Browsing by Author "Jansson-Knodell, Claire"

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    A Systematic Review and Meta-Analysis of Diet and Nutrient Intake in Adults with Irritable Bowel Syndrome
    (Wiley, 2024) Veraza, Diego Izquierdo; Calderon, Gerardo; Jansson-Knodell, Claire; Aljaras, Rawan; Foster, Erin D.; Xu, Huiping; Biruete, Annabel; Shin, Andrea; Medicine, School of Medicine
    Background: Numerous individual and environmental factors including diet may play an important role in the pathophysiology of irritable bowel syndrome (IBS). It is unclear to what degree dietary intake is affected in individuals with IBS. We aimed to perform a systematic review and meta-analysis to summarize dietary intake of adults with IBS and to compare dietary intake between adults with IBS and non-IBS controls. Methods: Ovid MEDLINE, Embase, Cochrane, CINAHL, and Scopus were searched through February 2023 for clinical trials and observational studies measuring usual diet in adults with IBS. Pooled weighted averages were estimated for total energy, macronutrient, and micronutrient data. Mean differences (MD) in nutrient intake were estimated for adults with IBS versus non-IBS controls using a random effects model. Heterogeneity was assessed by the inconsistency index (I2). Key results: Sixty-three full-text articles were included in the review of which 29 studies included both IBS and control subjects. Nutrients not meeting the recommended intake level for any dietary reference values in the IBS population were fiber and vitamin D. Meta-regression by female proportion was positively correlated with total fat intake and negatively correlated with carbohydrate intake. Comparisons between participants with IBS and controls showed significantly lower fiber intake in participants with IBS with high heterogeneity (MD: -1.8; 95% CI: -3.0, -0.6; I2 = 85%). Conclusions and inferences: This review suggests that fiber and vitamin D intake is suboptimal in IBS; however, overall dietary intake does not appear to be comprised. Causes and consequences of reduced fiber in IBS deserve further study. Results of this systematic review and meta-analysis suggest that fiber and vitamin D intake is suboptimal in IBS. However, overall intake of other macro- and micronutrients does not appear to be compromised. Causes and consequences of reduced fiber and Vitamin D intake in IBS deserve further study.
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    Not FIT for Use: Fecal Immunochemical Testing in the Inpatient and Emergency Settings
    (Elsevier, 2022-01) Bhatti, Umer; Jansson-Knodell, Claire; Saito, Akira; Han, Andrew; Krajicek, Edward; Han, Yan; Imperiale, Thomas F.; Fayad, Nabil; Medicine, School of Medicine
    Background Fecal immunochemical testing (FIT) is widely used for colorectal cancer screening, its only indication. Its effect on clinical decision-making beyond screening is unknown. We studied the use of FIT in emergency and inpatient settings and its impact on patient care. Methods Using electronic medical records, we reviewed all non-ambulatory FITs performed from November 2017 to October 2019 at a tertiary care community hospital. We collected data on demographics, indications, gastroenterology consultations, and endoscopic procedures. Multivariate logistic regression was performed to determine the effect of FIT on gastroenterology consultation and endoscopy. Results We identified 550 patients with at least 1 FIT test. Only 3 FITs (0.5%) were performed for colorectal cancer screening. FITs were primarily ordered from the emergency department (45.3%) or inpatient hospital floor (42.2%). Anemia (44.0%), followed by gastrointestinal bleeding (40.9%), were the most common indications. FIT was positive in 253 patients (46.0%), and gastroenterology consultation was obtained for 47.4% (n = 120), compared with 14.5% (n = 43) of the 297 FIT-negative patients (odds ratio 3.28; 95% confidence interval, 2.23-4.82, P < .0001). A potential bleeding source was identified in 80% of patients with reported or witnessed overt gastrointestinal bleeding, a similar proportion (80.7%; P = .92) to patients who were FIT positive with overt gastrointestinal bleeding. Multivariate analysis showed that melena, hematemesis, and a positive FIT were associated with gastroenterology consultation (all P < .05), while only melena (odds ratio 3.34; 95% confidence interval, 1.48-7.54) was associated with endoscopy. Conclusions Nearly all emergency department and inpatient FIT use was inappropriate. FIT resulted in more gastroenterology consultation but was not independently associated with inpatient endoscopy.
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    Practical Teaching Case – A Small Complaint
    (Elsevier, 2020) Obaitan, Itegbemie; Jansson-Knodell, Claire; Fayad, Nabil; Medicine, School of Medicine
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    Ruptured idiopathic hepatic artery pseudoaneurysm causing portal vein thrombosis with portal hypertension and variceal bleeding
    (Elsevier, 2021-01-27) Ni, Kevin; Jansson-Knodell, Claire; Krosin, Matthew E.; Obaitan, Itegbemie; Haste, Paul M.; Nephew, Lauren D.; Sagi, Sashidhar V.; Radiology and Imaging Sciences, School of Medicine
    Portal vein thrombosis (PVT) is an important cause of noncirrhotic portal hypertension. Noncancerous extrinsic compression of portal vein to drive PVT formation is rare, but important to identify. A 64-year-old female with idiopathic hepatic artery pseudoaneurysm (HAPA) rupture 7 months prior presented with acute-onset hematemesis and melena and was found to have prehepatic portal hypertensive variceal bleeding. Her HAPA-related retroperitoneal hematoma had resulted in portal vein compression, thrombosis, and cavernous transformation despite prompt stent graft placement across the ruptured HAPA, and required definitive treatment by transjugular intrahepatic portosystemic shunt creation with portal vein reconstruction utilizing a trans-splenic access. This case highlights the importance of interval abdominal imaging and hypercoagulability screening for noncirrhotic patients at-risk for PVT, which identified the patient as a heterozygous carrier of Factor V Leiden.
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    S0143 Association of Search Engine Queries for COVID-19 and Diarrhea With COVID-19 Epidemiology
    (Wolters Kluwer, 2020-10) Jansson-Knodell, Claire; Bhavsar, Indira; Shin, Andrea; Kahi, Charles; Medicine, School of Medicine
    INTRODUCTION: Coronavirus disease (COVID-19) is a far-reaching pandemic that has changed the landscape of human interaction. Gastrointestinal symptoms, such as diarrhea, are part of the spectrum of disease. Previous infectious disease studies have shown good correlation between online search engine queries and disease burden, thereby allowing tracking. We aimed to assess the relationship between Google searches for COVID-19 and diarrhea with COVID-19 epidemiology, including incidence and mortality. METHODS: Google Trends, a publicly available and free service that tracks online search frequency, was utilized to identify online searches for combined diarrhea plus COVID-19 from March 3, 2020 to May 4, 2020. These results were stratified by state and then compared with publicly reported incidence data from the US Centers for Disease Control and Prevention (CDC) for the same timeframe. A control search of other COVID-19 associated symptoms listed by the CDC was performed. Additional control searches of the individual search terms diarrhea and COVID-19 were conducted. Correlations between geographic location and epidemiologic trends were analyzed using the Pearson correlation coefficient. RESULTS: State-by-state searches for COVID-19 plus diarrhea were correlated with mortality reported as deaths per capita (R = 0.31; P = 0.03) [Figure 1], but not incidence reported as cases per capita (R = 0.19; P = 0.19). New Hampshire had the highest number of COVID-19 plus diarrhea searches while Alaska, Hawaii, Montana, and West Virginia had the lowest relative search frequency. Diarrhea was the second most searched symptom in conjunction with COVID-19 [Figure 2]. Fever and cough, which are thought of as more traditional upper respiratory viral symptoms, were also commonly searched. Diarrhea alone was more frequently searched than COVID-19 alone or COVID-19 plus diarrhea [Figure 3]. CONCLUSION: Our data show weak correlation between mortality and COVID-19 searches. This indicates that, for COVID-19, online search analysis is unlikely to be a good substitute for more traditional methods of patient testing, case tracking, and early detection. However, Google Trends of searches for COVID-19 plus diarrhea, in addition to being a marker for disease interest, may still be useful as part of a more complex model for tracking disease as they parallel search activity for COVID-19 in general.
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    Virtual Gastroenterology Fellowship Recruitment During COVID-19 and Its Implications for the Future
    (Springer, 2021) Hamade, Nour; Bhavsar-Burke, Indira; Jansson-Knodell, Claire; Wani, Sachin; Patel, Swati G.; Ehrlich, Adam C.; Paine, Elizabeth; Hosseini‑Carroll, Pegah; Menard-Katcher, Paul; Fayad, Nabil; Medicine, School of Medicine
    Background and Aims Amid the COVID-19 pandemic, medical education organizations endorsed a virtual recruitment format, representing a stark change from traditional in-person interviews. We aimed to identify the attitudes and perceptions of Gastroenterology Fellowship Program Directors (PDs) and applicants regarding the virtual interview experience and the role of virtual interviews (VI) in the future. Methods We designed separate surveys targeting PDs and applicants using the Qualtrics software. At the end of the interview season, we e-mailed both survey links to all PDs and requested that they forward the applicant survey to their interviewed candidates. Surveys were voluntary and anonymous. Descriptive statistics were used to analyze the data with results presented as percentages. Results A total of 29.7% of PDs completed the survey. Compared to traditional interviews, VI were viewed by 46.5% of PDs to be very suboptimal or suboptimal. Yet, 69.1% envisioned a role for VI in the future. A total of 14.2% of applicants completed the survey. Compared to traditional interviews, VI were viewed by 42.3% of applicants to be very suboptimal or suboptimal. However, 61.8% saw a future role for VI. While both applicants and PDs reported that establishing an interpersonal connection was a disadvantage with VI, applicants placed more emphasis on this need for connection (p = 0.001). Conclusion Overall, PDs and applicants report mixed views with regard to VI but anticipate that it may continue to have a future role. VI may augment future recruitment cycles with care taken to not disadvantage applicants, who rely heavily on the interview process to create personal connections with programs.