Introduction: Diabetes Mellitus (DM) can slow intestinal transit and delay gastric emptying potentially affecting the quality of bowel preparation (QBP) for colonoscopy. Suboptimal bowel preparation (BP) may lead to missed neoplastic or preneoplastic lesions. This study evaluates glycemic control’s impact on QBP in patients undergoing elective colonoscopy. Methods: A retrospective review of patients who underwent elective colonoscopy with HbA1c levels within one year of the procedure across eight hospitals was conducted. QBP was categorized as optimal or suboptimal based on the Boston Bowel Preparation and Ottawa Bowel Preparation Scales. The association between glycemic control, defined as Hba1c < 5.7 or FBS < 100 mg/dL (Non-diabetic); Hba1c: 5.7-6.4% or FBS: 100-125 mg/dL (Pre-diabetes); Hba1c: 6.5-9.5% or FBS: 126 mg/dL-225 mg/dL (Well-controlled diabetes); Hba1c: >9.5% or FBS >225 mg/dL (Poorly controlled diabetes), and QBP was investigated, along with other patient demographic and clinical characteristics. Socioeconomic status was decided based on the insurance coverage carried by the patient. Significance was assessed at P< 0.05. Results: A total of 1458 patients were included in the analysis (Table 1). QBP was suboptimal in 98 (6.7%) patients. Average days between HbA1c or FBS and colonoscopy were 119.4±89.2. Overall, optimal QBP rates were higher in poorly controlled diabetics (79.5% vs 20.5%, P< 0.001) compared to suboptimal QBP. However, non-diabetics (6.9%), pre-diabetics (4.8%) and well-controlled diabetics (7.7%), had lower rates of suboptimal QBP as compared to poorly controlled diabetics (20.5%). Patients from low socioeconomic status had higher rates of optimal QBP (90.7% vs 9.3%, P< 0.001) but higher rates of suboptimal QBP compared to high socioeconomic status patients (4.7%). Additionally, diabetics on insulin had higher rates of optimal QBP (78.1% vs 21.9%, P< 0.001) but higher rates of suboptimal QBP compared to non-insulin dependent diabetics (5.5%). There were no statistical differences in the QBP rates for age, gender, BMI and patients on GLP-1 agonists. Conclusion: This study shows that poorly controlled and insulin-dependent diabetics have higher rates of suboptimal QBP, leading to missed lesions and increased colon cancer risk. Limited access to healthcare due to low socioeconomic status indirectly contributes to poorly controlled DM and higher rates of suboptimal QBP. Identifying poor preparation risks allows targeted interventions to enhance QBP in high-risk patients. Table 1. - Patient Characteristics and Comparative Analysis of Optimal and Suboptimal Bowel Preparation Groups Patient Characteristics Overall Optimal Bowel Prep Quality Suboptimal Bowel Prep Quality 'P' Value Age (Mean±SD) in years 59.9±9.6 59.96±9.51 58.45±10.25 0.132 Sex Female Male 54.8%45.2% 94.1%92.3% 5.9%7.7% 0.159 Socioeconomic Status Low High 44.2%55.8% 90.7%95.3% 9.3%4.7% < 0.001 BMI (n=1407) Underweight (< 18.5) Healthy Weight (18.5-24.9) Overweight (25-29.9) Obese ( >30) 0.4%15.3%31.9%52.4% 100%94.4%93.3%92.7% 0%5.6%6.7%7.3% 0.736 Glycemic Control Non-diabetic Pre-diabetes Well Controlled Diabetes Poorly Controlled Diabetes 39.5%35.7%22.2%2.7% 93.1%95.2%92.3%79.5% 6.9%4.8%7.7%20.5% < 0.001 Insulin Yes No 7.2%92.8% 78.1%94.5% 21.9%5.5% < 0.001 GLP1 Agonist Yes No 4.5%95.5% 89.2%93.5% 7.1%6.5% 0.198 BMI: Body Mass Index, FBS: Fasting Blood Glucose, GLP-1: Glucagon Like Peptide 1.
Cholestasis due to sepsis is commonly seen in critically ill patients; however, it is often overlooked and poses a challenge in clinical diagnosis and management. In this report, we present a 29-year-old woman who presented to the emergency department with jaundice and symptoms of a urinary tract infection. Initially suspected to be Dubin-Johnson syndrome, sepsis-induced cholestasis was eventually diagnosed after testing. Sepsis should always be considered as part of the differential diagnosis while managing a patient with jaundice. The management of sepsis-induced cholestasis involves treating the underlying infection. In most cases, liver injury improves with the resolution of the infectious process.
Xylobezoar is indeed a rare condition associated with xylophagia, characterized by varying degrees of intestinal obstruction due to the entrapment of undigested paper in the gastrointestinal tract. Xylophagia is a form of pica that primarily affects children from low socioeconomic backgrounds with mental conditions and nutritional deficiencies. It is rarely seen in adults. Medical and endoscopic interventions are often challenging in these patients, and surgical intervention is often required. We present an endoscopically challenging case of pancolonic obstruction due to toilet paper accumulation in a patient with pica secondary to iron deficiency anemia.
Hepatitis A is a mild self-limiting infection of the liver with spontaneous resolution of symptoms in most cases. However, clinicians should be aware of some commonly encountered complications and extrahepatic manifestations associated with hepatitis A for timely diagnosis and treatment. Rhabdomyolysis, an exceedingly rare complication of hepatitis A, is scarcely documented. We present a case of a 64-year-old man with symptoms consistent with rhabdomyolysis and an evanescent rash secondary to acute hepatitis A. He eventually recovered with conservative management. This case emphasizes the importance of recognizing and treating atypical presentations of acute hepatitis A infection.
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