During the past 15 yr, the volume of procedures performed by endoscopists in the United States has increased two- to fourfold. Propofol is currently being used for sedation in approximately one quarter of all endoscopies in the United States. The findings from this survey may help in the formulation of updated policies and practice guidelines pertaining to endoscopic sedation.

Summary Background Blocking of lymphocyte trafficking to bile ducts is a potential mechanism to alter the disease course of patients with primary sclerosing cholangitis (PSC). Aim To describe the effect of the α4β7 integrin antibody, vedolizumab, on liver biochemistry and disease activity in patients with PSC and inflammatory bowel disease (IBD). Methods This is a retrospective multi-center study of adult patients with a diagnosis of both IBD and PSC. The primary outcome was change in serum alkaline phosphatase level at weeks 14 and 30. Secondary outcomes included changes in other liver biochemistries and in clinical outcomes for the bowel disease. A safety analysis for adverse events was performed. Results 34 patients (16 Crohn’s disease, 18 ulcerative colitis) were included. Nine (26%) had a history of liver transplant. Median follow-up on vedolizumab was 9 months [IQR: 7–16]. There was no overall change in serum alkaline phosphatase level with vedolizumab therapy (median 268 [IQR:105–551] IU/L at baseline versus 249 [IQR:183–634] IU/L, P=0.99 at week 30). No significant changes in other liver biochemistries or the Mayo PSC Risk Score were demonstrated at week 30. Clinical remission was achieved at week 30 in 55% of Crohn’s disease and 29% of ulcerative colitis patients. Seven (21%) patients ceased vedolizumab; six patients stopped therapy due to persistent IBD activity and one for worsening of liver biochemistries. Conclusion Vedolizumab treatment in patients with PSC and IBD did not improve liver biochemistry but was associated with improvement in bowel disease and a favorable safety profile.

BackgroundManagement of inpatients with inflammatory bowel disease (IBD) requires increasing resources. We aimed to identify factors associated with hospital readmissions among individuals with IBD.Materials & methodsWe collected data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database 2013. We identified individuals with index hospitalizations for IBD. Patient-specific factors, comorbidities and hospitalization characteristics were extracted for the index hospitalization. We performed logistic regression modeling to create adjusted odds ratios (ORs) for 30-day hospital readmission. Subgroup analysis was performed based on disease type and performance of surgery.ResultsWe analyzed a total of 55,942 index hospital discharges; 3037 patients (7.0%) were readmitted to the hospital within 30 days. Increasing patient age (> 65: OR: 0.45; 95% CI 0.39–0.53) was associated with a decreased risk of readmission, while a diagnosis of Crohn’s disease (OR: 1.09; 95% CI 1.00–1.18) and male sex (OR: 1.16; 95% CI 1.07–1.25) were associated with an increased risk of readmission. The comorbidities of smoking (OR: 1.09; 95% CI 1.00–1.19), anxiety (OR: 1.17; 95% CI 1.01–1.36) and opioid dependence (OR: 1.40; 95% CI 1.06–1.86) were associated with an increased risk of 30-day readmission. Individual hospitalization characteristics and disease complications were significantly associated with readmission. Performance of a surgery during the index admission was associated with a decreased risk of readmission (OR: 0.57; 95% CI 0.33–0.96).ConclusionAnalyzing data from a US publicly available all-payer inpatient healthcare database, we identified patient and hospitalization risk factors associated with 30-day readmission. Identifying patients at high risk for readmission may allow for interventions during or after the index hospitalization to decrease this risk.

Patients with UC and PSC who are in clinical remission are significantly more likely to have endoscopic and histologic inflammation in the right colon than patients with UC without PSC. Our findings provide insight into cause of colorectal cancer in UC patients with PSC.

Greater understanding of the hepatitis C virus (HCV) genome and life cycle of the HCV virion allows for new targets for therapy that directly act on the viral machinery to inhibit replication. Numerous direct-acting antivirals are in development, and four have been brought to market. Simeprevir, a second-generation protease inhibitor, has been approved for HCV genotype 1 patients in combination with pegylated interferon-α and ribavirin. Sofosbuvir, a novel nucleotide analog, has pangenotypic coverage and has been approved for HCV genotype 1 patients with ribavirin and pegylated interferon-α. For HCV genotypes 2 and 3, an all-oral regimen of sofosbuvir with ribavirin has become the new gold standard for treatment. The efficacy and safety for these two novel therapies among various subpopulations of those infected with chronic hepatitis C are discussed in the following review. In addition, off-label and future therapeutic regimens are addressed, as well as the concerns about cost of current and future therapies.