genotype 1.

Background: Patients with chronic hepatitis C virus (HCV) infection who have not had a response to therapy with peginterferon and ribavirin may benefit from the addition of multiple direct-acting antiviral agents to their treatment regimen.

Methods: This open-label, phase 2a study included an exploratory cohort of 21 patients with chronic HCV genotype 1 infection who had not had a response to previous therapy (i.e.

Endoscopic findings and clinical outcomes in ventricular assist device recipients with gastrointestinal bleeding.

Background: Gastrointestinal bleeding (GIB) is an important clinical problem in recipients of ventricular assist devices (VAD), although data pertaining to the endoscopic evaluation and management of this complication are limited in the medical literature.

Aims: We sought to identify the most common endoscopic findings in VAD recipients with GIB, and to better define the diagnostic and therapeutic utility of endosopy for this patient population.

Methods: Twenty-six subjects with VAD and overt GIB were retrospectively identified.