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Seok M, Lakhoo K, Lipowska AM. An Unusual Cause of a Cecal "Seesaw" and Pneumatosis Intestinalis. Gastroenterology 2023; 164:e14-e16. [PMID: 36155189 DOI: 10.1053/j.gastro.2022.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Minji Seok
- College of Medicine, University of Illinois Chicago, Chicago, Illinois.
| | - Krutika Lakhoo
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Anna M Lipowska
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Pajot G, Lipowska AM. Intramural Esophageal Dissection After Cardiopulmonary Resuscitation. Clin Gastroenterol Hepatol 2022; 20:e4. [PMID: 32712396 DOI: 10.1016/j.cgh.2020.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Gregory Pajot
- Division of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, Illinois
| | - Anna M Lipowska
- Division of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, Illinois
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Abstract
Optimal endoscopic operations incorporate ergonomic principles into the endoscopy environment benefiting endoscopists, endoscopy unit personnel, and patients. A high prevalence of occupational musculoskeletal injuries is well established among endoscopists and gastroenterology nurses. Ergonomics can be integrated into all facets of the endoscopy unit including scheduling, endoscopy unit design, training programs, and investment in technology. Preprocedure, intraprocedure, and postprocedure areas should aim to deliver patient safety, privacy, and comfort, while also supporting endoscopists and staff with adjustable rooms and effective work flows. Team-wide educational initiatives can improve ergonomic awareness. These strategies help mitigate risks for musculoskeletal injuries and can lead to increased productivity. The COVID-19 area brings novel challenges to endoscopy.
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Affiliation(s)
- Anna M Lipowska
- Division of Gastroenterology and Hepatology, University of Illinois at Chicago, 840 South Wood Street, CSB Suite 741 (MC 716), Chicago, IL 60612, USA.
| | - Amandeep K Shergill
- Division of Gastroenterology and Hepatology, San Francisco Veterans Affairs Medical Center and University of California, 4150 Clement Street, VA 111B/ GI Section, San Francisco, CA 94121, USA
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Thaker S, Pajot G, Mikolajczyk AE, Lipowska AM. Balloon Tamponade Utilization for Severe Esophagitis Causing Hemorrhagic Shock. Cureus 2021; 13:e17172. [PMID: 34548977 PMCID: PMC8437158 DOI: 10.7759/cureus.17172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 11/05/2022] Open
Abstract
Esophagitis causing upper gastrointestinal bleeding (UGIB) is associated with significant morbidity. We present a case report of two patients with hemorrhagic shock secondary to esophagitis. Both patients underwent esophagogastroduodenoscopy demonstrating severe bleeding pan-esophagitis complicated by hemodynamic instability. Balloon tamponade for hemostasis was performed with resultant hemodynamic improvement. Severe UGIB secondary to esophagitis is difficult to control, with a high risk of complications and limited available endoscopic therapies in extensive mucosal injury. Treatments such as angiography are ineffective due to collateralization and surgery carries high morbidity and mortality. Balloon tamponade provides a rescue option for severe, refractory UGIB secondary to esophagitis.
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Affiliation(s)
- Sarang Thaker
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Gregory Pajot
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Adam E Mikolajczyk
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Anna M Lipowska
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
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Sofia MA, Lipowska AM, Zmeter N, Perez E, Kavitt R, Rubin DT. Poor Sleep Quality in Crohn's Disease Is Associated With Disease Activity and Risk for Hospitalization or Surgery. Inflamm Bowel Dis 2020; 26:1251-1259. [PMID: 31820780 PMCID: PMC7365809 DOI: 10.1093/ibd/izz258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Poor sleep quality in Crohn's disease (CD) is associated with histologic activity and clinical relapse. We sought to characterize sleep dysfunction and determine the effect of poor sleep quality on risk for hospitalization and surgery. METHODS Clinical data were collected for CD subjects including the Pittsburgh Sleep Quality Index (PSQI) and Harvey-Bradshaw index (HBI). The PSQI score and a brief medical history were obtained for control subjects. The PSQI and HBI correlation was tested at an initial clinic visit and at follow-up. Crohn's disease subjects with and without poor sleep were compared for risk of hospitalization or surgery by Kaplan-Meier and Cox proportional hazards. RESULTS Ninety-two CD and 82 control subjects were included. Crohn's disease and control subjects shared similar baseline characteristics and PSQI (8.3 vs 7.8, P = 0.31), and 77% of the CD population had PSQI >5. Crohn's disease subjects with PSQI >5 more often had inflammatory phenotypes and reported increased benzodiazepine and psychiatric medication use. Crohn's disease subjects with PSQI >5 also reported more night awakenings due to pain and bathroom use. The PSQI correlated with HBI (r = 0.256, P = 0.014), and ΔPSQI on follow-up correlated with ΔHBI (r = 0.47, P = 0.002). Cox proportional hazards model for hospitalization or surgery showed that PSQI >8 was predictive of surgery or hospitalization (hazards ratio 5.37; 95% confidence interval, 1.39-27.54). CONCLUSION There is a high burden of poor sleep quality in CD, which is associated with risk for adverse outcomes. Sleep quality may identify CD patients at risk for complications and have prognostic value in CD.
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Affiliation(s)
- M Anthony Sofia
- Inflammatory Bowel Disease Center, Oregon Health and Science University, Portland, OR, USA
| | - Anna M Lipowska
- Division of Gastroenterology and Hepatology, University of Illinois Chicago, Chicago, IL, USA
| | - Nada Zmeter
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Edgar Perez
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Robert Kavitt
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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Lipowska AM, Kavitt RT. Current Diagnostic and Treatment Strategies for Eosinophilic Esophagitis. Gastroenterol Hepatol (N Y) 2017; 13:527-535. [PMID: 29038643 PMCID: PMC5635428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus diagnosed by the presence of esophageal symptoms accompanied by an esophageal eosinophilic infiltrate. EoE has an increasing worldwide prevalence and can be a cause of dysphagia and food impactions. There is an important role for the use of proton pump inhibitors in the diagnostic pathway of EoE. Treatment paradigms for EoE aim to minimize esophageal inflammation and improve symptom control. Dietary therapy targets dietary allergens and encompasses the elemental diet, the allergy testing-directed elimination diet, and the empiric elimination diet. Pharmacologic options include topical corticosteroids as the standard first-line treatment. Multiple other pharmacologic interventions are currently under investigation and are not recommended in the most recent guidelines. Endoscopic dilation is usually reserved for patients who relapse on pharmacologic or dietary regimens or who have symptomatic stricturing disease. This article provides a comprehensive discussion of existing diagnostic and management strategies for EoE.
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Affiliation(s)
- Anna M Lipowska
- Dr Lipowska is a gastroenterology fellow and Dr Kavitt is an assistant professor of medicine and director of the Center for Esophageal Diseases in the Section of Gastroenterology, Hepatology, and Nutrition at The University of Chicago Medicine in Chicago, Illinois
| | - Robert T Kavitt
- Dr Lipowska is a gastroenterology fellow and Dr Kavitt is an assistant professor of medicine and director of the Center for Esophageal Diseases in the Section of Gastroenterology, Hepatology, and Nutrition at The University of Chicago Medicine in Chicago, Illinois
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Lipowska AM, Johns MM. Actinomycosis of the pharynx. Ear Nose Throat J 2014; 93:404-408. [PMID: 25255347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Few cases of pharyngeal actinomycosis have been documented in the literature. We describe the case of a 67-year-old white man who presented with symptoms of dysphagia. Laryngoscopy revealed a pedunculated mass in the left posterior pharyngeal wall; an excisional biopsy confirmed the diagnosis. Postoperatively, the patient underwent 10 weeks of intravenous penicillin therapy followed by 4 months of oral antibiotics, and his condition resolved. We discuss the diagnosis, management, and complications of this rare infection.
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Affiliation(s)
- Anna M Lipowska
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cho YK, Lipowska AM, Nicodème F, Teitelbaum EN, Hungness ES, Johnston ER, Gawron A, Kahrilas PJ, Pandolfino JE. Assessing bolus retention in achalasia using high-resolution manometry with impedance: a comparator study with timed barium esophagram. Am J Gastroenterol 2014; 109:829-35. [PMID: 24710506 PMCID: PMC4307753 DOI: 10.1038/ajg.2014.61] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/13/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to assess whether high-resolution impedance manometry (HRIM) could be used to assess bolus retention similar to the timed barium esophagram (TBE). METHODS Twenty achalasia patients (10 males, aged 21-79 years) were prospectively evaluated with HRIM and TBE to determine the correlation between barium column height and the impedance bolus height (IBH). The TBE protocol used a 200-ml barium challenge and the HRIM protocol used a 200-ml saline challenge protocol. Both protocols were performed in an upright position and the heights of the barium and impedance columns were measured at 1 and 5 min. Analysis of IBH was performed with a topographic technique and a spatial impedance variation plot. RESULTS There was no significant difference between the median IBH and barium column at 1 min (IBH: 12.0 cm (interquartile range (IQR), 8.0-18.0); TBE: 12.0 cm (IQR, 7.0-19.0); P=0.90) or at 5 min (IBH: 11.0 cm (IQR, 1.0-17.0); TBE: 9.0 cm (IQR, 4.0-12.0); P=0.47). In addition, the correlation between the two measurements at 1 and 5 min was 0.60 and 0.86, respectively. Using a barium column or impedance height of >5.0 as a definition of bolus retention was associated with 75% concordance at 1 min and 95% concordance at 5 min. CONCLUSIONS There was excellent agreement between TBE and high-resolution impedance manometry (HRIM) for assessing bolus retention at 5 min. Thus, HRM with impedance may be used as a single test to assess bolus retention and motor function in the management of achalasia.
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Affiliation(s)
- Yu K. Cho
- Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Anna M. Lipowska
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Frédéric Nicodème
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A.,Department of Thoracic Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Ezra N. Teitelbaum
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Eric S. Hungness
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Elyse R. Johnston
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Andrew Gawron
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Peter J. Kahrilas
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - John E. Pandolfino
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
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