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| 1 | Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations显示文摘AIM:To examine the predictive factors of capsule endoscopy(CE) completion rate(CECR) including the effect of inpatient and outpatient status.METHODS:We identified 355 consecutive patients who completed CE at Rush University Medical Center between March 2003 and October 2005.Subjects for CE had either nothing by mouth or clear liquids for the afternoon and evening of the day before the procedure.CE exams were reviewed by two physicians who were unaware of the study hypotheses.After retrospective analysis,21 cases were excluded due to capsule malfunction,prior gastric surgery,endoscopic capsule placement or insufficient data.Of the remaining 334 exams [264 out-patient(OP),70 in-patient(IP)],CE indications,findings,location of the patients [IP vs OP and intensive care unit(ICU) vs general medical floor(GMF)] and gastrointestinal transit times were analyzed.Statistical analysis was completed using SPSS version 17(Chicago,IL).Chi-square,t test or fisher exact-tests were used as appropriate.Multivariate logistic regression analysis was used to identify variables associated with incomplete CE exams.RESULTS:The mean age for the entire study population was 54.7 years.Sixty-one percent of the study population was female,and gender was not different between IPs vs OPs(P = 0.07).The overall incomplete CECR was 14% in our study.Overt obscure gastrointestinal bleeding(OGB) was a significantly more common indication for the IP CE(P = 0.0001),while abdominal pain and assessment of IBD were more frequent indications for the OP CE exams(P = 0.002 and P = 0.01,respectively).Occult OGB was the most common indication and arteriovenous malformations were the most common finding both in the IPs and OPs.The capsule did not enter the small bowel(SB) in 6/70 IPs and 8/264 OPs(P = 0.04).The capsule never reached the cecum in 31.4%(22/70) of IP vs 9.5%(25/264) of OP examinations(P < 0.001).The mean gastric transit time(GTT) was delayed in IPs compared to OPs,98.5 ± 139.5 min vs 60.4 ± 92.6 min(P = 0.008).Minimal SB transit time was significantly prolonged in the IP compared to the OP setting [IP = 275.1 ±111.6 min vs OP = 244.0 ± 104.3 min(P = 0.037)].CECR was also significantly higher in the subgroup of patients with OGB who had OP vs IP exams(95% vs 80% respectively,P = 0.001).The proportion of patients with incomplete exams was higher in the ICU(n = 7/13,54%) as compared to the GMF(n = 15/57,26%)(P = 0.05).There was only a single permanent SB retention case which was secondary to a previously unknown SB stricture,and the remaining incomplete SB exams were due to slow transit.Medications which affect gastrointestinal system motility were tested both individually and also in aggregate in univariate analysis in hospitalized patients(ICU and GMF) and were not predictive of incomplete capsule passage(P > 0.05).Patient location(IP vs OP) and GTT were independent predictors of incomplete CE exams(P < 0.001 and P = 0.008,respectively).CONCLUSION:Incomplete CE is a multifactorial problem.Patient location and related factors such as severity of illness and sedentary status may contribute to incomplete exams. | Cemal Yazici John Losurdo Michael D Brown Scott Oosterveen Robert Rahimi Ali Keshavarzian Leila Bozorgnia Ece Mutlu | 2012 | World Journal of Gastroenterology2012，18，36： | 6 |
| 2 | Complications of cirrhosis显示文摘 | Robert S. Rahimi Don C. Rockey | 2012 | Current Opinion in Gastroenterology2012，，3： | 1 |
| 3 | Women on the liver transplantation waitlist are at increased risk of hospitalization compared to men显示文摘BACKGROUND Hospital admissions are common among patients with cirrhosis,but patient factors associated with hospitalization have not been well characterized.Given recent data suggesting increased liver transplant waitlist dropout among women,we hypothesized that women on the liver transplant waitlist would have increased rates of hospitalization compared with men.AIM To evaluate the role of gender on risk of hospitalization for patients on the liver transplant waitlist,in order to help explain gender disparities in waitlist outcomes.METHODS Patients listed for liver transplant at a single center in the United States were prospectively enrolled in the Functional Assessment in Liver Transplantation Study.Patients included in this retrospective analysis included those enrolled between March 2012 and December 2014 with at least 12 mo of follow up and without hepatocellular carcinoma.The primary and secondary outcomes were hospitalization and total inpatient days within 12 mo,respectively.Logistic and negative binomial regression associated baseline factors with outcomes.RESULTS Of the 392 patients,41%were female,with median(interquartile range)age 58 years(52-63)and model for end-stage liver disease 18(15-22).Within 12 mo,186(47%)patients were hospitalized≥1 time;48%were readmitted,with a median of 8(4-15)inpatient days.More women than men were hospitalized(54%vs 43%;P=0.03).In univariable analysis,female sex was associated with an increased risk of hospitalization[odds ratios(OR)1.6,95%confidence interval(CI)1.0-2.4;P=0.03],which remained significant on adjusted multivariable analysis(OR 1.6,95%CI:1.1-2.6;P=0.03).Female gender was also associated with an increased number of inpatient days within 12 mo in both univariable and multivariable regression.CONCLUSION Women with cirrhosis on the liver transplant waitlist have more hospitalizations and inpatient days in one year compared with men,suggesting that the experience of cirrhosis differs between men and women,despite similar baseline illness severity.Future studies should explore gender-specific vulnerabilities to help explain waitlist disparities. | Jessica B Rubin Marie Sinclair Robert S Rahimi Elliot B Tapper Jennifer C Lai | 2019 | World Journal of Gastroenterology2019，25，8： | 0 |
| 4 | Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis显示文摘BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent hospitalizations.Nonselective beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic patients.We hypothesized that since NSBBs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related hospitalizations.AIM To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic patients.METHODS In this retrospective cohort study,we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July 2018.Independent predictors of the first HErelated readmissions were identified using Cox proportional hazards analysis.The cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver transplantation.RESULTS The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or B(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs(71.8%vs 41.8%,P<0.0001).In multivariate analysis,after adjusting for demographics,markers of liver disease severity,selective beta-blocker,lactulose and rifaximin use,NSBB use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 years.CONCLUSION NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity. | Mohammad Amin Fallahzadeh Sumeet K Asrani Elliot B Tapper Giovanna Saracino Robert S Rahimi | 2022 | World Journal of Clinical Cases2022，10，23： | 0 |
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