Ryan E. Childers

Practice patterns of sedation for colonoscopy

BACKGROUND Sedative and analgesic medications have been used routinely for decades to provide patient comfort, reduce procedure time, and improve examination quality during colonoscopy. OBJECTIVE To evaluate trends of sedation during colonoscopy in the United States. SETTING Endoscopic data repository of U.S. gastroenterology practices (Clinical Outcomes Research Initiative, CORI database from 2000 until 2013). PATIENTS The study population was made up of patients undergoing a total of 1,385,436 colonoscopies. INTERVENTIONS Colonoscopy without any intervention or with mucosal biopsy, polypectomy, various means of hemostasis, luminal dilation, stent placement, or ablation. MAIN OUTCOME MEASUREMENTS Dose of midazolam, diazepam, fentanyl, meperidine, diphenhydramine, promethazine, and propofol used for sedation during colonoscopy. RESULTS During the past 14 years, midazolam, fentanyl, and propofol have become the most commonly used sedatives for colonoscopy. Except for benzodiazepines, which were dosed higher in women than men, equal doses of sedation were given to female and male patients. White patients were given higher doses than other ethnic groups undergoing sedation for colonoscopy. Except for histamine-1 receptor antagonists, all sedative medications were given at lower doses to patients with increasing age. The dose of sedatives was higher in colonoscopies associated with procedural interventions or of long duration. LIMITATIONS Potential for incomplete or incorrect documentation in the database. CONCLUSION The findings reflect on colonoscopy practice in the United States during the last 14 years and provide an incentive for future research on how sex and ethnicity influence sedation practices.

Family history of inflammatory bowel disease among patients with ulcerative colitis: a systematic review and meta-analysis.

BACKGROUND AND AIMS Despite numerous shared susceptibility loci between Crohns disease and ulcerative colitis, the prevalence of family history among ulcerative colitis patients is not well-established and considered to be less prevalent. A systemic review and meta-analysis were conducted to estimate the prevalence of family history of inflammatory bowel disease in ulcerative colitis patients, and its effect on disease outcomes. METHODS PubMED was searched to identify studies reporting the prevalence of family history of inflammatory bowel disease among ulcerative colitis patients. Definitions of family history, study type, and subtypes of family history prevalence were abstracted, as were disease outcomes including age at ulcerative colitis diagnosis, disease location, surgery and extraintestinal manifestations. Pooled prevalence estimates were calculated using random effects models. RESULTS Seventy-one studies (86,824 patients) were included. The prevalence of a family history of inflammatory bowel disease in ulcerative colitis patients was 12% (95% confidence interval [CI] 11 to 13%; range 0-39%). Family history of ulcerative colitis (9%; 22 studies) was more prevalent than Crohns disease (2%; 18 studies). Patients younger than 18years of age at time of diagnosis had a greater family history of inflammatory bowel disease (prevalence 15%, 95% CI: 11-20%; 13 studies). There were no differences in disease location, need for surgery, or extraintestinal manifestations among those with a family history, although very few studies reported on these outcomes. CONCLUSIONS Overall, 12% of ulcerative colitis patients have a family history of inflammatory bowel disease, and were more likely to have a family history of ulcerative colitis than Crohns disease. Pediatric-onset ulcerative colitis patients were more likely to have a family history of inflammatory bowel disease.

Diagnosis of Alcoholic Liver Disease: Key Foundations and New Developments

Alcoholic liver disease is a spectrum of conditions that include alcoholic fatty liver disease, alcoholic hepatitis, and chronic alcoholic liver disease. The diagnosis of alcoholic liver disease remains founded in an accurate patient history and detailed physical examination. Concurrent with the physical examination, objective data from laboratory, imaging, and histologic studies are helpful to confirm a diagnosis of alcoholic liver disease. Novel biomarkers, scoring systems, and imaging modalities are improving the ability to diagnose and manage alcoholic liver disease, but for most practicing clinicians, these have not been adopted widely because of their cost, but also because of limitations and uncertainty in their performance characteristics.

Highway Tollbooth Worker

Ten o’clock hits, and I am nestled. Thermos, newspaper, radio, Pictures of my wife, my kids Dog-eared and taped to the glass. Midnight; traffic becomes lighter. A few gulps of coffee help Wash my heart pills down. Doc said “Take ‘em at bedtime” But when you work a double, You sometimes forget. Two o’clock comes; the night whispers. I turn up the radio Against the chill of the winter air And the stillness of this highway. Funny beats in my chest—it’s just the coffee. Four o’clock glides; the night is long. My legs are heavy, cramped; The sweet surrender of sleep Beckons like the soft hoot Of a barn owl, or the horn of a barge On some cold, black water nearby. Six o’clock settles; the dawn quietly peeks. Notes of sweetness arrive On the crisp morning breeze And my heart, now steady, Lifts and soars; my soul warms With thoughts of home.

Family History of Inflammatory Bowel Disease Among Patients with Ulcerative Colitis: A Systematic Review and Meta-Analysis: P-77

postoperative use of anti-TNF biologics (16.7% vs. 7.9%, P 1⁄4 0.002) than the adults. Pouch failed in 100 patients (7.8%) after a mean follow-up of 10.666.8 years, including 13(12.0%) in the pediatric group and 87 (7.4%) in the adult group (P 1⁄4 0.082). Risk factors for pouch failure in the multivariate analysis included preoperative use of anti-TNF biologics, postoperative use of anti-TNF biologics, Crohn’s disease of pouch, pouch surgery-related complications and postoperative pouch-associated hospitalization. However, pediatric patients were not found to be significantly associated with pouch failure in neither the univariate nor multivariate analyses, with a hazard ratio of 0.67 (95% confidence interval: 0.36-1.24, P 1⁄4 0.2) from the multivariate analysis. CONCLUSION(S): Pediatric patients suffered from a higher incidence of postoperative pouch complications than adults; however the long-term pouch retention rates were comparable.