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1. Vacuum-Sponge Therapy Placed through a Percutaneous Gastrostomy to Treat Spontaneous Duodenal Perforation

Author

Maude Martinho-Grueber, Ioannis Kapoglou, Eileen Benz, Yves Borbély, Pascal Juillerat, and Riad Sarraj

Subjects
duodenal ulcer, duodenal perforation, postoperative leakage, endoscopic management, vacuum-sponge therapy, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Duodenal perforation is rare and associated with a high mortality. Therapeutic strategies to address duodenal perforation include conservative, surgical, and endoscopic measures. Surgery remains the gold standard. However, endoscopic management is gaining ground mostly with the use of over-the-scope clips and vacuum-sponge therapy. A 67-year-old male patient was admitted to the emergency room for persistent epigastric pain, melena, and signs of sepsis. The physical assessment revealed reduced bowel sounds, involuntary guarding, and rebound tenderness in the upper abdominal quadrant. A contrast-enhanced computed tomography (CT) scan confirmed the suspicion of ulcer perforation. The initial laparoscopic surgical approach required conversion to laparotomy with overstitching of the perforation. In the postoperative course, the patient developed signs of increased inflammation and dyspnea. A CT scan and an endoscopy revealed a postoperative leakage and pneumonia. We placed an endoscopic duodenal intraluminal vacuum-sponge therapy with endoscopic negative pressure for 21 days. The leakage healed and the patient was discharged. Most experience in endoscopic vacuum-sponge therapy for gastrointestinal perforations has been gained in the area of esophageal and rectal transmural defects, whereas only few reports have described its use in duodenal perforations. In our case, the need for further surgical management could be avoided in a patient with multiple comorbidities and a reduced clinical status. Moreover, the pull-through technique via PEG for sponge placement reduces the intraluminal distance of the Eso-Sponge tube by shortcutting the length of the esophagus, thus decreasing the risk of dislocation and increasing the chance of successful treatment.

Published
2022
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2. Alcohol and cannabis consumption in patients with inflammatory bowel disease: prevalence, pattern of consumption and impact on the disease

Author

Maude, Martinho-Grueber, Ioannis, Kapoglou, Francisco, Bravo, Riad, Sarraj, Eileen, Benz, Sophie, Restellini, Luc, Biedermann, Gerhard, Rogler, Stephan R, Vavricka, Alain, Schoepfer, Michel H, Maillard, Pierre, Michetti, Felix, Brunner, Carole, Clair, Mamadou Pathe, Barry, Valérie, Pittet, Roland, von Känel, Pascal, Juillerat, University of Zurich, and Martinho-Grueber, Maude

Subjects
Male, Alcohol Drinking, Ethanol, Hepatology, Gastroenterology, 610 Medicine & health, 2700 General Medicine, Inflammatory Bowel Diseases, Cohort Studies, Humans, Cannabis, Prevalence, Alcohol Drinking/adverse effects, Alcohol Drinking/epidemiology, Inflammatory Bowel Diseases/epidemiology, Chronic Disease, 10219 Clinic for Gastroenterology and Hepatology, 10057 Klinik für Konsiliarpsychiatrie und Psychosomatik, 610 Medizin und Gesundheit
Abstract

OBJECTIVES OF THE STUDY There is little guidance regarding the impact of alcohol and cannabis on the clinical course of inflammatory bowel disease. The aim of this study was to assess the prevalence, sociodemographic characteristics and impact of alcohol and cannabis use on the clinical course of the disease. METHODS We performed an analysis of prospectively collected data within the Swiss Inflammatory Bowel Disease Cohort Study with yearly follow-ups and substance-specific questionnaires. We analyzed the prevalence of use, the profile of users at risk for addiction and the impact of alcohol and cannabis on the course of the disease. RESULTS We collected data of 2828 patients included between 2006 and 2018 and analyzed it according to their completion of specific surveys on alcohol and cannabis use. The prevalence of patient-reported active use was 41.3% for alcohol and 6% for cannabis. Heavy drinkers were over-represented among retired, married smokers receiving mostly aminosalicylates and less immunosuppression. In ulcerative colitis patients, low-to-moderate drinking was associated with less extensive disease. Cannabis users were often students with ileal Crohn's disease. CONCLUSION A significant proportion of patients with inflammatory bowel disease consume alcohol or cannabis. Heavy alcohol consumption is most likely in male smokers >50 years, whereas young men with ileal disease rather use cannabis.

Published
2023
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3. Effects of anti-TNF therapy and immunomodulators on anxiety and depressive symptoms in patients with inflammatory bowel disease: a 5-year analysis

Author

Alexander R. Siebenhüner, Jean-Benoît Rossel, Philipp Schreiner, Matthias Butter, Thomas Greuter, Niklas Krupka, Sebastian B. U. Jordi, Luc Biedermann, Gerhard Rogler, Benjamin Misselwitz, Roland von Känel, Karim Abdelrahman, Gentiana Ademi, Patrick Aepli, Amman Thomas, Claudia Anderegg, Anca-Teodora Antonino, Eva Archanioti, Eviano Arrigoni, Nurullah Aslan, Diana Bakker de Jong, Bruno Balsiger, Mamadou-Pathé Barry, Polat Bastürk, Peter Bauerfeind, Andrea Becocci, José M. Bengoa, Janek Binek, Mirjam Blattmann, Stephan Boehm, Tujana Boldanova, Jan Borovicka, Christian P. Braegger, Stephan Brand, Francisco Bravo, Lukas Brügger, Simon Brunner, Patrick Bühr, Sabine Burk, Emanuel Burri, Sophie Buyse, Dahlia-Thao Cao, Ove Carstens, Dominique H. Criblez, Fabrizia D’Angelo, Philippe de Saussure, Lukas Degen, Joakim Delarive, Christopher Doerig, Barbara Dora, Susan Drerup, Carole Ducrey, Ali El-Wafa, Matthias Engelmann, Aude Erdmann-Voisin, Christian Felley, Markus Fliegner, Montserrat Fraga, Yannick Franc, Pascal Frei, Remus Frei, Michael Fried, Florian Froehlich, Raoul Ivano Furlano, Luca Garzoni, Martin Geyer, Marc Girardin, Delphine Golay, Ignaz Good, Ulrike Graf Bigler, Sébastien Godat, Beat Gysi, Johannes Haarer, Marcel Halama, Janine Haldemann, Pius Heer, Benjamin Heimgartner, Beat Helbling, Peter Hengstler, Denise Herzog, Cyrill Hess, Roxane Hessler, Klaas Heyland, Thomas Hinterleitner, Claudia Hirschi, Petr Hruz, Pascal Juillerat, Ioannis Kapoglou, Stephan Kayser, Céline Keller, Carolina Khalid-de Bakker, Christina Knellwolf, Christoph Knoblauch, Henrik Köhler, Rebekka Koller, Claudia Krieger, Patrizia Künzler, Rachel Kusche, Frank Serge Lehmann, Andrew Macpherson, Michel H. Maillard, Michael Manz, Maude Martinho, Rémy Meier, Christa Meyenberger, Pamela Meyer, Pierre Michetti, Bernhard Morell, Patrick Mosler, Eleni Moschouri, Christian Mottet, Christoph Müller, Beat Müllhaupt, Leilla Musso, Michaela Neagu, Cristina Nichita, Jan Niess, Andreas Nydegger, Nicole Obialo, Cassandra Oropesa, Ulrich Peter, Daniel Peternac, Laetitia Marie Petit, Valérie Pittet, Daniel Pohl, Marc Porzner, Claudia Preissler, Nadia Raschle, Ronald Rentsch, Sophie Restellini, Jean-Pierre Richterich, Sandra Riedmüller, Branislav Risti, Marc Alain Ritz, Nina Röhrich, René Roth, Vanessa Rueger, Markus Sagmeister, Gaby Saner, Riad Sarraj, Bernhard Sauter, Mikael Sawatzki, Michael Scharl, Sylvie Scharl, Martin Schelling, Susanne Schibli, Hugo Schlauri, Dominique Schluckebier, Daniela Schmid, Sybille Schmid, Jean-François Schnegg, Alain Schoepfer, Frank Seibold, Mariam Seirafi, Gian-Marco Semadeni, Arne Senning, Christiane Sokollik, Joachim Sommer, Johannes Spalinger, Holger Spangenberger, Philippe Stadler, Peter Staub, Dominic Staudenmann, Volker Stenz, Michael Steuerwald, Alex Straumann, Andreas Stulz, Michael Sulz, Michela Tempia-Caliera, Joël Thorens, Kaspar Truninger, Radu Tutuian, Patrick Urfer, Stephan Vavricka, Francesco Viani, Fabrizion Vinzens, Jürg Vögtlin, Roland Von Känel, Dominique Vouillamoz, Rachel Vulliamy, Marianne Vullièmoz, Paul Wiesel, Reiner Wiest, Stefanie Wöhrle, Bahtiyar Yilmaz, Samuel Zamora, Silvan Zander, Jonas Zeitz, Dorothee Zimmermann, University of Zurich, and Siebenhüner, Alexander R

Subjects
medicine.medical_specialty, mood, 610 Medicine & health, Disease, RC799-869, Hospital Anxiety and Depression Scale, Inflammatory bowel disease, Group B, depressive symptoms, inflammatory bowel disease, Internal medicine, medicine, 2715 Gastroenterology, psychosocial factors, Depression (differential diagnoses), Original Research, hospital anxiety and depression scale, business.industry, Gastroenterology, anti-TNF, Diseases of the digestive system. Gastroenterology, anxiety, medicine.disease, Ulcerative colitis, digestive system diseases, immune-modulatory therapy, 10219 Clinic for Gastroenterology and Hepatology, 10057 Klinik für Konsiliarpsychiatrie und Psychosomatik, Mood, Anxiety, medicine.symptom, business
Abstract

Background and aims: Anxiety and depression are prevalent in patients with inflammatory bowel diseases (IBD), especially during IBD flares. IBD therapies can profoundly affect the mood of patients with IBD. We aimed to determine the long-term impact of anti-tumor necrosis factor (anti-TNF) and immunomodulators (IM) on anxiety and depressive symptoms in IBD patients. Methods: We compared three treatment groups with IM only (group A), anti-TNF ± IM (group B) and no such therapy (group C). Patients completed the hospital anxiety and depression scale (HADS) at 1 year, 3 years, and 5 years after start of treatment. Results: In total, 581 patients with IBD (42.9% Crohn’s disease, 57.1% ulcerative colitis/IBD unclassified) participated in this study. Effects of treatment were analyzed in a mixed effects model, with and without correction for confounders. Compared with group C, group B showed a significant treatment-related improvement in both anxiety and depressive symptoms within the first 2.5 years and also thereafter. Group A showed a significant long-term improvement of anxiety and both short-term and long-term improvement in depressive symptoms. The significance of these results was maintained after correction for confounders, including corticosteroid treatment. Additionally, both groups A and B showed a significant decrease in disease activity in the first 2.5 years after start of treatment and also thereafter. Anti-TNF and IM treatment were associated with a similarly significant decrease in anxiety and depressive symptoms over an observation period of up to 5 years. Conclusion: Besides a clear benefit for disease activity, anti-TNF and IM apparently improve the mood of patients with IBD.

Published
2021
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4. Recurrent dysphagia after bariatric surgery

Author

Riad Sarraj, Heather Dawson, Niklas Krupka, and Marion Bionda

Subjects
medicine.medical_specialty, medicine.disease_cause, Epigastric pain, 03 medical and health sciences, 0302 clinical medicine, Weight loss, medicine, Outpatient clinic, 030212 general & internal medicine, 610 Medicine & health, Hepatology, Gastric bypass surgery, business.industry, digestive, oral, and skin physiology, Gastroenterology, Heartburn, Endoscopy, Trimipramine, Dysphagia, Surgery, B symptoms, 570 Life sciences, biology, 030211 gastroenterology & hepatology, medicine.symptom, business, medicine.drug
Abstract

A 62-year-old female patient with a history of gastric bypass surgery (Roux-en-Y) was seen in the surgical outpatient clinic complaining of epigastric pain, heartburn and mild dysphagia. The current symptoms had started 2 months before the presentation and were increased by hot food and beverages. The patient reported no weight loss or other B symptoms. The patient’s medication included trimipramine and several food supplements. Laboratory testing revealed no abnormal results. High-resolution manometry and 24 hours impedance pH measurement were normal. We performed an oesophagogastroduodenoscopy, which revealed shedding of the mucosa along the whole length of the oesophagus, consistent with desquamation (figure …

Published
2021
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