Michael Demyen

Lipid-Lowering Agents and Hepatotoxicity

Lipid-lowering therapy is increasingly being used in patients for a variety of diseases, the most important being secondary prevention of cardiovascular disease. Many lipid-lowering drugs carry side effects that include elevations in hepatic function tests and liver toxicity. In many cases, these drugs are not prescribed or they are underprescribed because of fears of injury to the liver. This article attempts to review key trials with respect to the hepatotoxicity of these drugs. Recommendations are also provided with respect to the selection of low-risk patients and strategies to lower the risk of hepatotoxicity when prescribing these medications.

A Review of the Long-Term Oncologic Outcomes of Robotic Surgery Versus Laparoscopic Surgery for Colorectal Cancer

[This corrects the article DOI: 10.1007/s12262-015-1375-8.].

Time Trends and Predictors of Acute Gastroenteritis in the United States: Results From National Health and Nutrition Examination Survey 2005-2014

GOALS To investigate the time trends of the prevalence and predictors of acute gastroenteritis (AGE) in the United States from 2005 to 2014 using nationally representative data. BACKGROUND AGE results in numerous visits to emergency departments and outpatient clinics annually in the United States with the estimated attributable cost to the US economy up to

Peppered and rare - Gastric and duodenal pseudomelanosis: A case series

145 billion dollars. However, time trends and predictors of AGE are not fully understood. METHODS Data were obtained from the National Health and Nutrition Survey (NHANES) 2005 to 2014, a nationally representative health survey. AGE was defined by a medical question (Do you have a stomach or intestinal illness with vomiting or diarrhea that started during last 30 d?). Prevalence of AGE was estimated in the total population as well as by selected demographic variables. Predictors of AGE and time trends of prevalence over survey periods were also investigated. RESULTS Overall monthly prevalence of AGE was 8.31% (95% confidence interval, 7.81-8.81), corresponding to 22.8 million people. AGE was associated with a younger age group, the highest in ages 0 to 9 years old, females, winter to early spring season, US born, divorced/separated/widowed individuals, current smokers, heavy alcohol users, and low household income. In the trends analyses, the prevalence of AGE significantly decreased over the study periods: 10.23% in 2005 to 2006, 9.89% in 2007 to 2008, 7.58% in 2009 to 2010, 6.44% in 2011 to 2012, and 7.47% in 2013 to 2014 (trend P<0.001). CONCLUSION In the United States from 2005 to 2014, the monthly prevalence of AGE was 8.31% and has been significantly decreasing over time.Goals: To investigate the time trends of the prevalence and predictors of acute gastroenteritis (AGE) in the United States from 2005 to 2014 using nationally representative data. Background: AGE results in numerous visits to emergency departments and outpatient clinics annually in the United States with the estimated attributable cost to the US economy up to

Lymphangioma of Esophagus Presenting with Dysphagia: A Case Report

145 billion dollars. However, time trends and predictors of AGE are not fully understood. Methods: Data were obtained from the National Health and Nutrition Survey (NHANES) 2005 to 2014, a nationally representative health survey. AGE was defined by a medical question (Do you have a stomach or intestinal illness with vomiting or diarrhea that started during last 30 d?). Prevalence of AGE was estimated in the total population as well as by selected demographic variables. Predictors of AGE and time trends of prevalence over survey periods were also investigated. Results: Overall monthly prevalence of AGE was 8.31% (95% confidence interval, 7.81-8.81), corresponding to 22.8 million people. AGE was associated with a younger age group, the highest in ages 0 to 9 years old, females, winter to early spring season, US born, divorced/separated/widowed individuals, current smokers, heavy alcohol users, and low household income. In the trends analyses, the prevalence of AGE significantly decreased over the study periods: 10.23% in 2005 to 2006, 9.89% in 2007 to 2008, 7.58% in 2009 to 2010, 6.44% in 2011 to 2012, and 7.47% in 2013 to 2014 (trend P<0.001). Conclusion: In the United States from 2005 to 2014, the monthly prevalence of AGE was 8.31% and has been significantly decreasing over time.

Intravenous Glucagon Beneficial During Colonoscopy in Patient with IBS

Upper Gastrointestinal (GI) pseudomelanosis is an uncommon entity characterized by endoscopic visualization of speckled dark mucosal pigmentation. While described in the rectum and colon, ‘melanosis’ or more aptly ‘pseudomelanosis’ is rare in the duodenum and exceedingly rare in the stomach. Five cases of pseudomelanosis were encountered at our department. Four females and one male were diagnosed, with a mean age of 70 years. All patients exhibited duodenal pseudomelanosis, with one demonstrating gastric antral pseudomelanosis as well. Common features among these patients included iron deficiency anemia, hypertension, chronic kidney disease, hydralazine use and iron supplementation. Biopsy specimens stained at least partially positive for iron and stains for calcium and copper were negative. Histochemical analysis revealed the pigment of pseudomelanosis to be mainly iron sulfide, exhibiting unpredictable staining patterns, hypothesized to be secondary to varying sulfur content and iron oxidation. It is visualized as dark deposits in macrophages at the tips of the duodenal villi. Upper GI pseudomelanosis remains a poorly understood finding, weakly associated with chronic kidney disease, diabetes, hypertension, iron supplements and anti-hypertensive medications. While the pathogenesis, clinical and prognostic significance remains unclear, it is thus far considered a benign condition.

Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population: Results From the National Health and Nutrition Examination Surveys 2009-2014

Lymphangioma of the esophagus is a benign vascular tumor that rarely occurs in the upper gastrointestinal tract. We report a rare case of lymphangioma of the esophagus and our experience with endoscopic resection of this lesion. Lymphangiomas are benign lesions that arise from the cystic dilatation of hamartomas in deep lymphatic tissue and are rarely found in the GI tract (1%). The esophagus is the most unusual location for this lesion. The diagnosis of lymphagioma is usually made on histopathology. The masses are composed of enlarged channels lined by lymphatic endothelial cells surrounded by a loose myxoid stroma. Standard biopsies are often normal as the lesions are submucosal. The treatment of esophageal lymphangioma is conservative in asymptomatic patients. For symptomatic pateints, response to surgical or endoscopic removal of these tumors is excellent. However, a large tumor with symptoms or a lesion suspicious for malignancy requires surgical resection. Conclusion: Lymphangioma of the esophagus is a rare submucosal tumor, generally small and benign in nature. Endoscopic ultrasound is an excellent tool for diagnosis of these lesions. Our experience reaffirms that endoscopic excision of such lesions is safe and appears to be without major complications.

Obesity, Metabolic Syndrome, and Cardiovascular Risk in Gluten-Free Followers Without Celiac Disease in the United States: Results from the National Health and Nutrition Examination Survey 2009–2014

Background and Aim: Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits. Patients with IBS requiring colonoscopy take longer time to cecum with higher need for medications used for conscious sedation. Glucagon is routinely used during endoscopic procedures to reduce peristalsis that interfere with the procedure. However, randomized controlled data using glucagon during endoscopic procedures are lacking. We designed a prospective randomized placebo-controlled trial to study the effect of intravenous glucagon given during colonoscopy. Materials and Methods: We received approval from the FDA for this off-label use of glucagon during colonoscopy. This is a double-blind randomized placebo-controlled study. Patients were selected based on ROME III criteria for IBS; patients who met Rome III criteria and had an indication for colonoscopy for age-specific colon cancer screening or for work up of any alarm signs. We selected 34 patients meeting the Rome III for IBS and randomized into Group A and Group B. Both the performing endoscopist and patients were blinded. These patients in both groups initially received a standard dose of conscious sedation, up to 100 mcg of fentanyl and up to 5 mg of midazolam intravenously. In Group A, 17 patients, in addition to conscious sedation, received 1 ml saline as placebo. In Group B, 17 patients, in addition to conscious sedation, received 1 mg of intravenous glucagon. Parameters evaluated were as follows: 1) Total time required for colonoscopy 2) Completion of colonoscopy as documented by cecal intubation or visualization of appendicular orifice 3) Level of comfort in patient concerned to postprocedure spasmodic pain, which was based on Wong-Baker FACES pain rating scale and 4) Calculate the amount of sedation required in both groups of patients and also at what extent glucagon helped to decrease the requirement of sedatives. Data was analyzed using the student t-test.