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Biomedical subjects

D S Pardi

Publications and source records attributed to D S Pardi.

16 recordsLinked to original sources
PubMed2006

Systematic review: the management of pouchitis.

Pouchitis is the most common complication following proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis. We aim at discussing relevant information on epidemiology, clinical features, risk factors, diagnostic testing, differential diagnosis and treatment of this idiopathic inflammatory condition. A computerized search of PubMed was performed with the search term 'pouchitis', limited to English papers on humans. This strategy identified 514 references. Relevant articles were selected from this list. In addition, the reference list for each of the selected articles was reviewed to identify any additional references. Pouchitis occurs in up to 60% of patients after ileal pouch-anal anastomosis for ulcerative colitis, and has characteristic clinical, endoscopic and histological features. The most important test for diagnosis is pouch endoscopy with biopsy. Antibiotics remain the mainstay of treatment, and other options are discussed for those patients who are refractory to antibiotic therapy.

Anti-Bacterial Agents↗
PubMed2005

Review article: drug-induced microscopic colitis - proposal for a scoring system and review of the literature.

The pathophysiology of microscopic colitis is unknown, although it is thought to be because of an abnormal immune reaction to luminal antigens in predisposed hosts. Specific antigens have not been proved, although various infectious triggers and drugs have been proposed. The responsibility of several drugs has been questioned, some with strong clinical and/or histological evidence suggesting causality. The issue of drug-induced microscopic colitis is important because of the burden of this disease. Thus, any case that can be cured by withdrawal of a drug must be identified. In this report, we propose a scoring system for drug-induced microscopic colitis, adapting existing criteria of drug causality, and review the literature using this framework. Based on this review, several drugs are identified with intermediate or high likelihood of inducing microscopic colitis. Finally, we suggest how to treat individual patients suspected of having drug-induced colitis according to the level of evidence for that particular drug.

Colitis, Microscopic↗
PubMed2001

Use of montelukast as steroid-sparing agent for recurrent eosinophilic gastroenteritis.

Patients with eosinophilic gastroenteritis generally respond well to corticosteroids but relapses are common. Patients with relapsing disease are usually placed on long-term low-dose prednisone or immunosuppressive therapy. Here we reported on a patient with severe steroid-dependent eosinophilic gastroenteritis who was able to successfully taper off steroids and maintain remission after starting montelukast, a leukotriene receptor antagonist. To our knowledge, this is the first use of montelukast as a steroid sparing agent for eosinophilic gastroenteritis.

Acetates↗
PubMed2001

Treatment of refractory microscopic colitis with azathioprine and 6-mercaptopurine.

Many patients with microscopic colitis will respond to antidiarrheal medications or to anti-inflammatory therapy with 5-aminosalicylates, although a few require corticosteroids. Some patients do not tolerate corticosteroid side effects, and a small subset are dependent on or refractory to corticosteroids. We report our experience with azathioprine and 6-mercaptopurine in patients with microscopic colitis.

Adult↗
PubMed2001

Gender-related differences in slowing colonic transit by a 5-HT3 antagonist in subjects with diarrhea-predominant irritable bowel syndrome.

OBJECTIVE: To evaluate the influence of gender on the effect of a 5-HT3 antagonist, alosetron, 1 mg b.i.d., on GI and colonic transit in D-IBS. METHODS: Thirty patients (15 male, 15 female) with D-IBS received 1 mg b.i.d. alosetron for 6 wk. Transit was measured by scintigraphy at baseline and at the end of treatment. RESULTS: Alosetron, 1 mg b.i.d., significantly retarded small bowel and, proximal and overall colonic transit in the 30 patients with D-IBS. The effect of alosetron on the primary endpoint, colonic geometric center at 24 h, was significantly greater in females than in males (p < 0.05). However, two females showed no slowing of colonic transit on treatment. Among male patients, two of 15 had a slowing of colonic transit at 24 h that was greater than the mean change in female patients, suggesting responsiveness to alosetron among a subgroup of males. CONCLUSION: A 5-HT3 antagonist, alosetron, significantly retards small intestinal and colonic transit in diarrhea-predominant IBS patients, with significantly greater female to male responsiveness. Gender partly contributes to differences in the serotonergic control of intestinal and colonic transit in patients with D-IBS.

Adult↗
PubMed2001

Iliac arteriovenous fistula with renal insufficiency, ascites, hepatomegaly, and abnormal liver test results.

Arteriovenous fistula presents rarely with liver involvement. A 73-year-old man had new-onset ascites, hepatomegaly, and abnormal liver and renal function test results. An abdominal computed tomogram revealed a 7.6-cm internal iliac aneurysm but no other abnormality to account for his ascites. An aortogram demonstrated a 1.5-cm internal iliac arteriovenous fistula that subsequently was repaired, leading to resolution of his symptoms and laboratory abnormalities. High-output cardiac failure should be considered in the differential diagnosis of patients with new-onset massive ascites, hepatomegaly, and liver test abnormalities.

Aged↗
PubMed2001

Clostridium difficile-associated diarrhea and colitis.

Clostridium difficile is a spore-forming toxigenic bacterium that causes diarrhea and colitis, typically after the use of broad-spectrum antibiotics. The clinical presentation ranges from self-limited diarrhea to fulminant colitis and toxic megacolon. The incidence of this disease is increasing, resulting in major medical and economic consequences. Although most cases respond quickly to medical treatment, C difficile colitis may be serious, especially if diagnosis and treatment are delayed. Recurrent disease represents a particularly challenging problem. Prevention is best accomplished by limiting the use of broad-spectrum antibiotics and following good hygienic techniques and universal precautions to limit the transmission of bacteria. A high index of suspicion results in early diagnosis and treatment and potentially reduces the incidence of complications.

Adult↗
PubMed2000

Early measles virus infection is associated with the development of inflammatory bowel disease.

OBJECTIVE: The measles virus has been implicated as a possible etiological agent in the development of inflammatory bowel disease (IBD). Measles infection at an early age is associated with subacute sclerosing panencephalitis, a degenerative neurological condition caused by persistent measles infection of the central nervous system. We sought to determine whether infection with measles virus at an early age was also associated with an increased risk of developing IBD. METHODS: Patients with measles infection diagnosed before the age of 5 yr were identified through the diagnostic indices of the Mayo Clinic and the Rochester Epidemiology Project. A questionnaire was used to ascertain a subsequent history of IBD, which was confirmed by records from the subjects' physicians. The risks of developing Crohn's disease and ulcerative colitis were calculated relative to expected rates for these conditions in the Olmsted County, Minnesota population. RESULTS: Of 1164 eligible cases, 662 (57%) completed the questionnaire. There were six confirmed cases of Crohn's disease and six of ulcerative colitis. The expected number of cases was 1.9 for Crohn's disease (standardized incidence ratio [SIR] 3.1, 95% confidence interval [CI] 1.1-6.8) and 2.0 for ulcerative colitis (SIR 3.0, CI 1.1-6.5). There was a trend towards a higher risk of developing IBD with an earlier age of infection. CONCLUSIONS: Early measles infection is associated with an increased risk of developing Crohn's disease and ulcerative colitis. The risk may be higher with earlier infection.

Aging↗
PubMed1999

Acute major gastrointestinal hemorrhage in inflammatory bowel disease.

BACKGROUND: Acute major gastrointestinal hemorrhage is uncommon in inflammatory bowel disease. METHODS: We characterized the clinical features and course of such hemorrhage in patients at our institution from 1989 to 1996. RESULTS: Thirty-one patients had acute lower gastrointestinal bleeding from inflammatory bowel disease and one had upper gastrointestinal bleeding from duodenal Crohn's disease. Three patients had ulcerative colitis and 28 had Crohn's disease, representing 0.1% of admissions for ulcerative colitis and 1.2% for Crohn's disease. In addition, another patient bled from an ileal J-pouch. In patients with Crohn's disease, the site of bleeding was duodenal in 1, small intestinal in 9, ileocolonic in 8, and colonic in 10. All ulcerative colitis patients had pancolitis. Medical therapy was initiated in 27 patients, including endoscopic therapy in 3. Five patients underwent surgery immediately, and 7 medically treated patients eventually required surgery for ongoing or recurrent bleeding. CONCLUSIONS: Acute major gastrointestinal bleeding is uncommon in inflammatory bowel disease. Most cases are due to Crohn's disease, without a predilection for site of involvement. The presence of an endoscopically treatable lesion is uncommon, and surgery is required in less than half of cases during the initial hospitalization. Recurrent hemorrhage is not rare, and for these cases surgery may be the most appropriate treatment.

Acute Disease↗
PubMed1999

Perinatal exposure to measles virus is not associated with the development of inflammatory bowel disease.

It has been suggested that early exposure to measles virus, including perinatal exposure via maternal infection, may lead to persistent measles virus infection and the subsequent development of inflammatory bowel disease (IBD). We sought to examine this association in our patient population. Maternal measles infection was identified through the Mayo Clinic diagnostic index, and cases were verified by chart review. Cases were included if infection occurred between the second trimester and 6 months postpartum. The offspring, or a first degree family member, were then interviewed regarding a history of IBD or symptoms which might suggest IBD. Seven cases of maternal infection were identified out of 67,912 pregnancies between 1935 and 1985. One offspring was lost to follow-up through adoption, and the remaining six have no evidence of Crohn's disease or ulcerative colitis after a mean of 38 years of follow-up (range 12-62 years). Evidence for an association between perinatal exposure to measles virus via maternal infection and the subsequent development of IBD was not found in our patient population.

Colitis, Ulcerative↗
PubMed1998

Melanosis coli in inflammatory bowel disease.

Melanosis coli is a relatively common condition in which pigment is deposited in macrophages in the colonic lamina propria. The association with anthraquinone laxatives is well described, but melanosis coli has also been described in patients not using these agents. We report 25 patients with inflammatory bowel disease and melanosis coli, 5 (20%) of whom had documented laxative use. Most patients had ulcerative colitis (72%) or Crohn's colitis (24%), and the mean duration of inflammatory bowel disease was more than 7 years. These data raise the possibility that chronic colitis could cause melanosis coli even in the absence of laxative use.

Adolescent↗
PubMed1998

Renal and urologic complications of inflammatory bowel disease.

Renal and urologic complications are not uncommon in patients with inflammatory bowel disease, and can be directly or indirectly related to the underlying disease process or its treatment. Many of these patients have asymptomatic disease, or the urinary symptoms are nonspecific or overshadowed by bowel symptoms. By the time a urinary complication is considered, significant disease progression or renal damage may have occurred. These risks necessitate a high degree of diligence and periodic urologic evaluation as part of the long-term management of patients with inflammatory bowel disease.

Amyloidosis↗
PubMed1998

Hepatitis-associated aplastic anemia and acute parvovirus B19 infection: a report of two cases and a review of the literature.

Hepatitis-associated aplastic anemia is rare in general, but occurs in up to 28% of patients receiving liver transplantation for fulminant non-A, non-B hepatitis. Cases are commonly young men with mild hepatitis but severe aplastic anemia. Although cases have been reported in association with hepatitis A, B, and C, most appear to be due to a non-A-B-C virus. We report two cases of acute hepatitis subsequently complicated by marrow hypoplasia in patients with acute parvovirus B19 infection. Hepatic manifestations of parvovirus B19 infection range from liver chemistry abnormalities to fulminant hepatic failure and aplastic anemia. Our cases demonstrate a less severe form of hepatitis-associated aplastic anemia, and together with other data, suggest that parvovirus B19 is at least one cause of hepatitis-associated aplastic anemia, and may be a heretofore underrecognized hepatotrophic virus.

Acute Disease↗