Browsing by Author "Bick, Benjamin"

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    Biliary Obstruction After Transjugular Intrahepatic Portosystemic Shunt Placement
    (Wolters Kluwer, 2021-06-21) Patel, Feenalie; Bick, Benjamin; Pediatrics, School of Medicine
    A 19-year-old man with noncirrhotic portal hypertension status post transjugular intrahepatic portosystemic shunt, gastric esophageal varices status post coil embolization, and thrombophilia because of Factor V Leiden heterozygosity presented with jaundice and elevated liver enzymes. His cholangiogram during endoscopic retrograde cholangiopancreatography demonstrated biliary tract obstruction at the bifurcation of the right and left hepatic ducts. With the aid of digital single-operator cholangioscopy, the patient was found to have a perforation of the common hepatic duct from the shunt. This case presents a novel use for digital single-operator cholangioscopy in identifying this rare complication and appropriately differentiating biliary compression vs perforation from transjugular intrahepatic portosystemic shunt.
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    Prolonged Gastrointestinal Manifestations After Recovery From COVID-19
    (Elsevier, 2023) Elmunzer, B. Joseph; Palsson, Olafur S.; Forbes , Nauzer; Zakaria , Ali; Davis, Christian; Canakis, Andrew; Qayed, Emad; Bick, Benjamin; Pawa, Swati; Tierney, William M.; McLeod, Caroline G.; Taylor, Jason; Patel, Harsh; Mendelsohn, Robin B.; Bala, Gokul; Sloan, Ian; Merchant, Ambreen A.; Smith, Zachary L.; Sendzischew Shane, Morgan A.; Aroniadis, Olga C.; Ordiah, Collins O.; Ruddy, Johannah M.; Simren, Magnus; Tack, Jan; Drossman, Douglas; Medicine, School of Medicine
    Background & Aims Acute enteric infections are well known to result in long-term gastrointestinal (GI) disorders. Although COVID-19 is principally a respiratory illness, it demonstrates significant GI tropism, possibly predisposing to prolonged gut manifestations. We aimed to examine the long-term GI impact of hospitalization with COVID-19. Methods Nested within a large-scale observational cohort study of patients hospitalized with COVID-19 across North America, we performed a follow-up survey of 530 survivors 12–18 months later to assess for persistent GI symptoms and their severity, and for the development of disorders of gut-brain interaction (DGBIs). Eligible patients were identified at the study site level and surveyed electronically. The survey instrument included the Rome IV Diagnostic Questionnaire for DGBI, a rating scale of 24 COVID-related symptoms, the Gastrointestinal Symptoms Rating Scale, and the Impact of Events–Revised trauma symptom questionnaire (a measure of posttraumatic stress associated with the illness experience). A regression analysis was performed to explore the factors associated with GI symptom severity at follow-up. Results Of the 530 invited patients, 116 responded (52.6% females; mean age, 55.2 years), and 73 of those (60.3%) met criteria for 1 or more Rome IV DGBI at follow-up, higher than the prevalence in the US general population (P < .0001). Among patients who experienced COVID-related GI symptoms during the index hospitalization (abdominal pain, nausea, vomiting, or diarrhea), 42.1% retained at least 1 of these symptoms at follow-up; in comparison, 89.8% of respondents retained any (GI or non-GI) COVID-related symptom. The number of moderate or severe GI symptoms experienced during the initial COVID-19 illness by self-report correlated with the development of DGBI and severity of GI symptoms at follow-up. Posttraumatic stress disorder (Impact of Events–Revised score ≥33) related to the COVID-19 illness experience was identified in 41.4% of respondents and those individuals had higher DGBI prevalence and GI symptom severity. Regression analysis revealed that higher psychological trauma score (Impact of Events–Revised) was the strongest predictor of GI symptom severity at follow-up. Conclusions In this follow-up survey of patients 12–18 months after hospitalization with COVID-19, there was a high prevalence of DGBIs and persistent GI symptoms. Prolonged GI manifestations were associated with the severity of GI symptoms during hospitalization and with the degree of psychological trauma related to the illness experience.
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    Targeted Drug Delivery for the Treatment of Abdominal Pain in Chronic Pancreatitis: A Retrospective Case Series
    (Springer Nature, 2024-03-30) Cooper, Guy P., Jr.; Progar, Victor; Grott, Kelly; Patel, Feenalie; Mon, Jackie; Bick, Benjamin; Kelly, Timothy D.; Darabad, Raheleh Rahimi; Anesthesia, School of Medicine
    Summary: Abdominal pain secondary to chronic pancreatitis (CP) is difficult to manage and often requires chronic oral opioid therapy (OOT). Targeted drug delivery (TDD) allows for a diminished dose of opioid intake and improved pain levels. TDD has been used in different pain syndromes with only limited reports in CP. Objective: The objective of this article is to perform a retrospective review of CP patients treated with TDD versus OOT to compare chronic pain control and consumed morphine-equivalent doses. Methods: Patients receiving TDD between September 2011 and August 2018 were included. All patients were weaned off oral opioids one week before intrathecal trial and pump implantation. Patients with intrathecal trials providing at least 50% pain relief underwent pump implantation. Data were collected while on OOT and at two weeks, three months, and nine months post-implant. Data were analyzed with Microsoft Excel 365 MSO using means and standard deviations. P-values were calculated using a two-tailed student’s t-test with paired two-sample means. Results: Twenty-three patients were analyzed. Pre-trial average pain score was 6.5/10 with a mean improvement with trials greater than 71%. The mean chronic baseline oral morphine milligram equivalents (MME) was 188. The mean MME on TDD at two weeks (0.36), three months (1.39), and nine months (2.47) were significantly lower than OOT. Mean pain scores were 6, 4.9, and 5.6 at two weeks, three months, and nine months, respectively, compared to 6.5 on OOT. Discussion: The results of this study indicate that TDD provides improved pain control with significantly lower opioid doses.