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| 1 | Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function显示文摘AIM: To assess and compare the esophageal function after peroral endoscopic myotomy(POEM) vs other conventional treatments in achalasia.METHODS: Chart review of all achalasia patients who underwent POEM, laparoscopic Heller myotomy(LHM) or pneumatic dilation(PD) at our institution between January 2012 and March 2015 was performed. Patient demographics, type of achalasia, prior treatments, pre- and post-treatment timed barium swallow(TBE) and high-resolution esophageal manometry(HREM) findings were compared between the three treatment groups. Patients who had both pre- and 2 mo posttreatment TBE or HREM were included in the final analysis. TBE parameters compared were barium column height, width and volume of barium remaining at 1 and 5 min. HREM parameters compared were basal lower esophageal sphincter(LES) pressures and LES-integrated relaxation pressures(IRP). Data are presented as mean ± SD, median [25th, 75 th percentiles] or frequency(percent). Analysis of variance, KruskalWallis test, Pearsons χ~2 test and Fishers Exact tests were used for analysis.RESULTS: A total of 200 achalasia patients were included of which 36 underwent POEM, 22 underwent PD and 142 underwent LHM. POEM patients were older(55.4 ± 16.8 years vs 46.5 ± 15.7 years, P = 0.013) and had higher BMI than LHM(29.1 ± 5.9 kg/m^2 vs 26 ± 5.1 kg/m^2, P = 0.012). More number of patients in POEM and PD groups had undergone prior treatments compared to LHM group(72.2% vs 68.2% vs 44.3% respectively, P = 0.003). At 2 mo post-treatment, all TBE parameters including barium column height, width and volume remaining at 1 and 5 min improved significantly in all three treatment groups(P = 0.01 to P < 0.001) except the column height at 1 min in PD group(P = 0.11). At 2 mo post-treatment, there was significant improvement in basal LES pressure and LES-IRP in both LHM(40.5 mm Hg vs 14.5 mm Hg and 24 mm Hg vs 7.1 mm Hg respectively, P < 0.001) and POEM groups(38.7 mm Hg vs 11.4 mm Hg and 23.6 mm Hg vs 6.6 mm Hg respectively, P < 0.001). However, when the efficacy of three treatments were compared to each other in terms of improvement in TBE or HREM parameters at 2 mo, there was no significant difference(P > 0.05).CONCLUSION: POEM, PD and LHM were all effective in improving esophageal function in achalasia at shortterm. There was no difference in efficacy between the three treatments. | Madhusudhan R Sanaka Umar Hayat Prashanthi N Thota Ramprasad Jegadeesan Monica Ray Scott L Gabbard Neha Wadhwa Rocio Lopez Mark E Baker Sudish Murthy Siva Raja | 2016 | World Journal of Gastroenterology2016，22，20： | 7 |
| 2 | The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis显示文摘 | Mustafa S. Ascha Ibrahim A. Hanouneh Rocio Lopez Tarek Abu‐Rajab Tamimi Ariel F. Feldstein Nizar N. Zein | 2010 | Hepatology2010，，6： | 4 |
| 3 | Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension显示文摘AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade fi ndings according to the Marsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty f ive patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded fi ndings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis. | Jamilé Wakim-Fleming Nizar N Zein Ana Bennett Rocio Lopez Janice Santisi William D Carey | 2008 | World Journal of Gastroenterology2008，14，41： | 4 |
| 4 | Alpha-1 antitrypsin deficiency and the risk of hepatocellular carcinoma in end-stage liver disease显示文摘AIM:To evaluate the association between alpha-1 antitrypsin deficiency(A1ATD) and hepatocellular carcinoma(HCC) in patients with end-stage liver disease(ESLD).METHODS:Patients with cirrhosis and ESLD referred to the Cleveland Clinic Foundation for liver transplantation between 2003 and 2014 were included in the study(N = 675). ESLD was defined as having histological features of cirrhosis and/or radiological evidence of cirrhosis in the context of portal hypertension(ascites,variceal bleeding,thrombocytopenia,or hepatic encephalopathy). A1 ATD was diagnosed using phenotype characterization(MZ or ZZ),liver biopsy detection of PAS-positive diastaseresistant(PAS+) globules,or both. Patients with other causes of liver diseases such as hepatitis C virus(HCV),alcoholic liver disease and non-alcoholic steatohepatitis(NASH) or NASH were also included in the study. HCC was diagnosed by using imaging modalities,biopsy findings,or explanted liver inspection. Follow-up time was defined as the number of years from the diagnosis of cirrhosis to the diagnosis of hepatocellular carcinoma,or from the diagnosis of cirrhosis to the last follow up visit. The rate of HCC was assessed using time-tointerval analysis for interval censored data.RESULTS:This study included 675 patients. 7% of subjects had A1ATD(n = 47). Out of all subjects who did not have A1 ATD,46% had HCV,17% had alcoholic liver disease,19% had NASH and 18% had another primary diagnosis. Of the 47 subjects with A1 ATD,15 had a primary diagnosis of A1ATD(PI*ZZ phenotype and PAS+ globules),8 had a PI*MZ phenotype alone,14 had PAS+ alone,and 10 had both the PI*MZ phenotype and PAS+. Median follow-up time was 3.4(25th,75 th percentiles:1,5.2) years. The overall rate of hepatocellular carcinoma in all subjects was 29%(n = 199). In the A1 ATD group,the incidence rate of HCC was 8.5% compared to 31% in the group of patients with other causes of cirrhosis(P = 0.001). Patients with ESLD due to A1 ATD had the lowest yearly cumulative rate of hepatocellular carcinoma at 0.88% per year compared to 2.7% for those with HCV cirrhosis,1.5% in patients with NASH and 0.9% in alcohol-induced liver disease(P < 0.001).CONCLUSION:Within this group of patients with ESLD,there was no significant association between A1 ATD and increased risk of HCC. | Clara Antoury Rocio Lopez Nizar Zein James K Stoller Naim Alkhouri | 2015 | World Journal of Hepatology2015，7，10： | 3 |
| 5 | Healthcare utilization and costs associated with gastroparesis显示文摘AIM To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis.METHODS We analyzed the National Inpatient Sample Database(NIS)for all patients in whom gastroparesis(ICD-9 code:536.3)was the principal discharge diagnosis during the period,1997-2013.The NIS is the largest publicly available all-payer inpatient care database in the United States.It contains data from approximately eight million hospital stays each year.The statistical significance of the difference in the number of hospital discharges,length of stay and hospital costs over the study period was determined by regression analysis.RESULTS In 1997,there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to16460 in 2013(P<0.01).The mean length of stay for gastroparesis decreased by 20%between 1997 and 2013from 6.4 d to 5.1 d(P<0.001).However,during this period the mean hospital charges increased significantly by 159%from$13350(after inflation adjustment)per patient in 1997 to$34585 per patient in 2013(P<0.001).The aggregate charges(i.e.,'national bill') for gastroparesis increased exponentially by 1026%from$50456642±4662620 in 1997 to$568417666±22374060 in 2013(P<0.001).The percentage of national bill for gastroparesis discharges(national bill for gastroparesis/total national bill)has also increased over the last 16 years(0.0013%in 1997 vs 0.004%in2013).During the study period,women had a higher frequency of gastroparesis discharges when compared to men(1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000vs 3/10000 in 2013).There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period(P<0.001).CONCLUSION The number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years.Inpatient costs associated with gastroparesis contribute significantly to the national healthcare bill.Further research on cost-effective evaluation and management of gastroparesis is required. | Vaibhav Wadhwa Dhruv Mehta Yash Jobanputra Rocio Lopez Prashanthi N Thota Madhusudhan R Sanaka | 2017 | World Journal of Gastroenterology2017，23，24： | 3 |
| 6 | Ultrasonographic Quantitative Estimation of Hepatic Steatosis in Children With NAFLD显示文摘 | Angela Shannon Naim Alkhouri Christine Carter-Kent Lidia Monti Rita Devito Rocio Lopez Ariel E. Feldstein Valerio Nobili | 2011 | Journal of Pediatric Gastroenterology and Nutrition2011，，2： | 3 |
| 7 | Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy显示文摘AIM: To compare post-orthotopic liver transplantation (OLT) survival between patients with recurrent hepatocellular carcinoma (HCC) after partial hepatectomy and those who received de novo OLT for HCC and to assess the risk factors associated with post-OLT mortality. METHODS: From July 2003 to August 2005, 77 consecutive HCC patients underwent OLT, including 15 patients with recurrent HCC after partial hepatectomy for tumor resection (the rescue OLT group) and 62 patients with de novo OLT for HCC (the de novo OLT group). Thirty-three demographic, clinical, histological, laboratory, intra-operative and post-operative variables were analyzed. Survival was calculated by the Kaplan- Meier method. Univariable and multivariable analyses were also performed. RESULTS: The median age of the patients was 49.0 years. The median follow-up was 20 mo. Three patients (20.0%) in the rescue OLT group and 15 patients (24.2%) in the de novo OLT group died during the follow-up period (P = 0.73). The 30-day mortality of OLT was 6.7% for the rescue OLT group vs 1.6% for the de novo OLT group (P = 0.27). Cox proportional hazards model showed that pre-OLT hyperbilirubinemia, the requirement of post-OLT transfusion, the size of the tumor, and family history of HCC were significantly associated with a higher hazard for mortality. CONCLUSION: There are no significant differences in survival/mortality rates between OLT as de novo therapy and OLT as a rescue therapy for patients with hcc. Pre-OLT hyperbilirubinemia, post-OLT requirement of transfusion, large tumor size and family history of HCC are associated with a poor survival outcome. | Zhuo Shao Rocio Lopez Bo Shen Guang-Shun Yang | 2008 | World Journal of Gastroenterology2008，14，27： | 3 |
| 8 | 食管闭锁和气管食管瘘患儿的长期结局显示文摘目的:评估食管闭锁合并(或不合并)气管食管瘘(EA/TEF)患儿的长期(不局限于儿童时期)并发症和临床结局。本研究旨在通过临床症状、诊断试验和治疗干预评估一家三甲医院EA/TEF患儿吞咽和呼吸系统并发症。方法:纳入2011-2014年间先天性EA/TEF患儿,收集这些患儿的人口统计特征、疾病分类和分型、临床症状、影像学、内镜下及支气管镜下发现及其治疗情况。结果:共计43例患儿纳入研究,其中以白人居多,中位年龄8岁(四分位间距320岁)。20例(62.5%,20/32)为C型异常(EA合并远端TEF)。21例(48.8%)有烧心症状,19例(44.1%)有反酸症状,31例(72.1%)吞咽固体食物困难。26例患儿接受钡餐检查,其中17例(65.4%)狭窄,20例(76.9%)动力不足,4例(15.4%)出现复发瘘。30例患儿接受上消化道内镜检查,其中21例(70.0%)发现狭窄,6例(20.0%)出现需外科干预的复发瘘。8例患儿行胃底折叠术。呼吸功能评估显示31例(72.1%)患儿有咳嗽和气梗,32例有呼吸困难和哮喘,19例(44.2%)患儿有反复的呼吸系统感染。其他发现包括气管软化(86.7%)和限制性肺病(54.5%)。结论:EA/TEF患儿残留的食管和气管具有较高的病理风险,需要长期随访来监测临床症状和治疗反应。 | Richard H.Cartabuke Rocio Lopez Prashanthi N.Thota | 2016 | Gastroenterology Report2016，4，4： | 2 |
| 9 | Comparative study of endoscopy vs.transjugular intrahepatic portosystemic shunt in the management of gastric variceal bleeding显示文摘Background and Aim:Gastric varices are associated with high mortality.There have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemic shunt(TIPS)is more effective in the treatment of gastric varices.We compared the outcomes of patients treated with cyanoacrylate glue or TIPS for the management of acute gastric variceal bleeding.Methods:The study was designed as a retrospective cohort analysis of patients undergoing either TIPS or endoscopic treatment with cyanoacrylate for acute gastric variceal bleeding at our institution from 2001 to 2011.Primary compared to studied between the two treatment modalities were the short-term treatment outcomes,including re-bleeding within 30 days,length of hospital stay and in-hospital mortality.Kaplan-Meier survival analysis was performed to assess factors associated with in-hospital mortality.Results:A total of 169 patients were included in the analysis.The TIPS arm contained 140 patients and the cyanoacrylate arm contained 29 patients.There was no evidence to suggest any significant differences in demographics or disease severity.There were no differences between the TIPS arm and the cyanoacrylate armtwo groups in treatment outcomes including re-bleeding within 30 days(17.4%vs.17.2%;P=0.98),median length of stay in the hospital(4.5 days vs.6.0 days;P紏0.35)or in-hospital mortality(9.0%vs.11.1%;P=0.74).In-hospital mortality was evaluated for 149 patients and lower albumin(P=0.015),higher MELD score(P<0.001),higher CTP score(P=0.005)and bleeding(P=0.008)were all significantly associated with in-hospital death.Conclusion:These findings suggest that both treatments are equally effective.Cyanoacrylate offers a safe,effective alternative to TIPS for gastric varices,and physician may choose the best therapy for each patient,factoring in the availability of TIPS or cyanoacrylate,the individual patient’s presentation,and cost. | Gursimran Singh Kochhar Udayakumar Navaneethan Jason Hartman Jose Mari Parungao Rocio Lopez Ranjan Gupta Baljendra Kapoor Paresh Mehta Madhu Sanaka | 2015 | Gastroenterology Report2015，3，1： | 2 |
| 10 | The Role of Rifaximin in the Primary Prophylaxis of Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis显示文摘 | Mohamad A. Hanouneh Ibrahim A. Hanouneh Jana G. Hashash Ryan Law Jamak Modaresi Esfeh Rocio Lopez Nyla Hazratjee Thomas Smith Nizar N. Zein | 2012 | Journal of Clinical Gastroenterology2012，，8： | 2 |
| 11 | Increased Rate of Spontaneous Bacterial Peritonitis Among Cirrhotic Patients Receiving Pharmacologic Acid Suppression显示文摘 | Gati A. Goel Abhishek Deshpande Rocio Lopez Geraldine S. Hall David van Duin William D. Carey | 2012 | Clinical Gastroenterology and Hepatology2012，，4： | 2 |
| 12 | Clostridium difficile infection is associated with worse long term outcome in patients with ulcerative colitis显示文摘 | Udayakumar Navaneethan Saurabh Mukewar Preethi GK Venkatesh Rocio Lopez Bo Shen | 2011 | Journal of Crohn’s and Colitis2011，，3： | 2 |
| 13 | Impact of Clostridium difficile infection in patients with ulcerative colitis显示文摘 | Revital Kariv Udayakumar Navaneethan Preethi G.K. Venkatesh Rocio Lopez Bo Shen | 2010 | Journal of Crohn’s and Colitis2010，，1： | 2 |
| 14 | Is liver transplantation a risk factor for cardiovascular disease? a meta‐analysis of observational studies显示文摘 | Surabhi Madhwal Ashish Atreja Mazen Albeldawdi Rocio Lopez Anthony Post Marco A. Costa | 2012 | Liver Transpl2012，，10： | 2 |
| 15 | Ultrasonographic Quantitative Estimation of Hepatic Steatosis in Children With NAFLD显示文摘 | Angela Shannon Naim Alkhouri Christine Carter-Kent Lidia Monti Rita Devito Rocio Lopez Ariel E. Feldstein Valerio Nobili | 2011 | Journal of Pediatric Gastroenterology and Nutrition2011，，2： | 2 |
| 16 | The Inflamed Liver and Atherosclerosis: A Link Between Histologic Severity of Nonalcoholic Fatty Liver Disease and Increased Cardiovascular Risk显示文摘 | Naim Alkhouri Tarek Abu-Rajab Tamimi Lisa Yerian Rocio Lopez Nizar N. Zein Ariel E. Feldstein | 2010 | Digestive Diseases and Sciences2010，，9： | 2 |
| 17 | Tu1249 Environmental Factors Impact the Natural History of Ulcerative Colitis (UC): Indian-Americans With UC Have a Higher Riks for Colectomy Than Asian Indian Counterparts显示文摘 | Saurabh Mukewar Shrikant Mukewar Kaustubh Limaye Rocio Lopez Xianrui Wu Bo Shen | 2012 | Gastroenterology2012，，5： | 1 |
| 18 | Differential Epidural Block Predicts the Success of Visceral Block in Patients with Chronic Visceral Abdominal Pain显示文摘 | Maged K. Rizk Reda Tolba Leonardo Kapural Justin Mitchell Rocio Lopez Ramatia Mahboobi Bruce Vrooman Nagy Mekhail | 2012 | Pain Practice2012，，8： | 1 |
| 19 | Validity of real time ultrasound in the diagnosis of hepatic steatosis: A prospective study显示文摘 | Srinivasan Dasarathy Jaividhya Dasarathy Amer Khiyami Rajesh Joseph Rocio Lopez Arthur J. McCullough | 2009 | Journal of Hepatology2009，，6： | 1 |
| 20 | Utility of urgent colonoscopy in acute lower gastro-intestinal bleeding:a single-center experience显示文摘Background.The role of urgent colonoscopy in lower gastro-intestinal bleeding(LGIB)remains controversial.Over the last two decades,a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions;however,studies comparing this approach to elective colonoscopy for LGIB are limited.Aims.To determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit(ICU)with acute LGIB.Methods.Consecutive patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed retrospectively.Patients were grouped into urgent vs.elective colonoscopy,depending on the timing of colonoscopy after admission to the ICU.Urgent colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered elective.Outcomes included length of hospital stay,early re-bleeding rates,and the need for additional diagnostic or therapeutic interventions.Multivariable logistic regression analysis was performed to identify factors associated with increased transfusion requirements.Results.Fifty-seven patients underwent colonoscopy for the evaluation of suspected LGIB,24 of which were urgent.There was no significant difference in patient demographics,co-morbidities,or medications between the two groups.Patients who underwent urgent colonoscopy were more likely to present with hemodynamic instability(P=0.019)and require blood transfusions(P=0.003).No significant differences in length of hospital stay,re-bleeding rates,or the need for additional diagnostic or therapeutic interventions were found.Patients requiring blood transfusions(n=27)were more likely to be female(P=0.016)and diabetics(P=0.015).Fourteen patients re-bled at a median of 2 days after index colonoscopy.Those with hemodynamic instability were more likely to re-bleed[HR 3.8(CI 1.06–13.7)],undergo angiography[HR 9.8(CI 1.8–54.1)],require surgery[HR 13.5(CI 3.2–56.5)],and had an increased length of hospital stay[HR 1.1(1.05–1.2)].Conclusion:The use of urgent colonoscopy,as an initial approach to investigate acute LGIB,did not result in significant differences in length of ICU stay,re-bleeding rates,the need for additional diagnostic or therapeutic interventions,or 30-day mortality compared with elective colonoscopy.In a pre-specified subgroup analysis,patients with hemodynamic instability were more likely to re-bleed after index colonoscopy,to require additional interventions(angiography or surgery)and had increased length of hospital stay. | Mazen Albeldawi Duc Ha Paresh Mehta Rocio Lopez Sunguk Jang Madhusudhan R.Sanaka John J.Vargo | 2014 | Gastroenterology Report2014，2，4： | 1 |
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