Background:Olmesartan,an angiotensin Ⅱ receptor blocker(ARB),is associated with gastrointestinal symptoms resembling sprue-like enteropathy.Some have proposed that enteropathy may be a class effect rather than olmesa...Background:Olmesartan,an angiotensin Ⅱ receptor blocker(ARB),is associated with gastrointestinal symptoms resembling sprue-like enteropathy.Some have proposed that enteropathy may be a class effect rather than olmesartan-specific.We performed a systematic review to identify literature of sprue-like enteropathy for all ARBs.Methods:Case reports,case series and comparative studies of ARBs were searched on PubMed and Embase databases through 21 November 2018 and then assessed.Results:A total of 82 case reports and case series as well as 5 comparative studies,including 248 cases,were selected and analysed.The ARBs listed in the case reports were olmesartan(233 users;94.0%),telmisartan(5 users;2.0%),irbesartan(4 users;1.6%),valsartan(3 users;1.2%),losartan(2 users;0.8%)and eprosartan(1 user;0.4%).The periods between ARB initiation and onset of symptoms ranged from 2 weeks to 13 years.Histologic results were reported in 218 cases,in which 201 cases(92.2%)were villous atrophy and 131 cases(60.1%)were intraepithelial lymphocytosis.Human leucocyte antigen(HLA)testing was performed in 147 patients,among whom 105(71.4%)had HLA-DQ2 or HLA-DQ8 haplotypes.Celiacassociated antibodies were tested in 169 patients,among whom 167(98.8%)showed negative results.Gluten exclusion from the diet failed to relieve symptoms of enteropathy in 127(97.7%)of 130 patients with information.Complete remission of symptoms after discontinuation of ARB was reported in 233(97.4%)of the 239 patients with information.Seven cases(2.8%)reported recurrence of symptoms after restarting olmesartan;rechallenge was not reported for the non-olmesartan ARBs.The retrospective studies conducted worldwide had inconsistent study designs(e.g.differences in periods of study and case definition)and findings.Conclusions:Although enteropathy is rare,clinicians should remain vigilant of this potential adverse event even years after medication initiation.展开更多
Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies.Preprocedural screening addresses sedation requirements;however,procedural safety may be compromised if scr...Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies.Preprocedural screening addresses sedation requirements;however,procedural safety may be compromised if screening is inaccurate.We sought to determine the reliability of our open-access scheduling system for appropriate use of conscious sedation.Methods:We prospectively and consecutively enrolled outpatient procedures booked at an academic center by open-access using screening after in-office gastroenterology(GI)consultation.We collected the cases inappropriately booked for conscious sedation and compared the characteristics for significant differences.Results:A total of 8063 outpatients were scheduled for procedures with conscious sedation,and 5959 were booked with open-access.Only 78 patients(0.97%,78/8063)were identified as subsequently needing anesthesiologist-assisted sedation;44(56.4%,44/78)were booked through open-access,of which chronic opioid(47.7%,21/44)or benzodiazepine use(34.1%,15/44)were the most common reasons for needing anesthesiologist-assisted sedation.Patients on chronic benzodiazepines required more midazolam than those not on chronic benzodiazepines(P=0.03)of those patients who underwent conscious sedation.Similarly,patients with chronic opioid use required more fentanyl than those without chronic opioid use(P=0.04).Advanced liver disease and alcohol use were common reasons for patients being booked after in-office consultation and were significantly higher than those booked with open-access(both P<0.01).Conclusions:We observed that the majority of patients can be triaged for conscious sedation using a multi-tiered screening process.Importantly,few patients(<1.0%)were inappropriately booked for conscious sedation.The most common reasons for considering anesthesiologist-assisted sedation were chronic opioid,benzodiazepine and/or alcohol use and advanced liver disease.This suggests that these entities could be included in screening processes for open-access scheduling.展开更多
Celiac disease is an autoimmune enteropathy caused by gluten in genetically predisposed individuals.In celiac disease,adaptive and innate immune activation results in intestinal damage and a wide range of clinical man...Celiac disease is an autoimmune enteropathy caused by gluten in genetically predisposed individuals.In celiac disease,adaptive and innate immune activation results in intestinal damage and a wide range of clinical manifestations.In the past,celiac disease was thought to result in signs and symptoms solely related to the gastrointestinal tract.Now,more than half of the adult population presents with extra-intestinal manifestations that can also be expected to improve on a gluten-free diet.For this reason,it is recommended that physicians have a low threshold of suspicion for celiac disease.Current knowledge of the immune pathogenesis of this autoimmune disease has served as a catalyst for the development of novel diagnostic tools and therapeutics.Over the years,highly sensitive and specific serological assays,in addition to genetic markers,have been found to target specific steps in the cascade pathway of celiac disease.Also the advent of the gluten challenge has enabled experts to design diagnostic algorithms and monitor clinical responses in clinical trials.The gluten challenge has provided substantial benefit in the advance of novel therapeutics as an adjuvant treatment to the gluten free diet.Generally,a strict gluten-free diet is highly burdensome to patients and can be limited in its efficacy.Alternative therapies-including gluten modification,modulation of intestinal permeability and immune response--could be central to the future treatment of celiac disease.展开更多
文摘Background:Olmesartan,an angiotensin Ⅱ receptor blocker(ARB),is associated with gastrointestinal symptoms resembling sprue-like enteropathy.Some have proposed that enteropathy may be a class effect rather than olmesartan-specific.We performed a systematic review to identify literature of sprue-like enteropathy for all ARBs.Methods:Case reports,case series and comparative studies of ARBs were searched on PubMed and Embase databases through 21 November 2018 and then assessed.Results:A total of 82 case reports and case series as well as 5 comparative studies,including 248 cases,were selected and analysed.The ARBs listed in the case reports were olmesartan(233 users;94.0%),telmisartan(5 users;2.0%),irbesartan(4 users;1.6%),valsartan(3 users;1.2%),losartan(2 users;0.8%)and eprosartan(1 user;0.4%).The periods between ARB initiation and onset of symptoms ranged from 2 weeks to 13 years.Histologic results were reported in 218 cases,in which 201 cases(92.2%)were villous atrophy and 131 cases(60.1%)were intraepithelial lymphocytosis.Human leucocyte antigen(HLA)testing was performed in 147 patients,among whom 105(71.4%)had HLA-DQ2 or HLA-DQ8 haplotypes.Celiacassociated antibodies were tested in 169 patients,among whom 167(98.8%)showed negative results.Gluten exclusion from the diet failed to relieve symptoms of enteropathy in 127(97.7%)of 130 patients with information.Complete remission of symptoms after discontinuation of ARB was reported in 233(97.4%)of the 239 patients with information.Seven cases(2.8%)reported recurrence of symptoms after restarting olmesartan;rechallenge was not reported for the non-olmesartan ARBs.The retrospective studies conducted worldwide had inconsistent study designs(e.g.differences in periods of study and case definition)and findings.Conclusions:Although enteropathy is rare,clinicians should remain vigilant of this potential adverse event even years after medication initiation.
文摘Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies.Preprocedural screening addresses sedation requirements;however,procedural safety may be compromised if screening is inaccurate.We sought to determine the reliability of our open-access scheduling system for appropriate use of conscious sedation.Methods:We prospectively and consecutively enrolled outpatient procedures booked at an academic center by open-access using screening after in-office gastroenterology(GI)consultation.We collected the cases inappropriately booked for conscious sedation and compared the characteristics for significant differences.Results:A total of 8063 outpatients were scheduled for procedures with conscious sedation,and 5959 were booked with open-access.Only 78 patients(0.97%,78/8063)were identified as subsequently needing anesthesiologist-assisted sedation;44(56.4%,44/78)were booked through open-access,of which chronic opioid(47.7%,21/44)or benzodiazepine use(34.1%,15/44)were the most common reasons for needing anesthesiologist-assisted sedation.Patients on chronic benzodiazepines required more midazolam than those not on chronic benzodiazepines(P=0.03)of those patients who underwent conscious sedation.Similarly,patients with chronic opioid use required more fentanyl than those without chronic opioid use(P=0.04).Advanced liver disease and alcohol use were common reasons for patients being booked after in-office consultation and were significantly higher than those booked with open-access(both P<0.01).Conclusions:We observed that the majority of patients can be triaged for conscious sedation using a multi-tiered screening process.Importantly,few patients(<1.0%)were inappropriately booked for conscious sedation.The most common reasons for considering anesthesiologist-assisted sedation were chronic opioid,benzodiazepine and/or alcohol use and advanced liver disease.This suggests that these entities could be included in screening processes for open-access scheduling.
文摘Celiac disease is an autoimmune enteropathy caused by gluten in genetically predisposed individuals.In celiac disease,adaptive and innate immune activation results in intestinal damage and a wide range of clinical manifestations.In the past,celiac disease was thought to result in signs and symptoms solely related to the gastrointestinal tract.Now,more than half of the adult population presents with extra-intestinal manifestations that can also be expected to improve on a gluten-free diet.For this reason,it is recommended that physicians have a low threshold of suspicion for celiac disease.Current knowledge of the immune pathogenesis of this autoimmune disease has served as a catalyst for the development of novel diagnostic tools and therapeutics.Over the years,highly sensitive and specific serological assays,in addition to genetic markers,have been found to target specific steps in the cascade pathway of celiac disease.Also the advent of the gluten challenge has enabled experts to design diagnostic algorithms and monitor clinical responses in clinical trials.The gluten challenge has provided substantial benefit in the advance of novel therapeutics as an adjuvant treatment to the gluten free diet.Generally,a strict gluten-free diet is highly burdensome to patients and can be limited in its efficacy.Alternative therapies-including gluten modification,modulation of intestinal permeability and immune response--could be central to the future treatment of celiac disease.
