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| 1 | Comparison of the diagnostic yield and outcomes between standard 8 h capsule endoscopy and the new 12 h capsule endoscopy for investigating small bowel pathology显示文摘AIM: To evaluate the completion rate and diagnostic yield of the Pill Cam SB2-ex in comparison to the Pill Cam SB2.METHODS:Two hundred cases using the 8-h Pill Cam SB2 were retrospectively compared to 200 cases using the 12 h Pill Cam SB2-ex at a tertiary academic center.Endoscopically placed capsules were excluded from the study.Demographic information,indications for capsule endoscopy,capsule type,study length,completion of exam,clinically significant findings,timestamp of most distant finding,and significant findings beyond 8 h were recorded.RESULTS:The 8 and 12 h capsule groups were well matched respectively for both age(70.90±14.19vs 71.93±13.80,P=0.46)and gender(45.5%vs48%male,P=0.69).The most common indications for the procedure in both groups were anemia and obscure gastrointestinal bleeding.Pill Cam SB2-ex had a significantly higher completion rate than Pill Cam SB2(88%vs 79.5%,P=0.03).Overall,the diagnostic yield was greater for the 8 h capsule(48.5%for SB2vs 35%for SB2-ex,P=0.01).In 4/70(5.7%)of abnormal SB2-ex exams the clinically significant findingwas noted in the small bowel beyond the 8 h mark.CONCLUSION:In our study,we found the Pill Cam SB2-ex to have a significantly increased completion rate,though without any improvement in diagnostic yield compared to the Pill Cam SB2. | Merajur Rahman Stuart Akerman Bethany De Vito Larry Miller Meredith Akerman Keith Sultan | 2015 | World Journal of Gastroenterology2015，21，18： | 12 |
| 2 | Histological healing favors lower risk of colon carcinoma in extensive ulcerative colitis显示文摘AIM:To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer(CC)or high grade dysplasia(HGD).METHODS:This is a single center(Lenox Hill Hospital)retrospective cohort and descriptive study of extensive ulcerative colitis(UC)for 20 years or more with a minimum of 3 surveillance colonoscopies and biopsies performed after the first 10 years of UC diagnosis.Data analyzed included:duration of UC,date of diagnosis of(CC)or(HGD),number of surveillance colonoscopies,and biopsies showing histological inflammation and its severity in each of 6 segments when endoscopic appearance is normal.Two subgroups of patients were compared:group 1 patients who developed CC/HGD and group 2 patients who did not develop CC/HGD.RESULTS:Of 115 patients with longstanding UC reviewed,68 patients met the inclusion criteria.Twenty patients were in group 1 and 48 in group 2.We identified the number of times for each patient when the endoscopic appearance was normal but biopsies nevertheless showed inflammation.Overall,histological disease activity in the absence of gross/endoscopic disease was found in 31.2%(95%CI:28%-35%)of colonoscopies performed on the entire cohort of 68 patients.Histological disease activity when the colonoscopy showed an absence of gross disease activity was more common in group 1 than group 2 patients,88%(95%CI:72%-97%)vs 59%(95%CI:53%-64%).Only 3/20(15%)of patients in group 1 ever had a colonoscopy completely without demonstrated disease activity(i.e.,no endoscopic or histological activity)as compared to 37/48(77%)of patients in group 2,and only 3.3%(95%CI:0.09%-8.3%)of colonoscopies in group 1 had no histological inflammation compared to23%(95%CI:20%-27%)in group 2.CONCLUSION:Progression to HGD or CC in extensive ulcerative colitis of long standing was more frequently encountered among those patients who demonstrate persistent histological inflammation in the absence of gross mucosal disease.Our findings support including the elimination of histological inflammation in the definition of mucosal healing,and support this endpoint as an appropriate goal of therapy because of its risk of increasing dysplasia and colon cancer. | Burton I Korelitz Keith Sultan Megha Kothari Leo Arapos Judy Schneider Georgia Panagopoulos | 2014 | World Journal of Gastroenterology2014，20，17： | 4 |
| 3 | Declining use of combination infliximab and immunomodulator for inflammatory bowel disease in the community setting显示文摘AIM To describe trends of combination therapy (CT) of infliximab (IFX) and immunomodulator (IMM) for inflammatory bowel disease(IBD) in the community setting. METHODS A retrospective study was conducted of all IBD patients referred for IFX infusion to our community infusion center between 04/01/01 and 12/31/14. CT was defined as use of IFX with either azathioprine, 6-mercaptopurine, or methotrexate. We analyzed trends of CT usage overall, for Crohn's disease (CD) and ulcerative colitis (UC), and for the subgroups of induction patients. We also analyzed the trends of CT use in these groups over the study period, and compared the rates of CT use prior to and after publication of the landmark SONIC trial.RESULTS Of 258 IBD patients identified during the 12 year study period, 60 (23.3%) received CT, including 35 of 133(26.3%) induction patients. Based on the CochranArmitage trend test, we observed decreasing CT use for IBD patients overall(P < 0.0001) and IBD induction patients,(P = 0.0024). Of 154 CD patients, 37(24.68%) had CT, including 20 of 77 (26%) induction patients.The Cochran Armitage test showed a trend towards decreasing CT use for CD overall(P < 0.0001) and CD induction,(P = 0.0024). Overall, 43.8% of CD patients received CT pre-SONIC vs 7.4% post-SONIC (P < 0.0001). For CD induction, 40.0% received CT preSONIC vs 10.8% post-SONIC(P = 0.0035). Among the 93 patients with UC, 19 (20.4%) received CT. Of 50 induction patients, 14 (28.0%) received CT. The trend test of the 49 patients with a known year of induction again failed to demonstrate any significant trends in the use of CT(P = 0.6). CONCLUSION We observed a trend away from CT use in IBD. A disconnect appears to exist between expert opinion and evidence favoring CT with IFX and IMM, and evolving community practice. | Joshua C Berkowitz Joanna Stein-Fishbein Sundas Khan Richard Furie Keith S Sultan | 2018 | World Journal of Gastrointestinal Pharmacology and Therapeutics2018，9，1： | 1 |
| 4 | Review of inflammatory bowel disease and COVID-19显示文摘The first cases of a novel corona virus infection were reported in Wuhan China in December of 2019,followed by the declaration of an international pandemic by the World Health Organization in March 2020.Early reports of the virus,now known as severe acute respiratory syndrome coronavirus 2,and its clinical disease coronavirus disease 2019(COVID-19),has shown higher rates of morbidity and mortality in the elderly and those with pre-existing medical conditions.Of particular concern is the safety of those with compromised immune systems.Inflammatory Bowel disease(IBD)is itself caused by a disordered immune response,with the most effective medical therapies being immune suppressing or modifying.As such,the risk of COVID-19,virus related outcomes,and appropriate management of IBD patients during the global pandemic is of immediate concern to gastroenterologists worldwide.There has been a rapid accumulation of clinical data and expert opinion on the topic.This review will highlight the latest source information on clinical observation/outcomes of the IBD population and provide a concise summary of the most up to date perspectives on IBD management in the age of COVID-19. | Keith Sultan Anjali Mone Laura Durbin Samreen Khuwaja Arun Swaminath | 2020 | World Journal of Gastroenterology2020，26，37： | 1 |
| 5 | Prognosis of lymphoma in patients following treatment with 6‐mercaptopurine/azathioprine for inflammatory bowel disease显示文摘 | Keith Sultan Burton I. Korelitz Daniel Present Seymour Katz Suzanne Sunday Iuliana Shapira | 2012 | Inflamm Bowel Dis2012，，10： | 1 |
| 6 | Hepatic manifestations of non-steroidal inflammatory bowel disease therapy显示文摘Inflammatory bowel disease(IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects. | Robert Hirten Keith Sultan Ashby Thomas David E Bernstein | 2015 | World Journal of Hepatology2015，7，27： | 1 |
| 7 | Hereditary diffuse gastric cancer: One family's story显示文摘Hereditary diffuse gastric cancer(HDGC) is an inherited form of gastric cancer that carries a poor prognosis. Most HDGCs are caused by an autosomal dominant genetic mutation in the CDH1 gene, which carries a 70%-80% lifetime risk of gastric cancer. Given its submucosal origin, endoscopic surveillance is an unreliable means of early detection, and prophylactic gastrectomy is recommended for CDH1 positive individuals older than age 20 years. We describe the case of a male with recurrent gastric cancer who was diagnosed with HDGC secondary to the CDH1 mutation, and we also describe the patient's pedigree and outcomes of recommended genetic testing. | Haley M Zylberberg Keith Sultan Steven Rubin | 2018 | World Journal of Clinical Cases2018，6，1： | 0 |
| 8 | Correlation of abnormal histology with endoscopic findings among mycophenolate mofetil treated patients显示文摘AIM To describe all abnormal histological findings and their associated endoscopic presentation in patients using mycophenolate mofetil(MMF).METHODS A retrospective review of all individuals prescribed MMF within 6 mo of a colonoscopy or flexible sigmoidoscopy between 07/2009 and 09/2015 was performed within Northwell Health system.Records were analyzed for age,gender,procedure indication,MMF indication,and both gross and microscopic findings.Only reports with abnormal histology were included.RESULTS One hundred and eighty-four procedures from 170 patients were found,of which 39 met inclusion criteria.Fifty-one point three percent were female.MMF was used for solid organ transplant in 71.8%.Diarrhea was the indication for 71.8% of colonoscopies.Fiftynine percent of reports revealed gross and microscopic abnormalities while 41.0% had only microscopic findings.Only 11 patients' reports(28.2%) indicated a specific histopathology of MMF colitis.Among the entire group,only 23.1% of abnormal histology was isolated proximal to the splenic flexure.CONCLUSION Our results demonstrate a high rate of left sided disease and microscopic findings without gross mucosal abnormalities among patients using MMF.Also,a broader definition of MMF-colonopathy may be appropriate,with a majority of our abnormal histology falling outside of the more narrowly defined MMF-colitis category.Given the high frequency of isolated microscopic abnormalities and distal disease,sigmoidoscopy with random biopsies may be an appropriate,less invasive initial endoscopic examination in selected MMF patients. | Mitchell A Izower Merajur Rahman Ernesto P Molmenti Madhu C Bhaskaran Viren G Amin Sundas Khan Keith Sultan | 2017 | World Journal of Gastrointestinal Endoscopy2017，9，8： | 0 |
| 9 | Combination therapy for inflammatory bowel disease显示文摘Biologic therapies such as infliximab and adalimumab have become mainstays of treatment for inflammatory bowel disease. Early studies suggested that combination therapy(CT) with infliximab and an immunomodulator drug such as azathioprine may help optimize biologic pharmacokinetics, minimize immunogenicity, and improve outcomes. The landmark SONIC trial in Crohn's disease and the UC SUCCESS trial in ulcerative colitis demonstrated CT with infliximab and azathioprine to be superior to monotherapy with either agent alone at inducing clinical remission in treatment na?ve patients with moderate to severe disease. However, many unanswered questions linger. The role of CT in non-naive patients as well as the optimal duration of CT remains unknown. The effectiveness of CT with alternate biologics and/or alternate immunomodulators is not as clear, and it is unknown whether SONIC's conclusions can be extrapolated beyond infliximab and azathioprine. Also looming are the risks of CT including opportunistic infection and malignancy; specifically, lymphoma. This review lays out the evidence as it pertains to the risks and benefits of CT as well as the areas that require further research. With this information in hand, the practitioner may develop a treatment strategy that best suits each individual patient. | Keith S Sultan Joshua C Berkowitz Sundas Khan | 2017 | World Journal of Gastrointestinal Pharmacology and Therapeutics2017，8，2： | 0 |
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