Amandeep Sahota

Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion

BACKGROUND Previous reports of foreign-body ingestions focused primarily on accidental ingestions. OBJECTIVE To describe the characteristics and management of foreign-body ingestions, with predominantly intentional ingestion, in a lower socioeconomic status population. DESIGN A retrospective case series. SETTING An urban county hospital. PATIENTS Patients >/=17 years old, with foreign-body ingestions between 2000 and 2006. MAIN OUTCOME MEASUREMENTS Characteristics of ingestion cases, endoscopic extraction, need for surgery, and complications. RESULTS Among 262 cases, 92% were intentional, 85% involved psychiatric patients, and 84% occurred in patients with prior ingestions. The time from ingestion to presentation was >48 hours in 168 cases (64%). The overall success rate for endoscopic extraction was 90% (165/183 cases). Surgery was performed in 30 cases (11%) and was more common for objects beyond the pylorus versus objects above the pylorus (16/43 [37%] vs 10/151 [7%], respectively) and in cases with a greater delay from ingestion to presentation (25/168 [15%] if >48 hours vs 4/77 [5%] if </=48 hours) and from presentation to intervention (15/40 [38%] if >48 hours vs 14/165 [8%] if </=48 hours). Perforation occurred in 16 cases (6%), with 6 perforations noted after endoscopy. LIMITATION A retrospective review of medical records. CONCLUSIONS Foreign-body ingestions in an urban county hospital occurred primarily in psychiatric patients who had repeated episodes of intentional ingestions. Endoscopic extraction was unsuccessful in 10% of cases. Long delays from ingestion to presentation and intervention may account for relatively high rates of surgery and perforation. Strategies to prevent ingestions and delays in endoscopic management are needed in this population.

Does Capsule Endoscopy Improve Outcomes in Obscure Gastrointestinal Bleeding? Randomized Trial Versus Dedicated Small Bowel Radiography

BACKGROUND & AIMS Capsule endoscopy improves the diagnostic yield in patients with obscure gastrointestinal (GI) bleeding, but whether it improves outcomes is uncertain. METHODS Patients with obscure GI bleeding and negative upper endoscopy, colonoscopy, and push enteroscopy were randomly assigned to capsule endoscopy or dedicated small bowel contrast radiography. Patients returned at 1, 2, 3, 6, 9, and 12 months for follow-up visits and to check hemoglobin level. The primary endpoint was further bleeding. RESULTS The predefined sample size of 136 patients (54 overt bleeding, 82 occult bleeding) was enrolled. Diagnostic yield was 20 (30%) with capsule vs 5 (7%) with radiography (difference = 23%; 95% CI: 11%-36%). Further bleeding with capsule versus radiography occurred in 20 (30%) versus 17 (24%) (difference, 6%; 95% confidence interval [CI], -9% to 21%), subsequent diagnostic or therapeutic interventions for bleeding were performed in 17 (26%) versus 15 (21%) (difference, 4%; 95% CI, -10% to 19%), subsequent hospitalizations for bleeding were required in 8 (12%) versus 4 (6%) (difference, 6%; 95% CI, -3% to 16%), and subsequent blood transfusions were given in 5 (8%) versus 4 (6%) (difference, 2%; 95% CI, -7% to 10%). Further bleeding was more common in patients presenting with overt bleeding than in those with occult bleeding (21/54 [39%] vs 16/82 [20%]; difference, 19%; 95% CI, 4% to 35%). CONCLUSIONS The significant improvement in diagnostic yield with capsule endoscopy may not translate into improved outcomes in a population with obscure GI bleeding. Most patients do well whether or not abnormalities are identified, and additional diagnostic or therapeutic interventions may be required whether or not capsule endoscopy identifies a source of bleeding.

Predictors of employment after liver transplantation

Abstract:  Employment after orthotopic liver transplantation (OLT) indicates recipients’ physical/psychosocial adjustment. Our aim was to determine clinical, socioeconomic and health‐related quality of life parameters influencing employment after OLT. Questionnaire on demographics, medical conditions, alcohol and drug use before/after OLT, and a validated 12‐Item Short Form Health Survey (SF‐12) were mailed to 126 adult OLT patients. Stepwise logistic regression was conducted to identify best predictors of post‐OLT employment. Among non‐retirees, 49% were employed after OLT. The predictors of employment were: employment status, income, disability status before OLT and Model of End Stage Liver Disease score. These variables had prediction rate of 82%. Individuals working during the five yr prior to OLT were likely to return to work (p < 0.0001), particularly those who held a job for >6 months prior to OLT (p < 0.0001), income >

Risk of Hepatitis B Virus Reactivation Among Patients Treated With Ledipasvir-Sofosbuvir for Hepatitis C Virus Infection

80 000 before OLT compared with <

Esophageal Capsule Endoscopy (PillCam ESO) Is Comparable to Traditional Endoscopy for Detection of Esophageal Varices-An International Multi-Center Trial

30 000 (p = 0.036). Patients receiving Social Security Insurance (SSI) payment for ≥6 months prior to OLT, were less likely to work (p = 0.0005). Severity/duration of liver dysfunction prior to OLT did not correlate with employment. Sense of physical health was poorer in those employed after OLT than in unemployed (p = 0.0003). Socioeconomic factors were the most important predictors of post‐OLT employment.

621 - Chronic Hepatitis C Virus Prevalence, Characteristics, and Genotypes Among Different Race/Ethnicity Groups in a Large Hmo Population in Southern California

Background: Direct acting antiviral (DAA) agents are the standard of care for treatment of hepatitis C virus (HCV)–infected individuals. Hepatitis B virus (HBV) reactivation during HCV treatment has been reported, the incidence and clinical outcome remains unclear. The aim of our study is to examine the risk of HBV reactivation in actively infected or previously exposed patients during or after HCV treatment with DAAs. Methods: Adults with chronic HCV infection previously exposed or actively infected with HBV and treated with DAAs between December 2015 to 2016 were included. Electronic medical records were reviewed for HCV treatment dates, HCV treatment response, DAA used, HBV status, and concurrent HBV treatment. Primary end-point was to determine the risk of HBV reactivation during or up to 3 months after DAA treatment. Results: We identified 283 patients, and 100% of patients completed HCV treatment with ledipasvir-sofosbuvir. 93% had HCV genotype-1 of whom 91% achieved sustained viral response at 12 weeks posttreatment (SVR-12). In total, 7% had HCV genotype-4 who achieved SVR-12 of 84%. Mean (±SD) age was 59.7 (±7) years, and 58% were male. A total of 45% of patients had hepatitis B core antibody (HBcAb) positive and hepatitis B surface antigen (HBsAg) negative. In total, 55% of patients had a positive HBsAg before HCV DAA treatment. No HBV reactivation was encountered in the (HBcAb) positive HBsAg-negative cohort nor in the (HBsAg) positive group with 95% confidence interval (0-0.023) and (0-0.019), respectively. Conclusion: In our study of patients with HCV and isolated hepatitis B core or HBsAg positivity, no HCV patients treated with DAA experienced HBV reactivation.