2024
Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study
Kurlander J, Laine L, Kim H, Roberts C, Saffar D, Myers A, Holleman R, Gao Y, Shank M, Nelson R, Forman J, Helfrich C, Krein S, Saini S, Yang Y. Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study. The BMJ 2024, 385: e076484. PMID: 38604668, PMCID: PMC11007585, DOI: 10.1136/bmj-2023-076484.Peer-Reviewed Original ResearchConceptsPrimary care visitsProton pump inhibitors prescriptionUpper gastrointestinal diagnosesMulticomponent interventionCare visitsHealthcare systemHospital admissionUS Veterans Affairs Healthcare SystemVeterans Affairs Healthcare SystemAbsolute reductionGastrointestinal diagnosesIntegrated healthcare systemProton pump inhibitor overuseReducing proton-pump inhibitorDifference-in-differences studyProton pump inhibitorsPercentage of patientsProton pump inhibitor useAcid peptic diseaseElectronic prescribingPrimary careHealthcare utilizationIntervention sitesPPI prescriptionsOlder adults
2023
Trends in Upper Gastrointestinal Bleeding in Patients on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, 2016-2020
Li D, Laine L, Shung D. Trends in Upper Gastrointestinal Bleeding in Patients on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, 2016-2020. The American Journal Of Medicine 2023, 136: 1179-1186.e1. PMID: 37696350, PMCID: PMC10841721, DOI: 10.1016/j.amjmed.2023.08.010.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingGastrointestinal bleedingRed blood cell transfusionNationwide Emergency Department SamplePrimary cardiovascular preventionRecent guideline recommendationsBlood cell transfusionProportion of hospitalizationsEmergency Department SampleMedicare reimbursementInternational Statistical ClassificationRelated Health ProblemsCardiovascular preventionCell transfusionOlder patientsHospital admissionCommon etiologyGuideline recommendationsMajor complicationsUlcer diseaseEndoscopic interventionRevision codesAppropriate indicationsRecent guidelinesCardiovascular disease
2022
Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding
Li D, Ong S, Hughes M, Hung K, Agarwal R, Alexis J, Damianos J, Sharma S, Pires J, Nanna M, Laine L. Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics 2022, 57: 94-102. PMID: 36394111, DOI: 10.1111/apt.17278.Peer-Reviewed Original ResearchConceptsMajor adverse cardiovascular eventsGastrointestinal bleedingPrimary preventionCardiovascular eventsRisk of MACEYale-New Haven HospitalPrimary cardiovascular preventionAdverse cardiovascular eventsKaplan-Meier curvesLong-term outcomesRisk-benefit ratioLog-rank testAspirin 81Hospitalised patientsPrimary endpointSecondary endpointsCardiovascular preventionSubsequent hospitalisationMedian ageDeprescriptionHigh riskAspirinHospitalisationPatientsPreventionRebleeding in peptic ulcer bleeding – a nationwide cohort study of 19,537 patients
Laursen S, Stanley A, Laine L, de Muckadell O. Rebleeding in peptic ulcer bleeding – a nationwide cohort study of 19,537 patients. Scandinavian Journal Of Gastroenterology 2022, 57: 1423-1429. PMID: 35853234, DOI: 10.1080/00365521.2022.2098050.Peer-Reviewed Original ResearchConceptsPeptic ulcer bleedingNationwide cohort studyUlcer bleedingHemodynamic instabilityCohort studyDuodenal ulcerHigh-risk endoscopic stigmataNon-ulcer lesionsHigh-risk stigmataLogistic regression analysisEndoscopic stigmataPersistent bleedingEndoscopic therapyFrequent complicationConsecutive patientsSuch patientsPrognostic consequencesHigh riskPatientsInterventional radiologyBleedingTwo-fold increaseMortalityUlcersStrongest predictor
2021
Neural network predicts need for red blood cell transfusion for patients with acute gastrointestinal bleeding admitted to the intensive care unit
Shung D, Huang J, Castro E, Tay JK, Simonov M, Laine L, Batra R, Krishnaswamy S. Neural network predicts need for red blood cell transfusion for patients with acute gastrointestinal bleeding admitted to the intensive care unit. Scientific Reports 2021, 11: 8827. PMID: 33893364, PMCID: PMC8065139, DOI: 10.1038/s41598-021-88226-3.Peer-Reviewed Original ResearchConceptsAcute gastrointestinal bleedingRed blood cell transfusionBlood cell transfusionGastrointestinal bleedingHigh-risk patientsCell transfusionRed blood cellsPatient cohortIntensive Care III (MIMIC-III) critical care databaseIntensive care unit staySevere acute gastrointestinal bleedingPacked red blood cellsBlood cellsCommon gastrointestinal causesLaboratory test featuresTime-updated dataIntensive care unitValidation patient cohortCritical care databaseLarge urban hospitalMedical Information MartInternal validation setGastrointestinal causesUnit stayCare unit
2020
Intestinal metaplasia around the gastroesophageal junction is frequently associated with antral reactive gastropathy: implications for carcinoma at the gastroesophageal junction
Vyas M, Celli R, Singh M, Patel N, Aslanian HR, Boffa D, Deng Y, Ciarleglio MM, Laine L, Jain D. Intestinal metaplasia around the gastroesophageal junction is frequently associated with antral reactive gastropathy: implications for carcinoma at the gastroesophageal junction. Human Pathology 2020, 105: 67-73. PMID: 32941964, PMCID: PMC11152084, DOI: 10.1016/j.humpath.2020.08.007.Peer-Reviewed Original ResearchConceptsNonsteroidal anti-inflammatory drugsBile refluxIntestinal metaplasiaReactive gastropathyGEJ regionMucosal injuryMucosal changesGastroesophageal junctionAntral intestinal metaplasiaDistal esophageal adenocarcinomaDetailed clinical historySex-matched patientsGastric antral biopsiesAnti-inflammatory drugsGastric bile refluxMucosal inflammationProximal stomachDistal esophagusMedication usePancreatic metaplasiaPathology databaseProximal gastricAntral biopsiesClinical historyGastric biopsiesABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study
Laursen SB, Oakland K, Laine L, Bieber V, Marmo R, Redondo-Cerezo E, Dalton HR, Ngu J, Schultz M, Soncini M, Gralnek I, Jairath V, Murray IA, Stanley AJ. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut 2020, 70: 707-716. PMID: 32723845, DOI: 10.1136/gutjnl-2019-320002.Peer-Reviewed Original ResearchConceptsLower gastrointestinal bleedingABC scoreLower riskHigher ABC scoresGastrointestinal bleedingRisk scoreMortality rateHospital mortality rateInternational cohort studyManagement of patientsNew risk scoreInternational multicentre studyLower ABC scoreLGIB patientsUGIB patientsComorbidity scoreCohort studyMulticentre studyBlood testsValidation cohortDevelopment cohortLGIBUGIBHigh riskPatients
2019
The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding
Saffouri E, Blackwell C, Laursen SB, Laine L, Dalton HR, Ngu J, Shultz M, Norton R, Stanley AJ. The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics 2019, 51: 253-260. PMID: 31642558, DOI: 10.1111/apt.15541.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overArea Under CurveBlood TransfusionCohort StudiesEndoscopy, GastrointestinalFemaleGastrointestinal HemorrhageHospitalizationHumansMaleMiddle AgedMortalityPredictive Value of TestsPrognosisProspective StudiesReproducibility of ResultsRisk AssessmentSeverity of Illness IndexShockSurvival AnalysisUpper Gastrointestinal TractYoung AdultConceptsUpper gastrointestinal bleedingGlasgow-Blatchford scoreShock indexGastrointestinal bleedingABC scoreMajor transfusionAcute upper gastrointestinal bleedingUK National Confidential EnquiryAdmission Rockall scoreSevere gastrointestinal bleedingMajor clinical endpointsPredictors of outcomeNational Confidential EnquiryRockall scoreBlatchford scoreEndoscopic therapyConsecutive patientsHospital admissionConfidential EnquiryProspective studyClinical endpointsPatient outcomesRisk scoreDeath reportsBleedingValidation of a Machine Learning Model That Outperforms Clinical Risk Scoring Systems for Upper Gastrointestinal Bleeding
Shung DL, Au B, Taylor RA, Tay JK, Laursen SB, Stanley AJ, Dalton HR, Ngu J, Schultz M, Laine L. Validation of a Machine Learning Model That Outperforms Clinical Risk Scoring Systems for Upper Gastrointestinal Bleeding. Gastroenterology 2019, 158: 160-167. PMID: 31562847, PMCID: PMC7004228, DOI: 10.1053/j.gastro.2019.09.009.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingHospital-based interventionsComposite endpointScoring systemRockall scoreGastrointestinal bleedingClinical riskConsecutive unselected patientsLow-risk patientsClinical scoring systemRisk-scoring systemExternal validation cohortCharacteristic curve analysisInternal validation setOutpatient managementUnselected patientsValidation cohortEmergency departmentMedical CenterGreater AUCPatientsAbstractTextCurve analysisEndpointAUCMAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding
Redondo‐Cerezo E, Vadillo‐Calles F, Stanley AJ, Laursen S, Laine L, Dalton HR, Ngu JH, Schultz M, Jiménez‐Rosales R. MAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding. Journal Of Gastroenterology And Hepatology 2019, 35: 82-89. PMID: 31359521, DOI: 10.1111/jgh.14811.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingGastrointestinal bleedingEndoscopic interventionGlasgow-Blatchford scoreSystolic blood pressureNew scoring systemBlatchford scoreProspective databaseBlood pressureRisk stratificationValidation cohortDevelopment cohortOriginal cohortEmergency roomMental statusRisk scoreClinical practiceFair discriminationScoring systemPatientsMortalityCohortNew scoreInterventionBleedingMachine Learning to Predict Outcomes in Patients with Acute Gastrointestinal Bleeding: A Systematic Review
Shung D, Simonov M, Gentry M, Au B, Laine L. Machine Learning to Predict Outcomes in Patients with Acute Gastrointestinal Bleeding: A Systematic Review. Digestive Diseases And Sciences 2019, 64: 2078-2087. PMID: 31055722, DOI: 10.1007/s10620-019-05645-z.Peer-Reviewed Original ResearchConceptsClinical risk scoreUpper gastrointestinal bleedingGastrointestinal bleedingOutcomes of mortalityRisk scoreSystematic reviewOvert gastrointestinal bleedingAcute gastrointestinal bleedingPrognosis Studies toolRisk of biasFull-text studiesCurrent risk assessment toolsRisk assessment toolHospital stayHemostatic interventionRisk stratificationInclusion criteriaPrognostic performanceHigh riskIndependent reviewersConference abstractsLower riskMedian AUCPatientsMortality
2018
Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding
Dunne P, Laursen SB, Laine L, Dalton HR, Ngu JH, Schultz M, Rahman A, Anderloni A, Murray IA, Stanley AJ. Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding. Clinical Gastroenterology And Hepatology 2018, 17: 440-447.e2. PMID: 29705263, DOI: 10.1016/j.cgh.2018.04.046.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingAnti-thrombotic agentsAnti-thrombotic drugsGlasgow-Blatchford scoreRockall scoreHospital stayGastrointestinal bleedingEndoscopic therapyAcute upper gastrointestinal bleedingAnesthesiologists classification scoreBleeding-related mortalityFull Rockall scoreMean hospital stayOutcomes of patientsHigher American SocietyLength of hospitalShorter hospital staySystolic blood pressureMean American SocietyFrequency of malignancyLevels of hemoglobinHigher mean American SocietyAmerican SocietyAIMS65 scoreAnesthesiologists classificationSeverity and Outcomes of Upper Gastrointestinal Bleeding With Bloody Vs. Coffee-Grounds Hematemesis
Laine L, Laursen SB, Zakko L, Dalton HR, Ngu JH, Schultz M, Stanley AJ. Severity and Outcomes of Upper Gastrointestinal Bleeding With Bloody Vs. Coffee-Grounds Hematemesis. The American Journal Of Gastroenterology 2018, 113: 358. PMID: 29380820, DOI: 10.1038/ajg.2018.5.Peer-Reviewed Original ResearchMeSH KeywordsAgedBlood PreservationBlood TransfusionEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHeart RateHematemesisHemoglobinsHemostasis, EndoscopicHumansMaleMelenaMiddle AgedMortalityProspective StudiesRecurrenceRisk AssessmentSeverity of Illness IndexUpper Gastrointestinal TractConceptsCoffee ground emesisBloody emesisHemostatic interventionUpper gastrointestinal bleedingComposite end pointRisk stratification scoresSystolic blood pressureTiming of endoscopyPredictors of outcomeBeats/minGastrointestinal bleedingConsecutive patientsPrimary outcomeSevere bleedingStratification scoresBlood pressureProspective studyHematemesisMelenaEmesisHigh mortalityEnd pointMortalityOutcomesSeverityImage-enhanced endoscopy is specific for the diagnosis of non-erosive gastroesophageal reflux disease
Parikh ND, Viana AV, Shah S, Laine L. Image-enhanced endoscopy is specific for the diagnosis of non-erosive gastroesophageal reflux disease. Scandinavian Journal Of Gastroenterology 2018, 53: 260-264. PMID: 29368532, PMCID: PMC6080852, DOI: 10.1080/00365521.2018.1430847.Peer-Reviewed Original ResearchConceptsNon-erosive gastroesophageal reflux diseaseGastroesophageal reflux diseaseImage-enhanced endoscopyNarrow-band imagingReflux diseaseEndoscopic findingsSquamocolumnar junctionUpper endoscopyPatient acceptanceEndoscopyBand imagingI-scanVascularityAdditional studiesPit patternHeartburnPatientsDiseaseDiagnosisImpedance monitoringRRSpecificityFindingsControlCases
2017
Optimal Timing of Endoscopic Retrograde Cholangiopancreatography in Acute Cholangitis
Hou LA, Laine L, Motamedi N, Sahakian A, Lane C, Buxbaum J. Optimal Timing of Endoscopic Retrograde Cholangiopancreatography in Acute Cholangitis. Journal Of Clinical Gastroenterology 2017, 51: 534-538. PMID: 27875357, DOI: 10.1097/mcg.0000000000000763.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAdolescentAdultAgedAged, 80 and overCholangiopancreatography, Endoscopic RetrogradeCholangitisFemaleHospitalizationHumansIntensive Care UnitsIntubation, IntratrachealLength of StayMaleMiddle AgedMultivariate AnalysisProspective StudiesTime FactorsTreatment OutcomeYoung AdultConceptsEndoscopic retrograde cholangiopancreatographyIntensive care unit admissionCare unit admissionLength of hospitalizationAcute cholangitisUnit admissionRetrograde cholangiopancreatographyFrequent intensive care unit admissionOptimal timingAdditional adverse outcomesCases of cholangitisProcedural adverse eventsDays of presentationVasopressor requirementVasopressor supportBiliary decompressionHospital stayVasopressor useSecondary outcomesAdverse eventsAntibiotic therapyPrimary outcomeEndotracheal intubationAdverse outcomesEmergency departmentPredictors and outcomes of delayed plastic biliary stent removal following endoscopic retrograde cholangiopancreatography
Kim SJ, Ohanian E, Lee F, Nam B, Che K, Laine L, Kim SE, Kim JJ. Predictors and outcomes of delayed plastic biliary stent removal following endoscopic retrograde cholangiopancreatography. Scandinavian Journal Of Gastroenterology 2017, 52: 1128-1132. PMID: 28657377, DOI: 10.1080/00365521.2017.1342138.Peer-Reviewed Original ResearchConceptsEndoscopic retrograde cholangiopancreatographyBiliary stent removalBiliary stent placementStent removalStent obstructionRetrograde cholangiopancreatographyStent placementIndex endoscopic retrograde cholangiopancreatographyNon-English primary languageOutcomes of patientsOutpatient endoscopic retrograde cholangiopancreatographyPreventable adverse eventsMultivariable regression analysisUniversity Medical CenterPlastic biliary stentsAnesthesia assistanceBaseline characteristicsAdverse eventsConsecutive patientsClinical outcomesLoma Linda University Medical CenterOne-fifthMedical CenterBiliary stentsLower oddsRelationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes: a prospective study
Laine L, Laursen SB, Dalton HR, Ngu JH, Schultz M, Stanley AJ. Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes: a prospective study. Gastrointestinal Endoscopy 2017, 86: 1028-1037. PMID: 28396275, DOI: 10.1016/j.gie.2017.03.1549.Peer-Reviewed Original ResearchMeSH KeywordsAgedBlood TransfusionConfusionDuodenal DiseasesEsophageal DiseasesFemaleGlasgow Coma ScaleHematemesisHemoglobinsHemostasis, EndoscopicHumansLength of StayLethargyMaleMelenaMiddle AgedPatient Acceptance of Health CarePrognosisProspective StudiesSerum AlbuminStomach DiseasesStuporTime-to-TreatmentConceptsUpper GI bleedingPatient characteristicsHemoglobin levelsDecreased hemoglobin levelLikelihood of transfusionLower hemoglobin levelsSignificant independent factorsGI bleedingHospital daysConsecutive patientsUpper GIHemostatic interventionPoor outcomeProspective studyEmergency departmentRelationship of timeMental statusIndependent factorsPatientsMulti-national studyLogistic regressionMelenaOutcomesTransfusionHospitalComparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study
Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, Zakko L, Thornton S, Wilkinson K, Khor CJ, Murray IA, Laursen SB. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. The BMJ 2017, 356: i6432. PMID: 28053181, PMCID: PMC5217768, DOI: 10.1136/bmj.i6432.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingRockall scoreGastrointestinal bleedingInternational multicentre prospective studyAdmission Rockall scoreFull Rockall scoreGlasgow-Blatchford scoreHigh-risk patientsMulticentre prospective studyAssessment of patientsPNED scoreHospital stayBlatchford scoreDay mortalityConsecutive patientsRisk patientsComposite endpointEndoscopic treatmentProspective studyClinical endpointsClinical utilityLower riskPatientsLarge hospitalsBleeding
2016
Randomized trial of 1‐week versus 2‐week intervals for endoscopic ligation in the treatment of patients with esophageal variceal bleeding
Sheibani S, Khemichian S, Kim JJ, Hou L, Yan AW, Buxbaum J, Dara L, Laine L. Randomized trial of 1‐week versus 2‐week intervals for endoscopic ligation in the treatment of patients with esophageal variceal bleeding. Hepatology 2016, 64: 549-555. PMID: 27082942, PMCID: PMC4956532, DOI: 10.1002/hep.28597.Peer-Reviewed Original ResearchConceptsEsophageal variceal bleedingVariceal bleedingVariceal eradicationAcute esophageal variceal bleedingBeta-blocker therapyProportion of patientsTreatment of patientsNumber of endoscopiesMean numberLigation sessionsChest painPrimary endpointAdverse eventsClinical outcomesEndoscopic ligationLast endoscopyPhysician preferencePatientsBleedingSuccessful ligationEndoscopyConfidence intervalsEradicationLigationWeeksNo Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents
Zakko L, Rustagi T, Douglas M, Laine L. No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents. Clinical Gastroenterology And Hepatology 2016, 15: 46-52. PMID: 27464591, DOI: 10.1016/j.cgh.2016.07.017.Peer-Reviewed Original ResearchConceptsGastrointestinal bleedingAntiplatelet agentsPlatelet transfusionsCardiovascular eventsNon-variceal upper gastrointestinal bleedingYale-New Haven HospitalRecurrent gastrointestinal bleedingSerious gastrointestinal bleedingMajor cardiovascular eventsRetrospective cohort studySevere gastrointestinal bleedingUpper gastrointestinal bleedingLower blood pressureMultivariable regression analysisHigher heart rateLack of benefitRecurrent bleedingBaseline characteristicsCohort studyBlood pressurePrimary outcomeSuch patientsHemoglobin levelsMultivariable analysisIntensive care