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Papers by Juan Enrique Dominguez Muñoz

Alimentary Pharmacology & Therapeutics, 2007

Background Several meta-analyses assessing the efficacy of anti-Helicobacter pylori treatment in ... more Background Several meta-analyses assessing the efficacy of anti-Helicobacter pylori treatment in adults have been published but a comparable meta-analysis in children is lacking. Aims To summarize the efficacy of treatments aimed at eradicating H. pylori in children and to identify sources of variation in treatment efficacy across studies. Methods We searched Medline, reference lists from published study reports, and conference proceedings for anti-H. pylori treatment trials in children. Weighted meta-regression models were used to find sources of variation in efficacy. Results Eighty studies (127 treatment arms) with 4436 children were included. Overall, methodological quality of these studies was poor with small sample sizes and few randomized-controlled trials. The efficacy of therapies varied across treatment arms, treatment duration, method of post-treatment assessment and geographic location. Among the regimens tested, 2-6 weeks of nitroimidazole and amoxicillin, 1-2 weeks of clarithromycin, amoxicillin and a proton pump inhibitor, and 2 weeks of a macrolide, a nitroimidazole and a proton pump inhibitor or bismuth, amoxicillin and metronidazole were the most efficacious in developed countries. Conclusions Before worldwide treatment recommendations are given for eradication of H. pylori, additional well-designed randomized placebo-controlled paediatric trials are needed, especially in developing countries where both drug resistance and disease burden is high.

Revista Española de Enfermedades Digestivas, 2005

The results of the 2 nd Spanish Consensus Conference for appropriate practice regarding indicatio... more The results of the 2 nd Spanish Consensus Conference for appropriate practice regarding indications for eradication, diagnostic tests, and therapy regimens for Helicobacter pylori infection are summarized. The Conference was based on literature searches in Medline, abstracts from three international meetings, and abstracts from national meetings. Results were agreed upon and approved by the whole group. Results are supplemented by evidence grades and recommendation levels according to the classification used in the Clinical Practice Guidelines issued by Cochrane Collaboration. Convincing indications (peptic ulcer, duodenal erosions with no history of ASA or NSAIDs, MALT lymphoma), and not so convincing indications (functional dyspepsia, patients receiving lowdose ASA for platelet aggregation, gastrectomy stump in patients operated on for gastric cancer, first-degree relatives of patients with gastric cancer, lymphocytic gastritis, and Ménétrier's disease) for H. pylori eradication are discussed. Diagnostic recommendations for various clinical conditions (peptic ulcer, digestive hemorrhage secondary to ulcer, eradication control, patients currently or recently receiving antibiotic or antisecretory therapy), as well as diagnostic tests requiring biopsy collection (histology, urease fast test, and culture) when endoscopy is needed for clinical diagnosis, and non-invasive tests requiring no biopsy collection (13 C-urea breath test, serologic tests, and fecal antigen tests) when endoscopy is not needed are also discussed. As regards treatment, first-choice therapies (triple therapy using a PPI and two antibiotics), therapy length, quadruple therapy, and a number of novel antibiotic options as "rescue" therapy are prioritized, the fact that prolonging PPI therapy following effective eradication is unnecessary for patients with duodenal ulcer but not for all gastric ulcers is documented, the fact that cultures and antibiograms are not needed for all eradicating therapies is indicated, and finally the test and treat strategy is considered adequate, however only under certain circumstances.

Gastroenterology, 2011

Introduction: At the Los Angeles County University of Southern California Medical Center (LAC+USC... more Introduction: At the Los Angeles County University of Southern California Medical Center (LAC+USC) we service an inflammatory bowel disease (IBD) clinic for a low economic population. We evaluated the frequency of the types of IBD and identified risk factors associated with ulcerative colitis (UC) versus Crohns disease (CD). Methods: This is a retrospective, cross-sectional review of patients with the diagnosis of IBD including UC, CD or indeterminate colitis that were seen at the Roybal Comprehensive Health Clinic between 1/01/2004 through 12/31/2009. Ulcerative colitis was defined as a continuous inflammation of the colon involving the distal rectum and with architectural distortion on histology. Crohn's disease was defined by characteristic small and large bowel changes on imaging studies and/or segmental colitis in untreated patients on colonoscopy. Using an IBD database, ICD-9 diagnosis codes, electronic medical records, and the Clinical Outcomes Research Initiative (CORI) system, the type of colitis, extent of disease, and demographic information were obtained. Univariate and stepwise multivariate analysis were performed. Results: A total of 287 patients with IBD were identified. The frequency of UC in this population was 68% (196/287); (95% Confidence Interval (CI): 63%-74%); CD 24% (70/287); (95% CI; 19%-29%); and indeterminate colitis (IC) 7% (21/287); (95% CI: 4-10). In the 266 patients with UC or CD, 55% were male, 65% over 30 years of age, 69% Hispanic, 12% African American (AA), 9% Asian and 9% non-Hispanic American. Sixty-one percent were immigrants and 52% were from Latin America. We did not include in the analysis education, history of smoking and family history of IBD because of the high percentage of missing data 37, 30 and 47% respectively. Table 1 provides the association of each risk factor with UC vs CD. Stepwise logistic regression yielded two significant independent risk factors: AA ethnicity [adjusted OR: 0.34; 95% CI: 0.15, 0.77; p=0.01] and immigrant [adjusted OR: 2.16; 95% CI: 1.19, 3.94, p=0.01). The R-squared for AA was 7% and that for immigrant was 3%. These two factors explained 10% of the variation between UC and CD. Conclusion: In the LAC+USC IBD clinic which serves low socioeconomic patients, there is a 3 to 1 ratio of UC to CD. Immigrant and non-African American ethnicity are predictive of UC whereas non-immigrant and African American ethnicity are predictive of CD.

Transplantation Proceedings, 2005

Orthotopic liver transplantation (OLT) as therapy of hepatocellular carcinoma (HCC) improves the ... more Orthotopic liver transplantation (OLT) as therapy of hepatocellular carcinoma (HCC) improves the survival of a selected group of patients. Unfortunately, the progressive increase in waiting time for OLT may allow tumor progression. Percutaneous ethanol injection (PEI) has been proposed as neoadjuvant therapy for HCC in patients awaiting OLT, but its safety has not been defined. Patients and Methods. During a 60-month period, 34 patients (27 men, overall mean age of 58.5 years, range 41-67) with HCC, were listed for OLT. Ultrasonography-guided PEI was delivered into 39 nodules at 117 sessions on an inpatient basis. Written informed consent was obtained from all patients before PEI. Doppler-ultrasonography was done before PEI, immediately after, and 4 weeks later. Noninvasive monitoring of arterial pressure, cardiac rate, and temperature was performed during the procedure and during a 24-hour period after each session. Pain was considered significant if analgesia was required or discontinuation of PEI necessary. Fever was defined as a temperature Ն37.5°C after PEI. Results. Minor complications included pain in 45 sessions (38.5%), fever in 17 (14.5%), arterial hypertension in 14 (12%), hypotension in 7 (7%), and vomiting in 2 (1.7%). The major complications were segmental liver infarction (n ϭ 3), portal branch venous thrombosis (n ϭ 2), ascites (n ϭ 2), and one case each of subcapsular hematoma, duodenal ulcer, pneumonia, hepatic encephalopathy, and hepatic artery thrombosis. In all cases, clinical outcomes were favorable with conservative treatment. No evidence of tumor seeding in the needle track was reported and no PEI-related mortality observed. Conclusions. PEI is a safe neoadjuvant therapy for HCC on waiting list liver transplant candidates. In our series, pain and self-limited fever were the most frequent complications. Clinically significant severe complications were uncommon, and nonconservative treatments were not required.

Gastroenterology, 2011

Background:Etiologies of recurrent pancreatitis include anatomical anomalies, hereditary, metabol... more Background:Etiologies of recurrent pancreatitis include anatomical anomalies, hereditary, metabolic and autoimmune disorders. A significant number of patients remain with a diagnosis of idiopathic pancreatitis. The advent of genetic analysis and electrophysiologic testing may further assist in the diagnostic process. Evidence has shown that specific genetic mutations in the cationic trypsinogen gene PRSS1 and the SPINK1 gene for pancreatic secretory trypsin inhibitor cause pancreatitis; furthermore cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations have been associated with pancreatitis. Aims :To present the work-up of patients with recurrent pancreatitis referred for genetic analysis and electrophysiological testing. Methods : Patients with recurrent, acute pancreatitis with no known etilology were referred to the Electrophysiology Laboratory, Division of Pediatric GI at Hadassah University Hospital for PRSS1 and SPINK1 gene mutations as well as evaluation of CFTR function by Nasal Potential Difference (NPD) testing. Results: A total of 42 patients with recurrent pancreatitis were evaluated; the mean age was 21 years ±14.9 years (range 2-54 yrs). A third (33%) of the patients was of Ashkenazi ancestry, 41% of mainly Sephardic ancestry, 24% of Arab ancestry and the remaining 2% of other ethnic background. There was a family history in 8 patients. The patients had a mean of 4 episodes (range 1-25). 6 (14%) patients showed PRSS1 genemutation (p.R112H and p.K23R) including 2 sets of siblings of Georgian Jewish ancestry with p.K23R. No SPINK1 mutation was found in the 26 patients submitted for testing. 3 patients out of 21 submitted for CFTR gene testing showed mutations (5T, F508del/p.L997F and D1152H/5T). 26 (61%) patients underwent sweat testing, with 13 patients with results >40 mmol/L. 35 (83%) patients had Nasal Potential Difference testing, 4 (11.5%) with abnormal results: 3 had sweat chloride>60mmol/L with no CFTR mutations found but one patient with D1152H/5T had a sweat test of 30 mmol/L. None of the 6 patients with PRSS1 gene mutation showed any concomitant CFTR dysfunction (by NPD or sweat testing) or gene mutation.Conclusion:This is the first study on recurrent pancreatitis in Israel examining both the presence of susceptibility gene mutations for pancreatitis and CFTR dysfunction. A prospective study with a larger number of patients may further clarify the impact of genetic mutations and CFTR dysfunction on the clinical presentation and outcome of recurrent pancreatitis.

Gastrointestinal Endoscopy, 2012

Introduction: Double blinded comparison of the diagnostic yield of endoscopic ultrasonography (EU... more Introduction: Double blinded comparison of the diagnostic yield of endoscopic ultrasonography (EUS) and Secretin enhanced Cholangio-MRI (S-CMRI) in patients with idiopathic acute pancreatitis (IAP) has never been published. Objective: To compare the diagnostic yield of EUS and S-CMRI in the etiological work-up of IAP. Methods: We performed a prospective double-blinded study including consecutive patients with IAP diagnosed between february-09 and may-11. IAP was defined as an acute pancreatitis bout without etiological findings after anamnesis, laboratory findings and two radiological explorations (2 transabdominal ultrasonography or 1 plus a CT). All patients who accepted to participate in the study underwent EUS and S-CMRI at least 4 weeks after the acute bout being both explorations performed as close as possible. Two radiologists and 2 endosonographers participated in the study and were blinded to the outcome of the other exploration thanks to a control investigator who did not perform EUS nor S-CMRI either. Chi-square was used to make the statistical analysis. Results: 21 consecutive patients diagnosed of IAP were proposed to participate. Six patients refused to participate: 4 did not want to undergo EUS and 2 did not accept S-CMRI. In the remaining 15, EUS found a possible cause of IAP in 13 (86.7%) and S-CRMI in 6 (40%) (p ϭ 0.21). In these 6 cases EUS was also positive. Both examinations were performed with a mean difference of 10 days (2-37). EUS diagnosed 7 cholelithiasis, 1 choledocholithiasis, 2 pancreas divisum with Santorinicele, 1 chronic pancreatitis and 2 intraductal papillary mucinous tumors (IPMN) (1 with malignant citology after FNA). The S-CRMI found 1 choledocholithiasis, 2 pancreas divisum with Santorinicele, 1 chronic pancreatitis and 2 IPMN. Six patients with cholelithiasis and the patient with malignant IPMN underwent surgery confirming the diagnosis. One patient with Santorinicele and the patient with choledocolithiasis underwent ERCP confirming the diagnosis. Chronic pancreatitis was confirmed by pancreatic function tests. The other 3 patients refused surgery or ERCP. One patient died during follow up because of unrelated cause. The others remain asymptomatic with mean follow up of 23 Ϯ 10.59 months. Conclusions: We found no significant differences between the diagnostic yield of EUS and S-CMRI in patients with IAP, although EUS provides superior diagnostic yield due to better detection of cholelithiasis which is the most frequent finding in these patients, and the ability to perform FNA.

Gastrointestinal Endoscopy, 2010

Gastrointestinal Endoscopy, 2010

Gastrointestinal Endoscopy, 2010

Gastroenterology, 2010

15 p.y threshold, diagnosis of acute pancreatitis and ACP was made significantly earlier (33y and... more 15 p.y threshold, diagnosis of acute pancreatitis and ACP was made significantly earlier (33y and 36y versus 45 and 46y resp) (p=0.005 and 0.005 resp), irrespective of the amount of alcohol intake. Chronic pancreatic pain was also more frequent (p=0.05). At 20 p.y threshold, ACP and acute pancreatitis occurred earlier (p=0.0002 and <0.0001), and the pts hade more often, calcifications and ductal changes (p=0.05 and 0.005 resp) irrespective of alcohol intake. Similar results were observed at the 30 p.y threshold, but additionally pancreatic exocrine insufficiency occurred earlier (p=0.04). Conclusion-Tobacco intake accelerates the course of ACP in a dose-dependent fashion. ACP occurs earlier as soon as 15 p.y, and a major threshold effect is seen at 20 p.y, where the frequency of all major complications of ACP is increased.

Gastroenterology, 2010

RESULTS: At standard endoscopy, anal lesions were observed in 11/15 (73.3%) patients. At CLE, 9 (... more RESULTS: At standard endoscopy, anal lesions were observed in 11/15 (73.3%) patients. At CLE, 9 (60%) patients showed irregular arrangements of epithelial cells (inhomogeneous cells with irregular and unclear border demarcation and presence of increased cell concentration). Long branching IPCLs and irregular shaped IPCLs/leakage were recorded in 14 (93.3%) and 8 (53.3%) patients, respectively. At standard histology, HG-AIN/carcinoma was diagnosed in 8 (53.3%) patients (AIN-3 in 4, AIN-2 in one, carcinoma in 3). LG-AIN was present in 4 (AIN-1 in 3, condyloma in one), while in the rest of patients histology showed normal squamous epithelium. HG-AIN/carcinoma could be predicted with a positive predictive value of 89%. CONCLUSION: Our preliminary data show that irregular cellular and irregular shaped IPCLs/leakage confocal patterns are pathognomonic features of neoplastic changes. On the other hand, long branching IPCLs are not a pathological feature. CLE could be an alternative tool to HRA and could improve the surveillance of AIN lesions. The small size of our population sample requires further studies for the results to be confirmed.

Gastroenterology, 2003

Effect of alcohol intake on gastric emptying of a solid meal: Is it advisable to eat with beer or... more Effect of alcohol intake on gastric emptying of a solid meal: Is it advisable to eat with beer or wine? ... No abstract is available. To read the body of this article, please view the PDF online. ... Visit SciVerse ScienceDirect to see if you have access via your institution.

Gastroenterology, 2010

No abstract is available. To read the body of this article, please view the PDF online. ... © 201... more No abstract is available. To read the body of this article, please view the PDF online. ... © 2010 AGA. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution. ... Advertisements on this site do not constitute a ...

Alimentary Pharmacology & Therapeutics, 2007

Background Several meta-analyses assessing the efficacy of anti-Helicobacter pylori treatment in ... more Background Several meta-analyses assessing the efficacy of anti-Helicobacter pylori treatment in adults have been published but a comparable meta-analysis in children is lacking. Aims To summarize the efficacy of treatments aimed at eradicating H. pylori in children and to identify sources of variation in treatment efficacy across studies. Methods We searched Medline, reference lists from published study reports, and conference proceedings for anti-H. pylori treatment trials in children. Weighted meta-regression models were used to find sources of variation in efficacy. Results Eighty studies (127 treatment arms) with 4436 children were included. Overall, methodological quality of these studies was poor with small sample sizes and few randomized-controlled trials. The efficacy of therapies varied across treatment arms, treatment duration, method of post-treatment assessment and geographic location. Among the regimens tested, 2-6 weeks of nitroimidazole and amoxicillin, 1-2 weeks of clarithromycin, amoxicillin and a proton pump inhibitor, and 2 weeks of a macrolide, a nitroimidazole and a proton pump inhibitor or bismuth, amoxicillin and metronidazole were the most efficacious in developed countries. Conclusions Before worldwide treatment recommendations are given for eradication of H. pylori, additional well-designed randomized placebo-controlled paediatric trials are needed, especially in developing countries where both drug resistance and disease burden is high.

Revista Española de Enfermedades Digestivas, 2005

The results of the 2 nd Spanish Consensus Conference for appropriate practice regarding indicatio... more The results of the 2 nd Spanish Consensus Conference for appropriate practice regarding indications for eradication, diagnostic tests, and therapy regimens for Helicobacter pylori infection are summarized. The Conference was based on literature searches in Medline, abstracts from three international meetings, and abstracts from national meetings. Results were agreed upon and approved by the whole group. Results are supplemented by evidence grades and recommendation levels according to the classification used in the Clinical Practice Guidelines issued by Cochrane Collaboration. Convincing indications (peptic ulcer, duodenal erosions with no history of ASA or NSAIDs, MALT lymphoma), and not so convincing indications (functional dyspepsia, patients receiving lowdose ASA for platelet aggregation, gastrectomy stump in patients operated on for gastric cancer, first-degree relatives of patients with gastric cancer, lymphocytic gastritis, and Ménétrier's disease) for H. pylori eradication are discussed. Diagnostic recommendations for various clinical conditions (peptic ulcer, digestive hemorrhage secondary to ulcer, eradication control, patients currently or recently receiving antibiotic or antisecretory therapy), as well as diagnostic tests requiring biopsy collection (histology, urease fast test, and culture) when endoscopy is needed for clinical diagnosis, and non-invasive tests requiring no biopsy collection (13 C-urea breath test, serologic tests, and fecal antigen tests) when endoscopy is not needed are also discussed. As regards treatment, first-choice therapies (triple therapy using a PPI and two antibiotics), therapy length, quadruple therapy, and a number of novel antibiotic options as "rescue" therapy are prioritized, the fact that prolonging PPI therapy following effective eradication is unnecessary for patients with duodenal ulcer but not for all gastric ulcers is documented, the fact that cultures and antibiograms are not needed for all eradicating therapies is indicated, and finally the test and treat strategy is considered adequate, however only under certain circumstances.

Gastroenterology, 2011

Introduction: At the Los Angeles County University of Southern California Medical Center (LAC+USC... more Introduction: At the Los Angeles County University of Southern California Medical Center (LAC+USC) we service an inflammatory bowel disease (IBD) clinic for a low economic population. We evaluated the frequency of the types of IBD and identified risk factors associated with ulcerative colitis (UC) versus Crohns disease (CD). Methods: This is a retrospective, cross-sectional review of patients with the diagnosis of IBD including UC, CD or indeterminate colitis that were seen at the Roybal Comprehensive Health Clinic between 1/01/2004 through 12/31/2009. Ulcerative colitis was defined as a continuous inflammation of the colon involving the distal rectum and with architectural distortion on histology. Crohn's disease was defined by characteristic small and large bowel changes on imaging studies and/or segmental colitis in untreated patients on colonoscopy. Using an IBD database, ICD-9 diagnosis codes, electronic medical records, and the Clinical Outcomes Research Initiative (CORI) system, the type of colitis, extent of disease, and demographic information were obtained. Univariate and stepwise multivariate analysis were performed. Results: A total of 287 patients with IBD were identified. The frequency of UC in this population was 68% (196/287); (95% Confidence Interval (CI): 63%-74%); CD 24% (70/287); (95% CI; 19%-29%); and indeterminate colitis (IC) 7% (21/287); (95% CI: 4-10). In the 266 patients with UC or CD, 55% were male, 65% over 30 years of age, 69% Hispanic, 12% African American (AA), 9% Asian and 9% non-Hispanic American. Sixty-one percent were immigrants and 52% were from Latin America. We did not include in the analysis education, history of smoking and family history of IBD because of the high percentage of missing data 37, 30 and 47% respectively. Table 1 provides the association of each risk factor with UC vs CD. Stepwise logistic regression yielded two significant independent risk factors: AA ethnicity [adjusted OR: 0.34; 95% CI: 0.15, 0.77; p=0.01] and immigrant [adjusted OR: 2.16; 95% CI: 1.19, 3.94, p=0.01). The R-squared for AA was 7% and that for immigrant was 3%. These two factors explained 10% of the variation between UC and CD. Conclusion: In the LAC+USC IBD clinic which serves low socioeconomic patients, there is a 3 to 1 ratio of UC to CD. Immigrant and non-African American ethnicity are predictive of UC whereas non-immigrant and African American ethnicity are predictive of CD.

Transplantation Proceedings, 2005

Orthotopic liver transplantation (OLT) as therapy of hepatocellular carcinoma (HCC) improves the ... more Orthotopic liver transplantation (OLT) as therapy of hepatocellular carcinoma (HCC) improves the survival of a selected group of patients. Unfortunately, the progressive increase in waiting time for OLT may allow tumor progression. Percutaneous ethanol injection (PEI) has been proposed as neoadjuvant therapy for HCC in patients awaiting OLT, but its safety has not been defined. Patients and Methods. During a 60-month period, 34 patients (27 men, overall mean age of 58.5 years, range 41-67) with HCC, were listed for OLT. Ultrasonography-guided PEI was delivered into 39 nodules at 117 sessions on an inpatient basis. Written informed consent was obtained from all patients before PEI. Doppler-ultrasonography was done before PEI, immediately after, and 4 weeks later. Noninvasive monitoring of arterial pressure, cardiac rate, and temperature was performed during the procedure and during a 24-hour period after each session. Pain was considered significant if analgesia was required or discontinuation of PEI necessary. Fever was defined as a temperature Ն37.5°C after PEI. Results. Minor complications included pain in 45 sessions (38.5%), fever in 17 (14.5%), arterial hypertension in 14 (12%), hypotension in 7 (7%), and vomiting in 2 (1.7%). The major complications were segmental liver infarction (n ϭ 3), portal branch venous thrombosis (n ϭ 2), ascites (n ϭ 2), and one case each of subcapsular hematoma, duodenal ulcer, pneumonia, hepatic encephalopathy, and hepatic artery thrombosis. In all cases, clinical outcomes were favorable with conservative treatment. No evidence of tumor seeding in the needle track was reported and no PEI-related mortality observed. Conclusions. PEI is a safe neoadjuvant therapy for HCC on waiting list liver transplant candidates. In our series, pain and self-limited fever were the most frequent complications. Clinically significant severe complications were uncommon, and nonconservative treatments were not required.

Gastroenterology, 2011

Background:Etiologies of recurrent pancreatitis include anatomical anomalies, hereditary, metabol... more Background:Etiologies of recurrent pancreatitis include anatomical anomalies, hereditary, metabolic and autoimmune disorders. A significant number of patients remain with a diagnosis of idiopathic pancreatitis. The advent of genetic analysis and electrophysiologic testing may further assist in the diagnostic process. Evidence has shown that specific genetic mutations in the cationic trypsinogen gene PRSS1 and the SPINK1 gene for pancreatic secretory trypsin inhibitor cause pancreatitis; furthermore cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations have been associated with pancreatitis. Aims :To present the work-up of patients with recurrent pancreatitis referred for genetic analysis and electrophysiological testing. Methods : Patients with recurrent, acute pancreatitis with no known etilology were referred to the Electrophysiology Laboratory, Division of Pediatric GI at Hadassah University Hospital for PRSS1 and SPINK1 gene mutations as well as evaluation of CFTR function by Nasal Potential Difference (NPD) testing. Results: A total of 42 patients with recurrent pancreatitis were evaluated; the mean age was 21 years ±14.9 years (range 2-54 yrs). A third (33%) of the patients was of Ashkenazi ancestry, 41% of mainly Sephardic ancestry, 24% of Arab ancestry and the remaining 2% of other ethnic background. There was a family history in 8 patients. The patients had a mean of 4 episodes (range 1-25). 6 (14%) patients showed PRSS1 genemutation (p.R112H and p.K23R) including 2 sets of siblings of Georgian Jewish ancestry with p.K23R. No SPINK1 mutation was found in the 26 patients submitted for testing. 3 patients out of 21 submitted for CFTR gene testing showed mutations (5T, F508del/p.L997F and D1152H/5T). 26 (61%) patients underwent sweat testing, with 13 patients with results >40 mmol/L. 35 (83%) patients had Nasal Potential Difference testing, 4 (11.5%) with abnormal results: 3 had sweat chloride>60mmol/L with no CFTR mutations found but one patient with D1152H/5T had a sweat test of 30 mmol/L. None of the 6 patients with PRSS1 gene mutation showed any concomitant CFTR dysfunction (by NPD or sweat testing) or gene mutation.Conclusion:This is the first study on recurrent pancreatitis in Israel examining both the presence of susceptibility gene mutations for pancreatitis and CFTR dysfunction. A prospective study with a larger number of patients may further clarify the impact of genetic mutations and CFTR dysfunction on the clinical presentation and outcome of recurrent pancreatitis.

Gastrointestinal Endoscopy, 2012

Introduction: Double blinded comparison of the diagnostic yield of endoscopic ultrasonography (EU... more Introduction: Double blinded comparison of the diagnostic yield of endoscopic ultrasonography (EUS) and Secretin enhanced Cholangio-MRI (S-CMRI) in patients with idiopathic acute pancreatitis (IAP) has never been published. Objective: To compare the diagnostic yield of EUS and S-CMRI in the etiological work-up of IAP. Methods: We performed a prospective double-blinded study including consecutive patients with IAP diagnosed between february-09 and may-11. IAP was defined as an acute pancreatitis bout without etiological findings after anamnesis, laboratory findings and two radiological explorations (2 transabdominal ultrasonography or 1 plus a CT). All patients who accepted to participate in the study underwent EUS and S-CMRI at least 4 weeks after the acute bout being both explorations performed as close as possible. Two radiologists and 2 endosonographers participated in the study and were blinded to the outcome of the other exploration thanks to a control investigator who did not perform EUS nor S-CMRI either. Chi-square was used to make the statistical analysis. Results: 21 consecutive patients diagnosed of IAP were proposed to participate. Six patients refused to participate: 4 did not want to undergo EUS and 2 did not accept S-CMRI. In the remaining 15, EUS found a possible cause of IAP in 13 (86.7%) and S-CRMI in 6 (40%) (p ϭ 0.21). In these 6 cases EUS was also positive. Both examinations were performed with a mean difference of 10 days (2-37). EUS diagnosed 7 cholelithiasis, 1 choledocholithiasis, 2 pancreas divisum with Santorinicele, 1 chronic pancreatitis and 2 intraductal papillary mucinous tumors (IPMN) (1 with malignant citology after FNA). The S-CRMI found 1 choledocholithiasis, 2 pancreas divisum with Santorinicele, 1 chronic pancreatitis and 2 IPMN. Six patients with cholelithiasis and the patient with malignant IPMN underwent surgery confirming the diagnosis. One patient with Santorinicele and the patient with choledocolithiasis underwent ERCP confirming the diagnosis. Chronic pancreatitis was confirmed by pancreatic function tests. The other 3 patients refused surgery or ERCP. One patient died during follow up because of unrelated cause. The others remain asymptomatic with mean follow up of 23 Ϯ 10.59 months. Conclusions: We found no significant differences between the diagnostic yield of EUS and S-CMRI in patients with IAP, although EUS provides superior diagnostic yield due to better detection of cholelithiasis which is the most frequent finding in these patients, and the ability to perform FNA.

Gastrointestinal Endoscopy, 2010

Gastrointestinal Endoscopy, 2010

Gastrointestinal Endoscopy, 2010

Gastroenterology, 2010

15 p.y threshold, diagnosis of acute pancreatitis and ACP was made significantly earlier (33y and... more 15 p.y threshold, diagnosis of acute pancreatitis and ACP was made significantly earlier (33y and 36y versus 45 and 46y resp) (p=0.005 and 0.005 resp), irrespective of the amount of alcohol intake. Chronic pancreatic pain was also more frequent (p=0.05). At 20 p.y threshold, ACP and acute pancreatitis occurred earlier (p=0.0002 and <0.0001), and the pts hade more often, calcifications and ductal changes (p=0.05 and 0.005 resp) irrespective of alcohol intake. Similar results were observed at the 30 p.y threshold, but additionally pancreatic exocrine insufficiency occurred earlier (p=0.04). Conclusion-Tobacco intake accelerates the course of ACP in a dose-dependent fashion. ACP occurs earlier as soon as 15 p.y, and a major threshold effect is seen at 20 p.y, where the frequency of all major complications of ACP is increased.

Gastroenterology, 2010

RESULTS: At standard endoscopy, anal lesions were observed in 11/15 (73.3%) patients. At CLE, 9 (... more RESULTS: At standard endoscopy, anal lesions were observed in 11/15 (73.3%) patients. At CLE, 9 (60%) patients showed irregular arrangements of epithelial cells (inhomogeneous cells with irregular and unclear border demarcation and presence of increased cell concentration). Long branching IPCLs and irregular shaped IPCLs/leakage were recorded in 14 (93.3%) and 8 (53.3%) patients, respectively. At standard histology, HG-AIN/carcinoma was diagnosed in 8 (53.3%) patients (AIN-3 in 4, AIN-2 in one, carcinoma in 3). LG-AIN was present in 4 (AIN-1 in 3, condyloma in one), while in the rest of patients histology showed normal squamous epithelium. HG-AIN/carcinoma could be predicted with a positive predictive value of 89%. CONCLUSION: Our preliminary data show that irregular cellular and irregular shaped IPCLs/leakage confocal patterns are pathognomonic features of neoplastic changes. On the other hand, long branching IPCLs are not a pathological feature. CLE could be an alternative tool to HRA and could improve the surveillance of AIN lesions. The small size of our population sample requires further studies for the results to be confirmed.

Gastroenterology, 2003

Effect of alcohol intake on gastric emptying of a solid meal: Is it advisable to eat with beer or... more Effect of alcohol intake on gastric emptying of a solid meal: Is it advisable to eat with beer or wine? ... No abstract is available. To read the body of this article, please view the PDF online. ... Visit SciVerse ScienceDirect to see if you have access via your institution.

Gastroenterology, 2010

No abstract is available. To read the body of this article, please view the PDF online. ... © 201... more No abstract is available. To read the body of this article, please view the PDF online. ... © 2010 AGA. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution. ... Advertisements on this site do not constitute a ...