Effects of lifestyle on hepatobiliary enzyme abnormalities following the Fukushima Daiichi nuclear power plant accident: The Fukushima health management survey.

Dramatic lifestyle changes due to the Fukushima Daiichi Nuclear Power Plant accident increased the prevalence of hepatobiliary enzyme abnormalities (HEA). We aimed to evaluate associations of HEA with specific lifestyle- and disaster-related factors in residents who lived near the Fukushima Daiichi Nuclear Power Plant.This cross-sectional study included 22,246 residents who underwent a Comprehensive Health Check and the Mental Health and Lifestyle Survey from June 2011 to March 2012. Residents were divided into 2 groups based on residential area and housing status after the accident. Associations between HEA and lifestyle- and disaster-related factors, including psychological distress, were estimated using logistic regression analysis adjusted for demographic and lifestyle factors.HEA was present in 27.3% of subjects. The prevalence of HEA was significantly higher in evacuees than controls (29.5% vs 25.7%, P < .001). There were significant differences in various lifestyle characteristics and the prevalence of post-traumatic stress disorder between evacuees and controls. Multivariable logistic regression analysis showed that age, sex, moderate to heavy drinking, and low/no physical activity were significantly associated with HEA regardless of evacuation status. Changes in jobs and unemployment were significantly associated with HEA in controls and evacuees, respectively.Lifestyle and disaster-related factors, but not psychological distress, were associated with HEA among subjects who lived near the Fukushima Daiichi Nuclear Power Plant accident.

Patient-provider relationships and health outcomes among hepatopancreatobiliary patients.

BACKGROUND: The patient-provider relationship (PPR) is an important element of health care delivery and may influence patient outcomes. The objective of the present study was to identify clinical predictors of PPR among patients with hepatopancreatobiliary (HPB) diseases and assess the association of PPR and health care utilization. MATERIALS AND METHODS: The Medical Expenditure Panel Survey database from 2008-2014 was used to identify adult patients with HPB diagnoses. A PPR score of "poor," "average," and "optimal" was calculated from the Consumer Assessment of Healthcare Providers and Systems Survey. Predictors of poor PPR and the association of PPR and health care utilization were assessed. RESULTS: Among 592 patients, PPR was optimal (210, 35.4%), average (270, 45.5%), or poor (114, 19.2%). Patients without insurance (36.3%) or with Medicaid (28.8%) were more likely to report poor PPR versus patients with private insurance (14.0%) or Medicare (15.4%) (P = 0.03). Poor (24.3%)- and low (21.5%)-income patients were more likely to report poor PPR versus middle (12.8%)- or high-income (14.0%) patients (P = 0.03). Poor mental health was also more common among patients with poor PPR (13.4%) versus average (5.4%) or optimal (3.7%) PPR (P = 0.02), and this association between poor PPR and poor mental health remained significant on multivariable analysis (odds ratio [OR] 2.43, 95% confidence interval [CI] 1.20-4.92). Poor PPR was associated with increased emergency room utilization on univariate (OR 2.50, 95% CI 1.21-5.14), but not multivariate (OR 2.18, 95% CI 0.92-5.15) analysis. CONCLUSIONS: Among patients with HPB diseases, PPR was associated with insurance type, socioeconomic status, and mental health scores. Patients reporting poor PPR were more likely to be high utilizers of the emergency room. Efforts to improve the PPR are needed and should be focused on these high-risk populations.

Effect of mobile phone reminder messages on adherence of stent removal or exchange in patients with benign pancreaticobiliary diseases: a prospectively randomized, controlled study.

BACKGROUND: Plastic and covered metal stents need to be removed or exchanged within appropriate time in case of undesirable complications. However, it is not uncommon that patients do not follow the recommendation for further stent management after Endoscopic Retrograde Cholangiopancreatography (ERCP). The effect of short message service (SMS) intervention monthly on the stent removal/exchange adherence in patients after ERCP is unknown at this time. METHODS: A prospective, randomized controlled study was conducted. After receiving regular instructions, patients were randomly assigned to receive SMS reminding monthly (SMS group) for stent removal/exchange or not (control group). The primary outcome was stent removal/exchange adherence within appropriate time (4 months for plastic stent or 7 months for covered stent). Multivariate analysis was performed to assess factors associated with stent removal/exchange adherence within appropriate time. Intention-to-treat analysis was used. RESULTS: A total of 48 patients were randomized, 23 to the SMS group and 25 to the control. Adherence to stent removal/exchange was reported in 78.2 % (18/23) of patients receiving the SMS intervention compared with 40 % (10/25) in the control group (RR 1.98, 95 % CI 1.16-3.31; p = 0 · 010). Among patients with plastic stent insertion, the median interval time from stent implantation to stent removal/exchange were 90 days in the SMS group and 136 days in the control respectively (HR 0.36, 95 % CI 0.16-0.84, p = 0.018). No difference was found between the two groups regarding late-stage stent-related complications. The rate of recurrent abdominal pain tended to be lower in SMS group without significant difference (8.7 vs 28 %, p = 0.144). Multivariate logistic regression analyses revealed that SMS reminding was the only factor associated with adherence of stent removal/exchange (OR 6.73, 95 % CI 1.64-27.54, p = 0.008). CONCLUSION: This first effectiveness trial demonstrated that SMS reminding monthly could significantly increase the patient adherence to stent removal/exchange after ERCP. TRIAL REGISTRATION: The study was respectively registered on July 10 in 2016 at ClinicalTrials.gov ( NCT02831127 ).

[Modern approaches to the treatment of biliary pathology in young patients with obesity].

The therapeutic efficiency of ursosan in 64 overweight patients with chronic noncalculous cholecystitis and dysfunction of biliary tract was evaluated. Including of ursosan in the complex therapy of patients with chronic noncalculous cholecystitis enhances the efficiency of therapy, causes the positive changes in clinical symptoms and indicators of the biliary tract function, diminishes the lithogenic properties of bile, normalize the food behavior.

[Biliary dysfunctions and their prevention].

THE AIM OF REVIEW: To present the up-to-date methods of prophylaxis of biliary system pathology. ORIGINAL POSITION: The number of patients with biliary tract pathology is constantly growing up. Participation of psychovegetative state in the development of gallbladder dysfunction was confirmed. CONCLUSION: Revealing and treatment of gallbladder dysfunction, treatment of disorders of psychovegetative disorders system in patients with dysfunction of gallbladder is the necessity for successful prophylaxis of chronic cholecystitis, cholelithiasis, pancreatitis.

[Psychosomatic aspects of pathology of biliary passages].

The work was designed to study psychological features of patients with hypomotor dysfunction of biliary passages, chronic non-calculous cholecystitis with and without opistorchosis and cholelithiasis before and after cholecystectomy. A total of 343 patients were examined between 1997 and 2007. The control group comprised 100 age- and sex-matched healthy subjects. All patients signed the informed consent. Significance of the difference between absolute and relative parameters was estimated using Student's t-test at three significance levels (0.05, 0.001, 0.001---??). There were no differences between psychological status of patients with biliary duct pathology, but they were significantly different from controls as regards this variable. Patients with different forms of biliary duct pathology showed unidirectional changes of psychological symptoms that deteriorated with severity of the main disease. The psychological portrait of the patients suggested emotionally labile, hypochondriac, irritable, self-confident, highly anxious and neurotic personality type.

[Possibilities of thermal medicine in gastrointestinal functional disorders]. / Possibilità della medicina termale nei disordini funzionali gastroenterici.

The aim of this review is that of offer an update on the real therapeutic possibility of the thermal medicine in the functional gastrointestinal disorders. The functional dyspepsia, the irritable bowel syndrome, the functional constipation and the functional disorders of the biliary tract (in accordance with Roma II criteria), are the illness for which the drinking mineral waters could give a valid therapeutic support.

Dysfunctional disorders of the biliary tract.

Gallbladder (GB) and Sphincter of Oddi (SO) dysfunctions represent the dysfunctional disorders of the biliary tract (BTDD) that manifest clinically as a variable combination of chronic or recurrent biliopancreatic symptoms and/or pancreatitis not explained by structural abnormalities. GB and SO dysfunctions are motor disorders of muscle contractility that, irrespective of the potential etiologic factors, cause abnormal GB emptying and, respectively, obstruction to the flow of bile and/or pancreatic juice into the duodenum. GB dysfunction is usually diagnosed on clinical grounds in patients with biliary type pain not accompanied by increase of temperature not by laboratory examinations and in whom ultrasonography (US) and/or cholescintigraphy can possibly detect an altered GB emptying. Although cholecystectomy is the most appropriate treatment of GB dysfunction and 50% to 70% of the patients benefit of cholecystectomy, no single test can predict the long-term outcome of surgery. SO dysfunction is usually suspected in cholecystectomized patients on clinical grounds, laboratory, US, and endoscopic retrograde cholangiopancreatography (ERCP) findings. The diagnosis is supported by the measure of the extrahepatic bile transit time at cholescintigraphy and confirmed by SO manometry. Endoscopic sphincterotomy is the usual treatment of SO dysfunction that has an elevated therapeutic efficacy in patients with manometric diagnosis. Emotional and behavioral factors may play a direct role as precipitants of biliary pain or an indirect role by inducing eating behaviors at risk for BTDD. The possible presence of psychological and/or psychiatric components which may predispose to, coexist with, or manifest in reaction to the BTDD should be taken into consideration when developing a treatment strategy for these patients.