The Experts below are selected from a list of 1737 Experts worldwide ranked by ideXlab platform
Lawrence J. Brandt - One of the best experts on this subject based on the ideXlab platform.
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Update on Colon Ischemia: Recent Insights and Advances
Current Gastroenterology Reports, 2015Co-Authors: Paul Feuerstadt, Lawrence J. BrandtAbstract:Colon Ischemia (CI) is the most common manifestation of ischemic injury to the gastrointestinal (GI) tract. This usually self-limited disease is being diagnosed more frequently, and the list of known causes is increasing. Local hypoperfusion and reperfusion injury are both thought to contribute to the disease process, which manifests with a wide spectrum of injury including reversible colopathy (subepithelial hemorrhage and edema), transient colitis, chronic colitis, stricture, gangrene, and fulminant universal colitis. The distribution is usually segmental with left-sided disease (e.g., inferior mesenteric artery distribution) being more frequently observed than right-sided involvement (e.g., superior mesenteric artery distribution). Any portion of the Colon can be affected, but the anatomic distribution of CI recently has been shown to be associated with outcome. Patients with isolated-right Colon Ischemia (IRCI) have a different presentation and worse outcomes than other distributions of disease. Although somewhat variable depending on disease location, CI presents with cramping abdominal pains over the segment of Colon involved followed by a short course of bloody diarrhea. Diagnosis is usually made clinically and is supported with serologic, radiologic, and Colonoscopic findings. Colonoscopy is the most accurate diagnostic study. Most patients respond to conservative supportive therapy although some with more severe disease require antimicrobials and/or surgical intervention.
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acg clinical guideline epidemiology risk factors patterns of presentation diagnosis and management of Colon Ischemia ci
The American Journal of Gastroenterology, 2015Co-Authors: Lawrence J. Brandt, Paul Feuerstadt, George F Longstreth, Scott J BoleyAbstract:ACG Clinical Guideline: Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)
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Colon Ischemia: Recent Insights and Advances
Current Gastroenterology Reports, 2010Co-Authors: Paul Feuerstadt, Lawrence J. BrandtAbstract:Ischemic colitis is the most common manifestation of ischemic injury to the gastrointestinal tract, and the variety of defined causes is increasing. Local hypoperfusion and reperfusion injury are both thought to contribute to the disease process, which manifests with a wide spectrum of injury including reversible colopathy (subepithelial hemorrhage and edema), transient colitis, chronic colitis, stricture, gangrene, and fulminant universal colitis. The distribution is typically segmental. Older studies showed that any portion of the Colon can be involved; recently, it was established that the site of involvement and prognosis can be correlated. In particular, isolated involvement of the right side of the Colon was shown to have a different presentation and worse outcome than ischemic colitis involving other segments. Diagnosis is usually made clinically and supported by radiologic imaging and Colonoscopic evaluation. Most patients respond to conservative supportive therapy, although some with severe disease require surgical intervention.
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Pharmacologically mediated Colon Ischemia.
The American journal of gastroenterology, 2007Co-Authors: David J. Hass, Patricia Kozuch, Lawrence J. BrandtAbstract:Colon Ischemia (CI) is the most common form of ischemic injury of the gastrointestinal tract. Determining the precise incidence of CI is a challenging task, because of its often brief, mild nature, and frequent spontaneous resolution, as well as its misdiagnosis as other diseases. While many underlying disease conditions may predispose patients to CI, an important and possibly overlooked etiology is that of pharmacologically induced alterations of Colonic blood flow. This review details the pharmacologic agents known to be associated with CI; when possible, their mechanisms of action are described. The aim of this paper is to highlight this often unrecognized cause of CI, thereby helping physicians to be aware of the association, to recognize its occurrence promptly, and to possibly reduce morbidity and mortality.
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Colon Ischemia
Current Treatment Options in Gastroenterology, 1999Co-Authors: David A. Greenwald, Lawrence J. BrandtAbstract:Colon Ischemia is expressed in a broad clinical spectrum, from mild, reversible Ischemia to intestinal infarction and gangrene. In most cases, the precipitating cause is unknown, and Colonic blood flow usually has normalized by the time the patient seeks medical attention. Satisfactory treatment begins with accurate diagnosis, which depends on serial Colonoscopic or roentgenographic studies and the exclusion of other disorders that may mimic Colon Ischemia. Prognosis typically is good, and most patients require only supportive care with close follow-up. More aggressive therapy, including surgery, is indicated in patients who early in their course develop massive bleeding, perforation, or signs of fulminant colitis or who subsequently develop symptomatic strictures or persistent symptoms of colitis.
Alexander M. Walker - One of the best experts on this subject based on the ideXlab platform.
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occurrence of Colon Ischemia in relation to irritable bowel syndrome
The American Journal of Gastroenterology, 2004Co-Authors: Alexander J Cole, Suzanne F. Cook, Anuli N. Ajene, Bruce E. Sands, David P Miller, Alexander M. WalkerAbstract:OBJECTIVE: In November 2000, alosetron HCl (Lotronex), a treatment for irritable bowel syndrome (IBS), was removed from the U.S. market in part because of the occurrence of Colon Ischemia in treated patients. Since the relation between Colon Ischemia and IBS is poorly understood, we evaluated the incidence of Colon Ischemia among people with and without IBS. METHODS: Using medical claims data from a large health care organization in the United States, we identified 87,449 people with an IBS diagnosis between January 1995 and December 1999. We calculated age- and sex-specific incidence rates in the general population and in IBS patients. RESULTS: There were 740 cases of Colon Ischemia during 8.5 million person-years of observation in 5.4 million persons. The crude incidence rate was 42.8 cases per 100,000 person-years for IBS patients. By comparison, the incidence rate was 7.2 per 100,000 person-years in the general population. After adjustment for age, sex, and calendar year, the incidence of Colon Ischemia in people with IBS was 3.4 times higher than in persons without (95% CI 2.6-4.5). CONCLUSIONS: Rates of Colon Ischemia among patients carrying a diagnosis of IBS are substantially higher than in the general population. Colon Ischemia, though unusual in IBS patients, may nonetheless constitute a distinct part of the IBS natural history. Alternatively, it may be a consequence of therapy, or a manifestation of other bowel pathology that is sometimes confused with IBS.
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Risk factors for Colon Ischemia.
The American journal of gastroenterology, 2004Co-Authors: Alexander M. Walker, Rhonda L. Bohn, Clorinda Cali, Suzanne F. Cook, Anuli N. Ajene, Bruce E. SandsAbstract:BACKGROUND: To identify predictors of Colon Ischemia, we examined demographic and clinical characteristics of patients, as well as their prior health care utilization. METHODS: Using insurance data, we identified 700 persons at least 20-yr old with presumed Colon Ischemia between 1995 and 1999, and 6,440 controls. Case identification was based on diagnosis and procedure codes in insurance claims for which we used a previously reported, validated algorithm. We ascertained preceding medical diagnoses and the use of drugs and health services from the insurance claims files. RESULTS: Patients with Colon Ischemia were nearly three times as likely to have IBS than controls. A history of nonspecific colitis, lower gastrointestinal tract hemorrhage, systemic rheumatologic disorders, and ischemic heart disease in the preceding 6 months, and abdominal surgery in the past month were also much more common in Colon Ischemia cases than controls. Use of a drug to treat diarrhea was strongly associated with risk. The most prevalent risk factor for Colon Ischemia was the use of drugs with a side effect of constipation, found in one-third of cases and one in nine controls. Cases had seen physicians, particularly gastroenterologists, much more commonly in the preceding 6 months than had controls. CONCLUSIONS: Clinically evident Colon Ischemia arises preferentially in persons with prior abdominal complaints, many of whom carry a diagnosis of IBS. Drugs that reduce bowel motility may constitute a widespread and potentially avoidable risk factor. The frequency of preceding doctor visits, without a specific diagnosis, suggests that Colon Ischemia may have a prolonged subacute presentation.
Paul Feuerstadt - One of the best experts on this subject based on the ideXlab platform.
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Update on Colon Ischemia: Recent Insights and Advances
Current Gastroenterology Reports, 2015Co-Authors: Paul Feuerstadt, Lawrence J. BrandtAbstract:Colon Ischemia (CI) is the most common manifestation of ischemic injury to the gastrointestinal (GI) tract. This usually self-limited disease is being diagnosed more frequently, and the list of known causes is increasing. Local hypoperfusion and reperfusion injury are both thought to contribute to the disease process, which manifests with a wide spectrum of injury including reversible colopathy (subepithelial hemorrhage and edema), transient colitis, chronic colitis, stricture, gangrene, and fulminant universal colitis. The distribution is usually segmental with left-sided disease (e.g., inferior mesenteric artery distribution) being more frequently observed than right-sided involvement (e.g., superior mesenteric artery distribution). Any portion of the Colon can be affected, but the anatomic distribution of CI recently has been shown to be associated with outcome. Patients with isolated-right Colon Ischemia (IRCI) have a different presentation and worse outcomes than other distributions of disease. Although somewhat variable depending on disease location, CI presents with cramping abdominal pains over the segment of Colon involved followed by a short course of bloody diarrhea. Diagnosis is usually made clinically and is supported with serologic, radiologic, and Colonoscopic findings. Colonoscopy is the most accurate diagnostic study. Most patients respond to conservative supportive therapy although some with more severe disease require antimicrobials and/or surgical intervention.
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acg clinical guideline epidemiology risk factors patterns of presentation diagnosis and management of Colon Ischemia ci
The American Journal of Gastroenterology, 2015Co-Authors: Lawrence J. Brandt, Paul Feuerstadt, George F Longstreth, Scott J BoleyAbstract:ACG Clinical Guideline: Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)
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Colon Ischemia: Recent Insights and Advances
Current Gastroenterology Reports, 2010Co-Authors: Paul Feuerstadt, Lawrence J. BrandtAbstract:Ischemic colitis is the most common manifestation of ischemic injury to the gastrointestinal tract, and the variety of defined causes is increasing. Local hypoperfusion and reperfusion injury are both thought to contribute to the disease process, which manifests with a wide spectrum of injury including reversible colopathy (subepithelial hemorrhage and edema), transient colitis, chronic colitis, stricture, gangrene, and fulminant universal colitis. The distribution is typically segmental. Older studies showed that any portion of the Colon can be involved; recently, it was established that the site of involvement and prognosis can be correlated. In particular, isolated involvement of the right side of the Colon was shown to have a different presentation and worse outcome than ischemic colitis involving other segments. Diagnosis is usually made clinically and supported by radiologic imaging and Colonoscopic evaluation. Most patients respond to conservative supportive therapy, although some with severe disease require surgical intervention.
Eva Ekblad - One of the best experts on this subject based on the ideXlab platform.
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Infiltration of Mast Cells in Rat Colon Is a Consequence of Ischemia/Reperfusion
Digestive diseases and sciences, 2008Co-Authors: Elin Sand, Anna Themner-persson, Eva EkbladAbstract:Intestinal Ischemia as well as mastocytosis occur in patients with inflammatory bowel disease and irritable bowel syndrome. Our aim was to clarify how Ischemia with reperfusion (I/R) affects the structure, enteric neurons, and immune cells in the Colon. Rats were subjected to Colon Ischemia for 1 h and reperfused for 1 day up to 20 weeks; sham-operated rats were used as controls. No structural remodeling of the intestinal segment was detected after I/R. The number and distribution of eosinophils were not affected by I/R. Local areas containing numerous mast cells were detected in the muscle layers, the serosa, and in and around the myenteric ganglia 4-20 weeks post Ischemia. It was notable that myenteric ganglionic formations within mast-cell-rich areas virtually lacked neurons. Mast cells were rarely found in controls. In conclusion, I/R of the Colon attracts mast cells, and death of myenteric neurons occurs in such locations.
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infiltration of mast cells in rat Colon is a consequence of Ischemia reperfusion
Digestive Diseases and Sciences, 2008Co-Authors: Elin Sand, Anna Themnerpersson, Eva EkbladAbstract:Intestinal Ischemia as well as mastocytosis occur in patients with inflammatory bowel disease and irritable bowel syndrome. Our aim was to clarify how Ischemia with reperfusion (I/R) affects the structure, enteric neurons, and immune cells in the Colon. Rats were subjected to Colon Ischemia for 1 h and reperfused for 1 day up to 20 weeks; sham-operated rats were used as controls. No structural remodeling of the intestinal segment was detected after I/R. The number and distribution of eosinophils were not affected by I/R. Local areas containing numerous mast cells were detected in the muscle layers, the serosa, and in and around the myenteric ganglia 4-20 weeks post Ischemia. It was notable that myenteric ganglionic formations within mast-cell-rich areas virtually lacked neurons. Mast cells were rarely found in controls. In conclusion, I/R of the Colon attracts mast cells, and death of myenteric neurons occurs in such locations.
Bruce E. Sands - One of the best experts on this subject based on the ideXlab platform.
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occurrence of Colon Ischemia in relation to irritable bowel syndrome
The American Journal of Gastroenterology, 2004Co-Authors: Alexander J Cole, Suzanne F. Cook, Anuli N. Ajene, Bruce E. Sands, David P Miller, Alexander M. WalkerAbstract:OBJECTIVE: In November 2000, alosetron HCl (Lotronex), a treatment for irritable bowel syndrome (IBS), was removed from the U.S. market in part because of the occurrence of Colon Ischemia in treated patients. Since the relation between Colon Ischemia and IBS is poorly understood, we evaluated the incidence of Colon Ischemia among people with and without IBS. METHODS: Using medical claims data from a large health care organization in the United States, we identified 87,449 people with an IBS diagnosis between January 1995 and December 1999. We calculated age- and sex-specific incidence rates in the general population and in IBS patients. RESULTS: There were 740 cases of Colon Ischemia during 8.5 million person-years of observation in 5.4 million persons. The crude incidence rate was 42.8 cases per 100,000 person-years for IBS patients. By comparison, the incidence rate was 7.2 per 100,000 person-years in the general population. After adjustment for age, sex, and calendar year, the incidence of Colon Ischemia in people with IBS was 3.4 times higher than in persons without (95% CI 2.6-4.5). CONCLUSIONS: Rates of Colon Ischemia among patients carrying a diagnosis of IBS are substantially higher than in the general population. Colon Ischemia, though unusual in IBS patients, may nonetheless constitute a distinct part of the IBS natural history. Alternatively, it may be a consequence of therapy, or a manifestation of other bowel pathology that is sometimes confused with IBS.
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Risk factors for Colon Ischemia.
The American journal of gastroenterology, 2004Co-Authors: Alexander M. Walker, Rhonda L. Bohn, Clorinda Cali, Suzanne F. Cook, Anuli N. Ajene, Bruce E. SandsAbstract:BACKGROUND: To identify predictors of Colon Ischemia, we examined demographic and clinical characteristics of patients, as well as their prior health care utilization. METHODS: Using insurance data, we identified 700 persons at least 20-yr old with presumed Colon Ischemia between 1995 and 1999, and 6,440 controls. Case identification was based on diagnosis and procedure codes in insurance claims for which we used a previously reported, validated algorithm. We ascertained preceding medical diagnoses and the use of drugs and health services from the insurance claims files. RESULTS: Patients with Colon Ischemia were nearly three times as likely to have IBS than controls. A history of nonspecific colitis, lower gastrointestinal tract hemorrhage, systemic rheumatologic disorders, and ischemic heart disease in the preceding 6 months, and abdominal surgery in the past month were also much more common in Colon Ischemia cases than controls. Use of a drug to treat diarrhea was strongly associated with risk. The most prevalent risk factor for Colon Ischemia was the use of drugs with a side effect of constipation, found in one-third of cases and one in nine controls. Cases had seen physicians, particularly gastroenterologists, much more commonly in the preceding 6 months than had controls. CONCLUSIONS: Clinically evident Colon Ischemia arises preferentially in persons with prior abdominal complaints, many of whom carry a diagnosis of IBS. Drugs that reduce bowel motility may constitute a widespread and potentially avoidable risk factor. The frequency of preceding doctor visits, without a specific diagnosis, suggests that Colon Ischemia may have a prolonged subacute presentation.