- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Novel Approach in the Management of Large Portosystemic Shunt Causing Recurrent Hepatic Encephalopathy (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3855;
Hence, we performed a TIPS procedure with repeat embolization of the shunt which ultimately minimized the blood flow through the large PSS and redirected flow into the portal vein. This novel modality of treatment may be beneficial in PSS which don’t respond to embolization, and further studies may be needed to understand the benefit in such refractory cases.
- |||||||||| lactulose / Generic mfg., albendazole / Generic mfg.
Isolated Pinworm in Ascites (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3776;
She initially received lactulose enemas with which her mentation improved...Treatment with albendazole 400 mg weekly for 4 weeks was effective in eradication of infection...Table: Table 1. Ascites fluid studies
- |||||||||| lactulose / Generic mfg.
Into the Unknown: A Curious Case of Hyperammonemia (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3759;
He was initially managed with lactulose, with partial response...This case reiterates the importance of a thorough clinical history, workup and interdisciplinary teamwork that can guide the treatment and resolution of challenging clinical cases. Figure: Grayscale ultrasound of the liver demonstrating normal hepatic parenchyma, with no sonographic evidence of surface nodularity or other cirrhotic features.
- |||||||||| lactulose / Generic mfg.
Harnessing EHR to Improve Care of Patients With Cirrhosis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3684;
For example, a patient with a history of decompensated cirrhosis with history of hepatic encephalopathy and an acute kidney injury. The flow sheet would compile the number of recorded bowel movements and the amount of lactulose ordered and received, amount of albumin given, and if their beta blocker and diuretics were held.
- |||||||||| Gastroenterological Manifestations in a Patient With Common Variable Immunodeficiency (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3666;
Non-cirrhotic portal hypertension was managed with furosemide and spironolactone...Recognition of this complication allowed for symptom resolution within two days of starting lactulose therapy. NRH in CVID represents an autoimmune-like liver disease that might be driven by a local vasculopathy, and thus severe cases can warrant a trial of immunosuppression.
- |||||||||| Resolor (prucalopride) / J&J, Takeda, Mycamine (micafungin) / Astellas
Functional Medicine Approach to Care Improves Quality of Life and Blood Alcohol Levels in a Patient With Autobrewery Syndrome (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3649;
From 10/2020 to 10/2021, he underwent multiple courses of antifungal medications (nystatin, fluconazole, micafungin, and oral amphotericin)...He started with an aggressive bowel regimen with prucalopride and lactulose...This case is a patient with GFS that failed all medical options and is now thriving after a functional medicine approach to care. Figure: BAC levels continued to spike with medical therapies and have sustained improvement with functional medicine care
- |||||||||| lactulose / Generic mfg.
Decerebrate Posturing and Convulsions: A Rare Hepatic Encephalopathy Presentation (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3522;
He was on oral lactulose as a home medication...There is a possibility we may see an increasing number of patients presenting with this manifestation of HE. Early recognition of posturing as a rare sign in the setting of HE can improve both early diagnosis and treatment along with decreasing excessive workup and length of hospital stay.
- |||||||||| Avastin (bevacizumab) / Roche, Tecentriq (atezolizumab) / Roche
A Rare Diagnosis of Hepatic Hemangioendothelioma Neoplasm of the Liver (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3318;
Tylenol and Salicylate levels were undetectable...CT chest revealed a 2.7 cm and 5 mm nodule in the left lung concerning for metastatic process.The patient was treated for urinary infection and ureteral stone and received lactulose with return of renal function and mental status to baseline...The patient was started on combination chemotherapy with Atezolizumab and Bevacizumab but follow up CT scan showed worsening disease...Different chemotherapy regimens have been suggested for metastatic HEH but there is no general consensus for a standard regimen. Figure: Liver mass
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
A Fatal Case of Herpes Simplex Hepatitis in Pregnancy (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_3252;
This case shows the importance of considering HSV in the pregnant population, for if it were recognized and treated earlier, patient may not have reached fulminant liver failure resulting in death. In conclusion, HSV hepatitis and initiation of early antiviral therapy should be considered in all pregnant patients with concern for evolving hepatic failure.
- |||||||||| lactulose / Generic mfg.
That's a Lot of Air! a Case of Incidental Pneumatosis Intestinalis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2913;
Common causes include pulmonary disease, chemotherapy, ileal surgeries or bowel obstruction with rare causes linked to lactulose or sorbitol-containing compounds...Therefore, in most patients, despite concerning features, PCI may be appropriately managed without surgical intervention. Figure: Diffuse Colonic Pneumatosis and Dilatation
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Small Intestine Bacterial Overgrowth After COVID-19 Infection (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2822;
Patient did not require steroid or Remdesivir therapy...Patient was prescribed Rifaximin and Neomycin and his symptoms completely resolved...It is hypothesized that COVID causes alteration of gut microbiota resulting in “gut dysbiosis” causing increased bacterial growth however further research is on SARS-Cov2 and gut microbiota is needed to have a better understanding of GI manifestation of COVID infection. Figure: Lactulose hydrogen breath test results
- |||||||||| lactulose / Generic mfg.
Plugging up the Leak After Transplant: Shunt-Induced Encephalopathy PARTO-ly Treated and Completed With CARTO (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2483;
The diagnosis was also supported by persistent hyperammonemia and improvement of sensorium with initiation of lactulose...Not only is shunt closure feasible, but it is also safe within the 1st year of transplantation without thrombosis or need for repeat embolization. Figure: Figure 1A: Pre-PARTO/CARTO contrasted computed tomography (coronal view) in the venous phase depicting the large tortuous shunt from the inferior mesenteric vein to the left renal vein (red arrow); Figure 1B: Post-PARTO/CARTO contrasted computed tomography (coronal view) in the venous phase depicting vascular occlusion device (red arrow) with successful thrombosis of the dilated shunt (yellow arrow); Figure 1C: Post-PARTO/CARTO angiography depicting vascular occlusion device (red arrow) and coils (yellow arrow)
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma, Gattex (teduglutide) / Takeda
Intestinal Failure-Associated Liver Disease vs Non Alcoholic Fatty Liver Disease in the Setting of Short Bowel Syndrome: A Case of Rapidly Progressive Hepatic Failure (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_2070;
PN was discontinued 6 months prior and she was gaining weight with enteral feeding and teduglutide...She was treated for hepatic encephalopathy with lactulose, rifaximin and carnitine...There may be benefit to diagnosis with liver biopsy early in the disease course to initiate prompt treatment or transplant, preventing rapid and fatal progression. Figure: Image A : Liver biopsy showing cirrhosis with marked steatohepatitis, mild lobular inflammation, ballooning hepatocyte degeneration nodular and peri-cellular fibrosis stage IV Table: Table 1: Differentiating features between IFALD vs NAFLD
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Flood Syndrome: A Challenge for the Clinician (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1701;
Additionally, he received albumin 25g every 6 hours, lactulose and rifaximin...Early surgical intervention to prevent rupture of these umbilical hernias may ensure the best chance at positive patient outcomes. Figure: A. Large 6.5cm umbilical hernia
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Fatal Drug-Induced Liver Injury in a Patient With Known Chronic Liver Disease Secondary to Ethanol and Hemochromatosis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_1672;
This case report emphasizes the importance of identifying potential hepatotoxic agents such as AC in patients with already established chronic liver disease as they can precipitate life threatening complications such as DILI or DIC. Physicians should also be aware that susceptibility to drugs or chemical compounds can be altered in iron-overloaded livers such as this patient with known history of Hemochromatosis.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
An Unusual Suspect in a Case of Severe Hyperammonemia (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_926;
Cryptococcus neoformans is a less recognized urease-producing organism and was the major source of ammonia production in our patient (coupled with impaired metabolism and excretion from cirrhosis and sarcopenia/kidney disease, respectively). Gastroenterologists need to be aware of Cryptococcus neoformans as an etiology of hyperammonemia, particularly in immunosuppressed patients unresponsive to standard therapy.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
An Unusual Cause of Encephalopathy (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_914;
In the absence of varices, bland embolization with ectopic coils and vascular plugs can be utilized. Endovascular treatment carries an improvement of hepatic encephalopathy by 50 to 80% at 18 to 24 months.
- |||||||||| lactulose / Generic mfg., paracetamol / Generic mfg., spironolactone / Generic mfg.
Acute Decompensation of Late-Onset Glutaric Acidemia Type II in the Setting of Multifactorial Cirrhosis (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_799;
Initial lab studies were significant for platelets of 131k, potassium of 2.4 mmol/L, total bilirubin 3.7 mg/dL, AST 355 ALT 130 ALP 143 IU/L, and no detectable ethanol, acetaminophen or salicylates...Hypokalemia from decreased absorption and lactulose use resolved with potassium supplements and addition of spironolactone...They can decompensate after periods of dehydration, exercise, alcohol ingestion or illnesses and develop hyperammonemia, transaminitis, metabolic acidosis. These individuals have a lifelong risk of intermittent episodes of metabolic crisis and prompt management is imperative to recovery.
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
A Rare Case of Drug-Induced Liver Injury (DILI) Due to Valproate Hepatocellular Injury (Crown Ballroom) - Sep 4, 2022 - Abstract #ACG2022ACG_643;
Case Description/ A 45-year old African American female with a history of hypertension and trigeminal neuralgia was prescribed divalproex for trigeminal neuralgia pain after trials of duloxetine, gabapentin, baclofen, oxcarbazepine, carbamazepine, topiramate, amitriptyline, and tizanidine failed to provide relief...Divalproex was discontinued and the patient was admitted for two weeks of stabilizing treatment including N-acetylcysteine, lactulose, rifaximin, Vitamin K, and L-carnitine transfusion (Figure 1)...Figure 1B. Patient’s INR values over the course of her hospital admission.
- |||||||||| lactulose / Generic mfg.
Retrospective data, Review, Journal, Adverse events: Adverse Effects of Excessive Zinc Intake in Infants and Children Aged 0-3 Years: A Systematic Review and Meta-Analysis. (Pubmed Central) - Sep 4, 2022
Lactulose: mannitol ratio was improved with zinc supplementation, and no significant effect was observed on CRP, eSOD, ZPP and blood cholesterol and iron deficiency anemia...Although possible adverse effects of zinc supplementation were observed in some subgroups, it is unclear whether these findings are clinically important. The synthesized data can be used to undertake a dose-response analysis to update current guidelines of ULs of zinc intake for young children.
- |||||||||| lactulose / Generic mfg.
Journal: Measuring Medication Use, Obstacles and Knowledge in Individuals with Cirrhosis. (Pubmed Central) - Sep 3, 2022
These results suggest that the o-RUTF exerts its beneficial effect through mechanisms other than reducing intestinal permeability or altering the fecal 16S configuration.Clinical Trial Registry: The trial was registered at ClinicalTrials.gov (NCT04334538). In a large, diverse cohort, we validated the My Cirrhosis Coach which can serve to standardize medication use and knowledge measurement in clinical practice and education-based studies in cirrhosis.
- |||||||||| lactulose / Generic mfg.
Biomarker, Observational data, Journal: Putative Biomarkers of Environmental Enteric Disease Fail to Correlate in a Cross-Sectional Study in Two Study Sites in Sub-Saharan Africa. (Pubmed Central) - Sep 3, 2022
Here, we assessed in a cross-sectional study of children aged 2-5 years for a large set of biomarkers including markers of protein exudation (duodenal and fecal alpha-1-antitrypsin (AAT)), inflammation (duodenal and fecal calprotectin, duodenal, fecal and blood immunoglobulins, blood cytokines, C-reactive protein (CRP)), gut permeability (endocab, lactulose-mannitol ratio), enterocyte mass (citrulline) and general nutritional status (branched-chain amino acids (BCAA), insulin-like growth factor) in a group of 804 children in two Sub-Saharan countries...Our results show that while several of the biomarkers are associated with anemia, there is little correlation between the different biomarkers. Better biomarkers and a better definition of EED are thus urgently needed.
- |||||||||| lactulose / Generic mfg.
Trial completion, Trial completion date: Validation of the Small Intestine Microbiome Aspiration (SIMBA) Capsule (clinicaltrials.gov) - Sep 2, 2022
P=N/A, N=30, Completed,
Better biomarkers and a better definition of EED are thus urgently needed. Active, not recruiting --> Completed | Trial completion date: Dec 2022 --> Jun 2022
- |||||||||| lactulose / Generic mfg.
Journal: Constipation and GI diagnoses in children with solid tumours: prevalence and management. (Pubmed Central) - Aug 31, 2022
Constipation is the most common gastrointestinal issue that children with solid tumours experience while receiving chemotherapy in the inpatient setting. Increased attention should be given to constipation prophylaxis and treatment in children with solid tumours undergoing chemotherapy, particularly those identified as high risk.
- |||||||||| lactulose / Generic mfg.
Preclinical, Journal: Protective effect of probiotics and ascorbic acid on bile duct ligation-induced chronic hepatic encephalopathy in rats. (Pubmed Central) - Aug 30, 2022
Groups III and IV were treated with a low and high dose of combination therapy, respectively, while group V was given lactulose...Histological changes were observed in the brain and liver of BDL animals. The additive impact of probiotics and ascorbic acid on BDL-induced chronic HE in rats was mediated by a reduction in ammonia and oxidative stress, implying the therapeutic potential of combination therapy in HE.
- |||||||||| lactulose / Generic mfg.
Review, Journal: Synbiotics and Gut Microbiota: New Perspectives in the Treatment of Type 2 Diabetes Mellitus. (Pubmed Central) - Aug 27, 2022
The use of synbiotics (a combination of prebiotics and probiotics) can thus show a synergistic effect on T2DM through modulating the gastrointestinal microenvironment. This review summarizes the research progress in the treatment of T2DM from the perspective of synbiotics and gut microbiota and provides a class of synbiotics which are composed of lactulose, arabinose, and Lactobacillus plantarum, and can effectively adjust the blood glucose, blood lipid, and body weight of T2DM patients to ideal levels.
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