Lukens, Frank

Objectives Recent studies have suggested that small intestinal bacterial overgrowth (SIBO) could be a predisposing factor for nonalcoholic fatty liver disease (NAFLD) although the results were inconsistent. This systematic review and meta-analysis was conducted with the aim to summarize all available data. Methods A comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through September 2018 to identify all studies that compared the risk of NAFLD among patients with SIBO versus those without SIBO. Effect estimates from each study were extracted and combined together using the random effect, generic inverse variance method of DerSimonian and Laird. Results A total of 10 studies with 1093 participants fulfilled the eligibility criteria and were included in the meta-analysis. A significant association between NAFLD and SIBO was observed with the pooled odds ratio of 3.82 (95% confidence interval, 1.93–7.59; I 2 65%). Funnel plot is relatively symmetric and is not suggestive of the presence of publication bias. Conclusion A significant association between NAFLD and SIBO was observed in this meta-analysis.

AbstractBackground/objectivesSeveral epidemiologic studies have suggested that patients with celiac disease may be at an increased risk of sarcoidosis but the results were inconsistent. This systematic review and meta‐analysis was conducted with the aim to better characterize this risk by summarizing all available data.MethodsA literature review was performed using MEDLINE and EMBASE database from inception to February 2019. Studies that compared the risk of sarcoidosis among patients with celiac disease versus individuals without celiac disease were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method.ResultsOf 426 retrieved studies, four studies with 693 639 participants met the eligibility criteria and were included in meta‐analysis. The risk of sarcoidosis among patients with celiac disease was higher than individuals without celiac disease with the pooled OR of 7.16 (95% CI, 1.48‐34.56). The statistical heterogeneity of this study was high (I2 = 95%).ConclusionsThis systematic review and meta‐analysis found a significantly higher risk of sarcoidosis among patients with celiac disease.

Background/ObjectivesA negative association between cigarette smoking and celiac disease has been observed but results were inconsistent across the published studies. A meta‐analysis was conducted with the aim to identify all studies that investigated this association and to summarize the results of those studies.MethodsA comprehensive literature review was conducted utilizing MEDLINE and Embase databases through March 2018 to identify all cohort studies and case‐control studies that compared the risk of celiac disease among current and/or former smokers versus never‐smokers. Effect estimates from each study were extracted and combined together using the random‐effect, generic inverse variance method of DerSimonian and Laird.ResultsA total of seven studies with 307,924 participants fulfilled the eligibility criteria and were included in the meta‐analysis. The pooled analysis found a significantly decreased risk of celiac disease among current smokers compared with never‐smokers with the pooled odds ratio (OR) of 0.52 (95% confidence interval (CI), 0.32–0.84; I2 86%). However, the risk of celiac disease among former smokers was not significantly different from never‐smokers with the pooled OR of 1.10 (95% CI, 0.76–1.60; I2 of 73%).ConclusionsA significantly decreased risk of celiac disease among current smokers compared with never‐smokers was demonstrated in this meta‐analysis.

Abstract Background Volumetric laser endomicroscopy (VLE) provides circumferential images 3 mm into the biliary and pancreatic ducts. We aimed to correlate VLE images with the normal and abnormal microstructure of these ducts. Methods: Samples from patients undergoing hepatic or pancreatic resection were evaluated. VLE images were collected using a low-profile VLE catheter inserted manually into the biliary and pancreatic ducts ex vivo. Histological correlation was assessed by two unblinded investigators. Results 25 patients (20 liver and 5 pancreatic samples) and 111 images were analyzed. VLE revealed three histological layers: epithelium, connective tissue, and parenchyma. It identified distinctive patterns for primary sclerosing cholangitis (PSC), pancreatic cysts, neuroendocrine tumor, and adenocarcinoma adjacent to the pancreatic duct or ampulla. VLE failed to identify dysplasia in a dominant stricture and inflammatory infiltrates in PSC. Reflectivity measurements of the liver parenchyma diagnosed liver cirrhosis with high sensitivity. Conclusions VLE can identify histological changes in the biliary and pancreatic ducts allowing real-time diagnosis. Further studies are needed to measure the accuracy of VLE in a larger sample and to validate our findings in vivo.

Objectives. Surgery is the most effective treatment for pancreatic cancer. However, present literature varies on outcomes of curative pancreatic resection in the elderly. The objective of the study was to evaluate age as an independent risk factor for 90-day mortality and complications after pancreatic resection. Methods. Nine hundred twenty-nine consecutive patients underwent 934 pancreatic resections between March 1995 and July 2014 in a tertiary care center. Primary analyses focused on outcomes in terms of 90-day mortality and postoperative complications after pancreatic resection in these two age groups. Results. Even though patients aged 75 years or older had significantly more postoperative morbidities compared with the younger patient group, the age group was not associated with increased risk of 90-day mortality after pancreatic resection. Discussion. The study suggests that age alone should not preclude patients from undergoing curative pancreatic resection.