Background Newer oral anticoagulants (NOACs) are being utilized increasingly for the treatment of venous thromboembolism (VTE). NOAC use is the standard of care for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute VTE involving extremities and pulmonary embolism. In contrast, most guidelines in the literature support the treatment of acute portal vein thrombosis (PVT) with low molecular weight heparin (LMWH) and vitamin K antagonists (VKA). Literature evaluating NOAC use in the treatment of acute portal vein thrombosis is sparse. This review focuses on the safety and efficacy of the use of NOACs in the treatment of acute PVT in patients, with or without concomitant cirrhosis, based on the most recent data available in the current literature. Methods A systematic review was conducted through a series of advanced searches in the following medical databases: PubMed, BioMed Central, Cochrane, and Google Scholar. Keywords utilized were as follows: NOAC, DOAC (direct oral anticoagulants), portal vein thrombosis, rivaroxaban, apixaban, dabigatran, and edoxaban. Articles related to newer anticoagulant use in patients with portal vein thrombosis were included. Results The adverse events, including bleeding events (major and minor) and the failure of anticoagulation (propagation of thrombus or recurrence of PVT), are similar between the NOACs and traditional anticoagulants for the treatment of acute PVT, irrespective of the presence of cirrhosis. Conclusions Newer oral anticoagulants are safe and efficacious alternatives to traditional anticoagulation with low molecular weight heparin and vitamin K antagonists in the treatment of acute portal vein thrombosis with or without cirrhosis.

Poor inpatient colonoscopy preparations can provide multiple challenges to healthcare providers and patients alike. Poor preparations can make the colonoscopy difficult to perform, and can require the procedure to be repeated. This can in turn lead to greater costs, longer length of stays, less patient satisfaction and worse outcomes. The aim of this quality improvement project was to decrease the rate of poor inpatient colonoscopy preparations using the plan-do-study-act approach. Inpatient colonoscopies at our institution from a 3-month span (November 2016 to January 2017) were evaluated, and found to have a 19% rate of poor preparations. A multiphase intervention programme was then conducted to improve the quality of these preparations. This intervention programme was threefold, and involved (1) direct education to physicians and nursing staff on the preparation process and its importance; (2) the implementation of an electronic order set within our electronic medical record (EMR) to standardise and simplify the process of ordering colonoscopy preparations; and (3) patient education in the form of a handout explaining the steps and importance of a good preparation. Through these interventions, we were able to bring down our rate of poor preparations over a 3-month average from 19% to 4%. Specifically, the implementation of an electronic order set within our EMR resulted in the greatest impact. Our interventions can be replicated at other institutions in order to decrease the rate of poor preparations, and thus result in better outcomes for patients, providers and healthcare facilities.

Since 1964 only nine cases of multiple myeloma occurring in the setting of inflammatory bowel disease have been reported. Although this occurrence may be a mere unfortunate coincidence, there are sound pathophysiological reasons for such an event. The possibility that chronic inflammatory conditions, immunomodulator therapy, and infliximab can predispose to multiple myeloma and lymphoma is reviewed. We discuss in detail the only reported case of multiple myeloma arising in the setting of infliximab treatment for Crohn's disease. It is highly probable that infliximab therapy had a causal role in our patient developing multiple myeloma. The pathogenesis of multiple myeloma arising in the setting of infliximab therapy may be related to decreased apoptosis of plasma cell populations. Since it is possible that a causal association exists between infliximab therapy and multiple myeloma, additional screening measures may be required in patients with Crohn's disease on infliximab.

Objective. Patients are increasingly using the Internet to inform themselves of health-related topics and procedures, including EGD. We analyzed the quality of information and readability of websites after a search on 3 different search engines. Methods. We used an assessment tool for website quality analysis that we developed in addition to using validated instruments for website quality, Global Quality Score (GQS) and Health on Net (HON) certification. The readability was assessed using Flesch-Kincaid Reading Ease (FRE) and Flesch-Kincaid Grade level (FKG). 30 results of each search terms 'EGD' and 'Upper Endoscopy' from Google and 15 each from Bing and Yahoo were analyzed. A total of 45 websites were included from 100 URLs after removing duplicates, video links, and journal articles. Results. Only 3 websites were found to have good quality and comprehensive and authentic information. These websites were https://www.healthline.com, https://www.uptodate.com, and https://www.emedicine.medscape.com. There were additional 13 sites with moderate quality of information. The mean Flesch-Kincaid Reading Ease (FRE) score was 46.92 (range 81.6-6.5). The mean Flesch-Kincaid Grade level (FKG) was 11th grade, with a range of 6th grade to 12th grade and above making them difficult to read. Conclusions. Our study shows that there are quite a few websites with moderate quality content. We recommend 3 comprehensive and authentic websites out of 45 URLs analyzed for information on Internet for EGD. In addition, the readability of the websites was consistently at a higher level than recommended by AMA at 11th grade level. In addition, we identified 3 websites with moderate quality content written at 8th grade and below readability level. We feel that gastroenterologists can help their patients better understand this procedure by directing them to these comprehensive websites.

Objective Patients are increasingly using the Internet to inform themselves of health-related topics and procedures, including EGD. We analyzed the quality of information and readability of websites after a search on 3 different search engines. Methods We used an assessment tool for website quality analysis that we developed in addition to using validated instruments for website quality, Global Quality Score (GQS) and Health on Net (HON) certification. The readability was assessed using Flesch-Kincaid Reading Ease (FRE) and Flesch-Kincaid Grade level (FKG). 30 results of each search terms ‘EGD' and ‘Upper Endoscopy' from Google and 15 each from Bing and Yahoo were analyzed. A total of 45 websites were included from 100 URLs after removing duplicates, video links, and journal articles. Results Only 3 websites were found to have good quality and comprehensive and authentic information. These websites were https://www.healthline.com, https://www.uptodate.com, and https://www.emedicine.medscape.com. There were additional 13 sites with moderate quality of information. The mean Flesch-Kincaid Reading Ease (FRE) score was 46.92 (range 81.6-6.5). The mean Flesch-Kincaid Grade level (FKG) was 11th grade, with a range of 6th grade to 12th grade and above making them difficult to read. Conclusions Our study shows that there are quite a few websites with moderate quality content. We recommend 3 comprehensive and authentic websites out of 45 URLs analyzed for information on Internet for EGD. In addition, the readability of the websites was consistently at a higher level than recommended by AMA at 11th grade level. In addition, we identified 3 websites with moderate quality content written at 8th grade and below readability level. We feel that gastroenterologists can help their patients better understand this procedure by directing them to these comprehensive websites.