Abstract:
BACKGROUND AND AIMS:Multiple medications are associated with an increased risk of incident hepatic encephalopathy. Despite this known risk, medications such as opioids, benzodiazepines, gabapentin/pregabalin, and/or proton pump inhibitors are increasingly prescribed to persons with cirrhosis. Deprescribing is a promising intervention to reduce the burden of hepatic encephalopathy. Given that deprescribing has not been trialed in cirrhosis, we evaluated the barriers and facilitators to safe and successful deprescribing in cirrhosis. METHODS:We conducted, transcribed, and analyzed semi-structured interviews using qualitative methodology with 22 subjects. This included eight patients with cirrhosis and recent use of opiates, benzodiazepines, gabapentin/Lyrica, and/or proton pump inhibitors as well as 14 providers (primary care, transplant surgery, transplant hepatology). Interviews explored opinions, behaviors, and understanding surrounding the risks and benefits of deprescribing. RESULTS:Major provider-specific barriers included deferred responsibility of the deprescribing process, knowledge gaps regarding the risk of hepatic encephalopathy associated with medications (e.g. proton pump inhibitors) as well as the safe method of deprescription (i.e. benzodiazepines), and time constraints. Patient-specific barriers included knowledge gaps regarding the cirrhosis-specific risks of their medications and anxiety about the recurrence of symptoms after medication discontinuation. Patients uniformly reported trust in their provider's opinions on risks and wished for more comprehensive education during or after visits. Providers uniformly reported support for deprescription resources including pharmacist or nurse outreach. CONCLUSION:Given knowledge of medication risks related to hepatic encephalopathy in patients with cirrhosis, deprescribing is universally seen as important. Knowledge gaps, inaction, and uncertainty regarding feasible alternatives prevent meaningful implementation of deprescription. Trials of protocolized pharmacy-based deprescribing outreach and patient-facing education on risks are warranted.
journal_name
United European Gastroenterol Jjournal_title
United European gastroenterology journalauthors
Williams S,Louissaint J,Nikirk S,Bajaj JS,Tapper EBdoi
10.1177/2050640620975224subject
Has Abstractpub_date
2020-11-23 00:00:00pages
2050640620975224eissn
2050-6406issn
2050-6414pub_type
杂志文章abstract:Background:Endoscopic mucosal resection is well-established for resecting flat or sessile benign colon polyps. The novel underwater endoscopic mucosal resection eschews submucosal injection prior to endoscopic mucosal resection. Reports about underwater endoscopic mucosal resection were limited to small series of singl...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640617733923
更新日期:2018-04-01 00:00:00
abstract:Background and objective:Psychological states may interfere with visceral sensitivity. Here we investigate associations between psychosocial factors and visceral sensitivity in irritable bowel syndrome (IBS). Methods:Two IBS patient cohorts (Cohort 1: n = 231, Rome II; Cohort 2: n = 141, Rome III) underwent rectal bar...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640617715851
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abstract:Background:Dysplasia in Barrett's esophagus (BE) biopsies is associated with low observer agreement among general pathologists. Therefore, expert review is advised. We are developing a web-based, national expert review panel for histological review of BE biopsies. Objective:The aim of this study was to create benchmar...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640618764710
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Reliable and safe sedation is a prerequisite for endoscopic interventions. The current standard is rather safe, yet, an objective device to measure sedation depth is missing. To date, anaesthesia monitors based on processed electroencephalogram (EEG) have not been utilised in conscious sedation. OBJECTIVE:T...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640620959153
更新日期:2020-09-14 00:00:00
abstract::One of the aims of the Young Talent Group (YTG) is to make United European Gastroenterology (UEG) more attractive for young fellows interested in gastroenterology, and to involve them actively in UEG activities, by collaborating with young GI sections (YGIS) across Europe. Therefore, the YTG launched a survey to colle...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640617713936
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND AND AIMS:The search for a source of gastrointestinal bleeding is associated with two distinct approaches of trying to rule in a specific diagnosis or rule out any potential source of bleeding. The study aim was to understand the conceptual differences underlying the two searches. METHODS:The performance of ...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640614557319
更新日期:2014-12-01 00:00:00
abstract::The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the bound...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640615624631
更新日期:2016-02-01 00:00:00
abstract:Background:The ability to predict the severity of disease is important to reduce morbidity and mortality in patients with acute pancreatitis (AP). Vitamin D deficiency has been associated with severity in various diseases. Objective:This study was conducted to assess vitamin D as a predictor of disease severity in pat...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640618811489
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND AND AIMS:Some studies have explored the prevalence of pancreatic cystic lesions (PCLs). Only one study based on magnetic resonance imaging (MRI) report examination focused specifically on intraductal papillary mucinous neoplasm (IPMN) in a European general population. The aim of this study was to evaluate th...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640616664842
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Recent reports from western countries have indicated an increased incidence and a decreased mortality in acute pancreatitis. However, the incidence assessment has often been hampered by the inclusion of both first-time and recurrent episodes of acute pancreatitis. METHODS:In this retrospective cohort study,...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640620913737
更新日期:2020-05-01 00:00:00
abstract::The statements produced by the Consensus Conference on Diverticular Disease promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease (DD) in patients wit...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640614547068
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Women conceiving following in vitro fertilization (IVF) likely have a variety of risk factors that predispose them to gastroesophageal reflux disease (GERD) in the future. OBJECTIVE:We aimed to investigate whether pregnancy through IVF may predispose to subsequent GERD compared with pregnancies without IVF....
journal_title:United European gastroenterology journal
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doi:10.1177/2050640615597836
更新日期:2016-04-01 00:00:00
abstract::Eosinophilic esophagitis (EoE) is an emerging esophageal inflammatory disorder affecting children and young adults. As a relatively new disease, EoE is still burdened by frequent diagnostic and therapeutic pitfalls in clinical practice. This manuscript posits a number of similarities with Crohn's disease, which may he...
journal_title:United European gastroenterology journal
pub_type: 杂志文章,评审
doi:10.1177/2050640616672953
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Acute abdominal pain (AAP) is one of the most common causes of referral to an emergency department (ED), but information about its impact is limited. OBJECTIVES:The objectives of this article are to define the prevalence of AAP among ED visits in a large university hospital and analyze its main clinical fea...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640615606012
更新日期:2016-04-01 00:00:00
abstract::This guideline presents recommendations for the management of coeliac disease (CD) and other gluten-related disorders both in adults and children. There has been a substantial increase in the prevalence of CD over the last 50 years and many patients remain undiagnosed. Diagnostic testing, including serology and biopsy...
journal_title:United European gastroenterology journal
pub_type: 杂志文章,实务指引
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更新日期:2019-06-01 00:00:00
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journal_title:United European gastroenterology journal
pub_type: 杂志文章,多中心研究
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更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Patients with primary oesophageal squamous cell carcinoma are at risk of developing multiple primary tumours in the upper aero digestive tract. To date, most studies are performed in the Asian population. We aimed to evaluate the risk of multiple primary tumours in the upper aero digestive tract and stomach ...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640620977129
更新日期:2020-12-03 00:00:00
abstract::Stricturing Crohn's disease (CD) is a significant clinical problem. The presence of a stricture may be suggested by clinical symptoms. Cross-sectional imaging using computed tomography or magnetic resonance enterography is essential in diagnosing strictures as it allows further characterization and evaluation for comp...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640620901960
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abstract::Barrett's oesophagus is a pre-malignant condition associated with the development of oesophageal adenocarcinoma. Currently white light endoscopy and biopsy is the mainstay diagnostic tool. Yet this approach is troubled by issues related to cumbersome biopsy sampling, biopsy sampling errors and cost. Therefore in order...
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doi:10.1177/2050640615619281
更新日期:2016-12-01 00:00:00
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更新日期:2015-04-01 00:00:00
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journal_title:United European gastroenterology journal
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更新日期:2018-06-01 00:00:00
abstract:Background and aims:In complex endoscopies, the initial attempt is often associated with the highest success and subsequent attempts to achieve the same outcome have a higher failure rate. An attending physician needs to decide how the ultimate success may become compromised by letting a fellow start the procedure. A d...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640617696401
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Eosinophilic oesophagitis (EoO) has been associated with allergic disorders as well as aeroallergens. The current literature has shown a possible association between seasonal variation, mainly in the spring, and the incidence of EoO. However, this data was based on small population studies that did not exclu...
journal_title:United European gastroenterology journal
pub_type: 杂志文章
doi:10.1177/2050640614525152
更新日期:2014-04-01 00:00:00
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journal_title:United European gastroenterology journal
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doi:10.1177/2050640617693524
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Prucalopride is a selective, high-affinity, 5-hydroxytryptamine (serotonin) type 4 (5-HT4) receptor agonist with gastrointestinal prokinetic activities. This integrated analysis of data from three double-blind phase III trials (ClinicalTrials.gov: NCT00488137, NCT00483886, NCT00485940) compared the efficacy ...
journal_title:United European gastroenterology journal
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doi:10.1177/2050640612474651
更新日期:2013-02-01 00:00:00
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journal_title:United European gastroenterology journal
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doi:10.1177/2050640616647816
更新日期:2017-02-01 00:00:00
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journal_title:United European gastroenterology journal
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doi:10.1177/2050640617732651
更新日期:2018-04-01 00:00:00
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journal_title:United European gastroenterology journal
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更新日期:2019-04-01 00:00:00