Emad Mansoor

Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017

BACKGROUND & AIMS: Although eosinophilic esophagitis (EoE) has been extensively studied, there have been few epidemiology studies of other eosinophilic gastrointestinal disorders (EGIDs). Using a large, population‐based database, we investigated epidemiologic features of eosinophilic gastroenteritis (EoGE) and eosinophilic colitis (EoC) in the United State. METHODS: We collected data from a commercial database (Explorys Inc, Cleveland, OH) that provided electronic health records from 26 major integrated U.S. healthcare systems from 1999 to March 2017. We identified a cohort of adult and pediatric patients with EoGE and EoC from March 2012 to March 2017, based on the Systematized Nomenclature of Medicine Clinical Terms. We calculated the overall prevalence of EoGE and EoC among different patient groups, and performed age‐ and gender‐adjusted analyses to assess for differences in the prevalence of associated medical conditions in patients with EoGE and EoC and control patients (patients in the database between March 2012 and March 2017 without EGID‐associated diagnoses). RESULTS: Of the 35,826,830 individuals in the database, we identified 1820 patients with EoGE and 770 with EoC. The overall prevalence rate of EoGE was 5.1/100,000 persons; the overall prevalence rate of EoC was 2.1/100,000 persons. Each of the non‐EoE EGIDs was more prevalent in Caucasians than in African‐Americans and Asians, and in female patients than male patients. Although EoGE was more prevalent in children (under 18 years of age) than in adults, EoC was more prevalent in adults (older than 18 years of age). Compared with control patients, individuals with non‐EoE EGIDs were more likely to have been diagnosed with other gastrointestinal or allergic disorders. CONCLUSIONS: In a population‐based study in the United States, using the Explorys database, we found the overall prevalence rate of EoGE to be 5.1/100,000 persons and the prevalence rate of EoC to be 2.1/100,000; these values are at the lower end of prevalence rates previously reported in the United States.

Massive Gastrointestinal Bleeding Due to Isolated Jejunal Varices in a Patient With Extrahepatic Portal Hypertension: A Case Report.

Massive Gastrointestinal Bleeding Due to Isolated Jejunal Varices in a Patient With Extrahepatic Portal Hypertension: A Case Report

The Premise and Promise of Big Data for Tracking Population Health: Big Deal or Big Disappointment?

It is estimated that 60% of adults in the USA search for health information online, with the majority searching for a specific disease or treatment [1]. The patterns of these searches can provide important temporal and spatial data that reflect health indicators at the individual and the population levels. As examples, Google searches for a multitude of keywords accurately predicted influenza outbreaks in real-time [2]; searches for specific symptoms preceded searches for terms strongly suggestive of lung cancer [3]. In this issue of Digestive Diseases and Sciences, Hassid and colleagues [4] offer a pertinent study of the utilization of worldwide web search engine queries to study the prevalence of common gastrointestinal symptoms. The authors used Google search engine data (Google Trends) to evaluate the volume of searches for dysphagia, vomiting, and diarrhea in the USA over three years, correlating the relative changes in the search volume for these symptoms with an inpatient (National Inpatient Sample) and an outpatient (National Hospital Ambulatory Medical Care Survey) clinical dataset. The authors reported that the changes in Google search volume for dysphagia (r = 0.5, P = 0.002), diarrhea (r = 0.79, P\ 0.001), and vomiting (r = 0.76, P\ 0.001) correlated significantly with the inpatient data. Both Google Trends and NIS data indicated that the prevalence of these symptoms increased over the study period, with concordant seasonal variations. Hassid’s study, as part of the recent explosion of the application of big data analytics of the output of web search engines and social media platforms for disease epidemiology and surveillance [5], is among the first to investigate the use of web search trends to identify the prevalence of non-communicable diseases. Although this fresh approach to disease epidemiology has raised cautious optimism for the use of real-time examination and analysis of freely available online data, its relationship to tangible clinical data has not yet been fully investigated, particularly in the field of gastroenterology. Hassid’s study emphasizes that terms used by the public (e.g., diarrhea, vomiting) may be more accurately tracked through public web searches than terms used mostly by healthcare professionals (e.g., dysphagia), as evidenced by the difference in correlation strengths. One opportunity is to model multiple search terms with different weights, as originally used in the Google Flu Trends to identify relationships to clinical data, which are now made publicly available through Google Correlate and Google Insights for search. The temporal use of web searches for symptoms may also prove useful in the early detection of serious diseases. Such analyses will provide not only descriptive trends of diagnoses, but also hold promise to introduce new information acquired from the public. This study reports that the frequency of at least a few gastroenterological symptoms prevalent in the population can be tracked through web-based search engines with reasonable accuracy, providing a template for the utilization of open-access large datasets in the examination of variation in non-communicable disease epidemiology, thereby helping assign timely resources for efficient patient management of these diseases in inpatient and outpatient & Sadeer G. Al-Kindi sadeer.alkindi@uhhospitals.org

Characterization of long-term prognosis in acute pancreatitis: An explorative analysis

BACKGROUND/OBJECTIVES Severity classification systems of acute pancreatitis (AP) assess inpatient morbidity and mortality without predicting outpatient course of AP. To provide appropriate outpatient care, determinants of long-term prognosis must also be identified. The aim of this study was to define clinical groups that carry long-term prognostic significance in AP. METHODS A retrospective study that included patients admitted with AP was conducted. Determinants of long-term prognosis were extracted: These included Revised Atlanta and Determinant Based Classification (RAC), Charlson Comorbidity Index (CCI), Modified CT Severity Index (MCTSI), etiology, and local complications (LCs). Seven surrogates of morbidity up to 1 year after discharge were also collected and subsequently imputed into a clustering algorithm. The algorithm was set to produce three categories and multinomial regression analysis was performed. RESULTS 281 patients were included. The incidences of morbidity endpoints were similar among the 3 RAC categories. Three clusters were identified that carried long-term prognostic significance. Each cluster was given a name to reflect prognosis. The limited AP had the best prognosis and included patients without LCs with a low co-morbidity burden. The brittle AP had a low co-morbidity burden and high MCTSI (LCs 94%). It ran a very morbid course but had excellent survival. The high-risk AP had the worst prognosis with the highest mortality rate (28%). They had a high co-morbidity burden without local complications. CONCLUSION Categories that carry long-term prognostic significance in AP have been developed. This study could help formulate appropriate follow-up and ultimately improve AP outcomes.

Case of familial hyperlipoproteinemia type III hypertriglyceridemia induced acute pancreatitis: Role for outpatient apheresis maintenance therapy

Hypertriglyceridemic pancreatitis (HTGP) accounts for up to 10% of acute pancreatitis presentations in non-pregnant individuals and is the third most common cause of acute pancreatitis after alcohol and gallstones. There are a number of retrospective studies and case reports that have suggested a role for apheresis and insulin infusion in the acute inpatient setting. We report a case of HTGP in a male with hyperlipoproteinemia type III who was treated successfully with insulin and apheresis on the initial inpatient presentation followed by bi-monthly outpatient maintenance apheresis sessions for the prevention of recurrent HTGP. We also reviewed the literature for the different inpatient and outpatient management modalities of HTGP. Given that there are no guidelines or randomized clinical trials that evaluate the outpatient management of HTGP, this case report may provide insight into a possible role for outpatient apheresis maintenance therapy.

Visceral adiposity predicts severity of acute pancreatitis

OBJECTIVES The aim of this study was to determine the association of visceral adiposity with severe outcomes in acute pancreatitis (AP). METHODS This retrospective study included consecutive patients with AP admitted to a tertiary care hospital between January 2010 and January 2015 who underwent a computed tomography scan. The visceral adipose tissue (VAT) volume was estimated using the method of Linder and colleagues. Multivariable logistic regression analysis was conducted to assess VAT as a predictor of severe AP compared with other validated predictors of severity. RESULTS Five hundred and seventy four patients were admitted during the study period, of which 252 had a computed tomography scan available. Patients with severe AP had a larger VAT area compared with those with mild or moderate AP (mean: 184.9 cm vs 79.9 cm, P = 0.006). Patients who developed multisystem organ failure or had acute necrotic collections had a larger VAT area than those who did not (150.6 cm vs 91.0 cm, P = 0.004 and 174.0 cm vs 91.9 cm, P = 0.003, respectively). Visceral adipose tissue area demonstrated superior discrimination of severe AP compared with other severity predictors. CONCLUSIONS Increased VAT area is a strong predictor of severe pancreatitis, necrosis, and multisystem organ failure.Objectives The aim of this study was to determine the association of visceral adiposity with severe outcomes in acute pancreatitis (AP). Methods This retrospective study included consecutive patients with AP admitted to a tertiary care hospital between January 2010 and January 2015 who underwent a computed tomography scan. The visceral adipose tissue (VAT) volume was estimated using the method of Linder and colleagues. Multivariable logistic regression analysis was conducted to assess VAT as a predictor of severe AP compared with other validated predictors of severity. Results Five hundred and seventy four patients were admitted during the study period, of which 252 had a computed tomography scan available. Patients with severe AP had a larger VAT area compared with those with mild or moderate AP (mean: 184.9 cm2 vs 79.9 cm2, P = 0.006). Patients who developed multisystem organ failure or had acute necrotic collections had a larger VAT area than those who did not (150.6 cm2 vs 91.0 cm2, P = 0.004 and 174.0 cm2 vs 91.9 cm2, P = 0.003, respectively). Visceral adipose tissue area demonstrated superior discrimination of severe AP compared with other severity predictors. Conclusions Increased VAT area is a strong predictor of severe pancreatitis, necrosis, and multisystem organ failure.