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Voiosu AM, Voiosu TA, Smarandache B, Rădoi A, Mateescu RB, Băicuş CR, Voiosu MR, Diculescu MM. The Impact of Hypoxaemia on the Outcome in Liver Cirrhosis. J Gastrointestin Liver Dis 2017; 25:481-487. [PMID: 27981304 DOI: 10.15403/jgld.2014.1121.254.voi] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Prognostic factors for poor evolution are critical in the setting of limited access to liver transplantation for patients with cirrhosis. We aimed to investigate the impact of hypoxaemia on the outcome in cirrhosis and the evolution of arterial oxygen tension during long-term follow-up in these patients. METHODS Consecutive cirrhotic patients were prospectively enroled and followed-up in our tertiary referral center. Clinical features, biological tests, arterial blood gases, NT-proBNP levels, pulse oximetry measurements, 12-lead ECG, and transthoracic contrast echocardiography were documented on enrolment. The main outcomes were death and decompensation due to liver disease. RESULTS 87 cirrhotic patients were included in the analysis and followed-up for a mean of 16 months. At enrolment, 27 (31%) patients were hypoxaemic, 19 had hepatopulmonary syndrome (HPS), but only 6 of those who were sampled at follow-up had persistent hypoxaemia. During the study period, 22 patients died of liver-related complications. Nine of them (41%) were hypoxaemic on enrolment but none had severe hypoxaemia. Hypoxaemia present at enrollment was not a risk factor for death (p=0.29) or decompensation of liver disease (p=0.7). A higher MELD score at baseline or increase during follow-up was a risk factor for death (p=0.02) and correlated with the presence of hypoxaemia. Normalization of the arterial oxygen levels was accompanied by a significant decrease in NT-proBNP (83 pg/ml vs 0 pg/mL, p=0.023). CONCLUSION Mild and moderate hypoxaemia was frequent in our patients but was not associated with adverse outcome in cirrhosis. Repeated arterial blood gas sampling is advisable, especially in patients diagnosed with hepatopulmonary syndrome.
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Affiliation(s)
- Andrei Mihai Voiosu
- Gastroenterology Department, Colentina Clinical Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Theodor Alexandru Voiosu
- Gastroenterology Department, Colentina Clinical Hospital;Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bianca Smarandache
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Aurelia Rădoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Bogdan Mateescu
- Gastroenterology Department, Colentina Clinical Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian Răsvan Băicuş
- Carol Davila University of Medicine and Pharmacy; Internal Medicine Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Mihai Mircea Diculescu
- Carol Davila University of Medicine and Pharmacy; Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania
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Chitul A, Voiosu AM, Marinescu M, Caraiola S, Nicolau A, Badea GC, Pârvu MI, Ionescu RA, Mateescu BR, Voiosu MR, Băicuş CR, Rimbaş M. Different effects of anti-TNF-alpha biologic drugs on the small bowel macroscopic inflammation in patients with ankylosing spondylitis. ACTA ACUST UNITED AC 2017; 55:44-52. [PMID: 28103201 DOI: 10.1515/rjim-2017-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS Considering the ability of anti-TNF alpha drugs to lower the burden intestinal inflammation in patients with inflammatory bowel disease (IBD), and the similarity between IBD and ankylosing spondylitis (AS) regarding inflammatory intestinal involvement, we aimed to investigate the impact of anti-TNF alpha biologic therapy on subclinical intestinal inflammation in AS patients. METHODS Between January 2008 and December 2013, 38 AS patients and 23 controls were enrolled in the study and investigated with small bowel videocapsule endoscopy examination and ileocolonoscopy. Each tertile of the small bowel (proximal, mid and distal) was assessed by calculating the Lewis score based on the image stream. RESULTS The Lewis scores were significantly higher in the AS group compared to controls (580.9 ± 818 vs. 81 ± 121, p<0.001). 16 patients (42.1%) were on anti-TNF alpha therapy (Adalimumab (n = 5), Infliximab (n = 5) or Etanercept (n = 6)).31.3% of them used NSAIDs simultaneously, compared with 77.3% of the other patients (p<0.01). Their Lewis scores were lower compared to the other patients for the entire small bowel (306 ± 164 vs. 790 ± 1038, p = 0.015), its proximal and distal tertiles (238 ± 154 vs. 560 ± 543, p = 0.021, and 140 ± 189 vs. 300 ± 220, p = 0.027, respectively). The Lewis score was also lower in patients receiving Adalimumab/Infliximab compared to those on Etanercept for the entire bowel and its distal tertile (262 ± 165 vs. 380 ± 148, p = 0.069 and 62 ± 101 vs. 273 ± 236, p = 0.060, respectively). CONCLUSION Anti-TNF alpha therapy in patients with AS reduces the subclinical intestinal inflammation, but the magnitude seems to depend upon the class anti-TNF alpha agent used (Clinical Trials. gov NCT00768950).
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Rimbaş M, Zahiu DCM, Voiosu AM, Voiosu TA, Zlate AAM, Dinu R, Galasso D, Minelli Grazioli L, Campanale M, Barbaro F, Mateescu BR, Busuioc B, Iordache T, Dolofan O, Popescu AM, Balaban VD, Raducan MM, Spada C, Băicuş CR, Costamagna G. Usefulness of virtual chromoendoscopy in the evaluation of subtle small bowel ulcerative lesions by endoscopists with no experience in videocapsule. Endosc Int Open 2016; 4:E508-14. [PMID: 27227106 PMCID: PMC4874791 DOI: 10.1055/s-0042-106206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/29/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS In videocapsule endoscopy examination (VCE), subtle variations in mucosal hue or pattern such as those seen in ulcerations can be difficult to detect, depending on the experience of the reader. Our aim was to test whether virtual chromoendoscopy (VC) techniques, designed to enhance the contrast between the lesion and the normal mucosa, could improve the characterization of ulcerative mucosal lesions. PATIENTS AND METHODS Fifteen trainees or young gastroenterologists with no experience in VCE were randomly assigned to evaluate 250 true ulcerative and 100 false ulcerative, difficult-to-interpret small bowel lesions, initially as white light images (WLI) and then, in a second round, with the addition of one VC setting or again as WLI, labeling them as real lesions or artifacts. RESULTS On the overall image evaluation, an improvement in lesion characterization was observed by adding any chromoendoscopy setting, especially Blue mode and FICE 1, with increases in accuracy of 13 % [95 %CI 0.8, 25.3] and 7.1 % [95 %CI - 17.0, 31.3], respectively. However, when only false ulcerative images were considered, with the same presets (Blue mode and FICE 1), there was a loss in accuracy of 10.7 % [95 %CI - 10.9, 32.3] and 7.3 % [95 %CI - 1.3, 16.0], respectively. The interobserver agreement was poor for both readings. CONCLUSIONS VC helps beginner VCE readers correctly categorize difficult-to-interpret small bowel mucosal ulcerative lesions. However, false lesions tend to be misinterpreted as true ulcerative with the same presets. Therefore care is advised in using VC especially under poor bowel preparation.
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Affiliation(s)
- Mihai Rimbaş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | | | - Andrei Mihai Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | - Theodor Alexandru Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | | | - Roxana Dinu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | | | | | - Bogdan Radu Mateescu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania,Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | - Bogdan Busuioc
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Tiberiu Iordache
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Oana Dolofan
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | - Mircea Mihai Raducan
- Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
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Rimbaş M, Marinescu M, Voiosu MR, Băicuş CR, Caraiola S, Nicolau A, Niţescu D, Badea GC, Pârvu MI. NSAID-induced deleterious effects on the proximal and mid small bowel in seronegative spondyloarthropathy patients. World J Gastroenterol 2011; 17:1030-5. [PMID: 21448355 PMCID: PMC3057146 DOI: 10.3748/wjg.v17.i8.1030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the small bowel of seronegative spondyloarthropathy (SpA) patients in order to ascertain the presence of mucosal lesions.
METHODS: Between January 2008 and June 2010, 54 consecutive patients were enrolled and submitted to avideo capsule endoscopy (VCE) examination. History and demographic data were taken, as well as the history of non-steroidal anti-inflammatory drug (NSAID) consumption. After reading each VCE recording, a capsule endoscopy scoring index for small bowel mucosal inflammatory change (Lewis score) was calculated. Statistical analysis of the data was performed.
RESULTS: The Lewis score for the whole cohort was 397.73. It was higher in the NSAID consumption subgroup (P = 0.036). The difference in Lewis score between NSAID users and non-users was reproduced for the first and second proximal tertiles of the small bowel, but not for its distal third (P values of 0.036, 0.001 and 0.18, respectively). There was no statistical significant difference between the groups with regard to age or sex of the patients.
CONCLUSION: The intestinal inflammatory involvement of SpA patients is more prominent in NSAID users for the proximal/mid small bowel, but not for its distal part.
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