Scholars@Duke
Darshan J Kothari

Darshan J Kothari

Associate Professor of Medicine
Medicine, Gastroenterology

Selected Publications

Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room.

Journal Article World J Gastroenterol · March 21, 2024 Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States, resulting in 300000 admissions per year with an estimated cost of over $2.6 billion annually. The severity of AP is determined by the presence of ... Full text Link to item Cite

Long-Term Follow-up of Disabled Patients With Chronic Pancreatitis: Evaluation of Clinical Characteristics, Outcomes, and Predictors.

Journal Article J Clin Gastroenterol · January 1, 2024 BACKGROUND/AIMS: Patients with chronic pancreatitis (CP) often report a poor quality of life and may be disabled. Our study identifies clinical characteristics, predictors and outcomes in CP patients with disability. METHODS: A review of established CP pat ... Full text Link to item Cite

Hypophosphatemia as a Predictor of Clinical Outcomes in Acute Pancreatitis: A Retrospective Study.

Journal Article Pancreas · January 1, 2024 OBJECTIVE: Phosphate is crucial for cellular repair after injury and may be important in recovery following acute pancreatitis (AP). This study aimed to evaluate the association between hypophosphatemia and severity of AP. METHODS: Patients admitted with A ... Full text Link to item Cite

Smoking Is Associated with Worse Clinical Outcomes in Chronic Pancreatitis.

Journal Article Dig Dis Sci · June 2023 BACKGROUND: Tobacco smoking is a known risk factor for progression of chronic pancreatitis (CP). AIM: We compare clinical outcomes of CP patients with current or former smoking with those who have never smoked. METHODS: We reviewed all patients with follow ... Full text Link to item Cite

Pre-existing, Concurrent/Early-Onset, and Late-Onset Diabetes in Chronic Pancreatitis: Do Outcomes Differ?

Journal Article Dig Dis Sci · April 2023 BACKGROUND/AIMS: Diabetes secondary to endocrine insufficiency in chronic pancreatitis (CP) may develop at any time during the disease course. We sought to evaluate the differences in clinical characteristics and outcomes in CP patients with pre-existing, ... Full text Link to item Cite

Prospective evaluation of an emergency department protocol to prevent hospitalization in mild acute pancreatitis: Outcomes and predictors of discharge.

Journal Article Pancreatology · April 2023 BACKGROUND: While acute pancreatitis (AP) contributes significantly to hospitalizations and costs, most cases are mild with minimal complications. In 2016, we piloted an observation pathway in the emergency department (ED) for mild AP and showed reduced ad ... Full text Link to item Cite

Building a Quality Practice in Chronic Pancreatitis.

Journal Article J Clin Gastroenterol · March 1, 2023 Chronic pancreatitis (CP) is a fibroinflammatory disorder that results in irreversible scarring to pancreatic parenchyma and presents with a myriad of symptoms including abdominal pain, nausea, weight loss, steatorrhea, and diabetes. Furthermore, patients ... Full text Link to item Cite

Comparison of Opioid-Based Patient-Controlled Analgesia with Physician-Directed Analgesia in Acute Pancreatitis: A Retrospective Cohort Study.

Journal Article Dig Dis Sci · February 2023 BACKGROUND: Patient-controlled analgesia (PCA) is commonly used for acute postoperative pain management. Clinicians may also use PCA in the management of acute pancreatitis (AP); however, there is limited data on its impact on patient outcomes. We aimed to ... Full text Link to item Cite

Natural history, clinical characteristics, outcomes, and long-term follow-up of pain-free chronic pancreatitis.

Journal Article Gastroenterol Rep (Oxf) · 2023 BACKGROUND: Chronic pancreatitis (CP) is characterized by chronic abdominal pain and functional insufficiency. However, a small subset of patients with prior acute pancreatitis (AP) and/or underlying risk factors for developing CP may be pain-free at diagn ... Full text Link to item Cite

Evaluating Outcomes and Misuse in Opioid-Dependent Chronic Pancreatitis Using a State-Mandated Monitoring System.

Journal Article Dig Dis Sci · December 2022 INTRODUCTION: Patients with chronic pancreatitis (CP) often require opioids for pain control. The goal of our study was to characterize opioid use in patients with CP in a real-life practice using a state-mandated online monitoring program and to assess ou ... Full text Link to item Cite

Impact of recurrent acute pancreatitis on the natural history and progression to chronic pancreatitis.

Journal Article Pancreatology · December 2022 BACKGROUND AND AIMS: It is believed that acute pancreatitis (AP), recurrent AP (RAP) and chronic pancreatitis (CP) represent stages of the same disease spectrum. We aimed to identify risk factors, clinical presentation and outcomes in patients with prior R ... Full text Link to item Cite

Improving documentation of anticoagulation and antiplatelet recommendations after outpatientendoscopy.

Journal Article BMJ Open Qual · December 2022 Clear documentation of instructions for resuming anticoagulant and antiplatelet (AC/AP) medications after gastrointestinal endoscopy is essential for high-quality postprocedure care. Yet, these recommendations are frequently absent, which may impact patien ... Full text Link to item Cite

Inpatient Alcohol Cessation Counseling Is Associated With a Lower 30-Day Hospital Readmission in Acute Alcoholic Pancreatitis.

Journal Article J Clin Gastroenterol · October 1, 2022 BACKGROUND: Alcohol use is a common cause of recurrent acute pancreatitis. Thus, guidelines recommend providing alcohol prevention resources during hospitalization. There is limited data on the real-world implementation of this recommendation. We aimed to ... Full text Link to item Cite

Racial Variations in Pain Management and Outcomes in Hospitalized Patients With Acute Pancreatitis.

Journal Article Pancreas · October 1, 2022 OBJECTIVES: Acute pancreatitis (AP) is a common cause of hospitalization. Black AP patients have higher risk for alcoholic etiology and hospitalization than White patients. We evaluated outcomes and treatment disparities by race in hospitalized AP patients ... Full text Link to item Cite

Evaluating the Clinical Characteristics and Outcomes of Idiopathic Acute Pancreatitis: Comparison With Nonidiopathic Acute Pancreatitis Over a 10-Year Period.

Journal Article Pancreas · October 1, 2022 OBJECTIVE: Up to 30% of acute pancreatitis (AP) cases do not have an established etiology (idiopathic AP [IAP]). We evaluated the characteristics and outcomes of hospitalized IAP patients compared with those with established AP cause (non-IAP). METHODS: A ... Full text Link to item Cite

Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis.

Journal Article World J Gastroenterol · April 28, 2022 BACKGROUND: Acute gallstone pancreatitis (AGP) is the most common cause of acute pancreatitis (AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy (ASGE) sugges ... Full text Link to item Cite

The Impact of an Inpatient Pancreatitis Service and Educational Intervention Program on the Outcome of Acute Pancreatitis.

Journal Article The American journal of medicine · March 2022 BackgroundWe introduced an inpatient pancreatitis consultative service aimed to 1) provide guideline-based recommendations to acute pancreatitis inpatients and 2) educate inpatient teams on best practices for acute pancreatitis management. We asse ... Full text Cite

Extrapancreatic Complications in Hospitalized Patients With Mild Acute Pancreatitis Are Associated With Poorer Outcomes: Results From a Single-Center Study.

Journal Article Pancreas · February 1, 2022 OBJECTIVE: Patients with acute pancreatitis (AP) are at risk for extrapancreatic complications (EPCs) when admitted to the intensive care unit (ICU). We assessed the prevalence of EPCs in non-ICU AP patients and their outcomes. METHODS: We retrospectively ... Full text Link to item Cite

Pain management in chronic pancreatitis incorporating safe opioid practices: Challenge accepted.

Journal Article World J Gastroenterol · June 21, 2021 Patients with chronic pancreatitis often experience severe, unrelenting abdominal pain, which can significantly impact their quality of life. Pain control, therefore, remains central to the overall management of chronic pancreatitis. Most of the strategies ... Full text Link to item Cite

Hyperlipasemia in absence of acute pancreatitis is associated with elevated D-dimer and adverse outcomes in COVID 19 disease.

Journal Article Pancreatology · June 2021 BACKGROUND: Coronavirus SARS-CoV-2 affects multiple organs. Studies have reported mild elevations of lipase levels of unclear significance. Our study aims to determine the outcomes in patients with COVID-19 and hyperlipasemia, and whether correlation with ... Full text Link to item Cite

Patient Safety Reporting in GI: All Hands on Deck.

Journal Article Clin Gastroenterol Hepatol · April 2021 Full text Link to item Cite

Reducing Hospitalization in Mild Acute Pancreatitis: Results of Long-term Follow-up.

Journal Article J Clin Gastroenterol · February 1, 2021 GOALS AND BACKGROUND: Acute pancreatitis (AP) is a common emergency department (ED) diagnosis, amounting to enormous costs. Our previous pilot study demonstrated the feasibility of reducing hospitalization using an ED-based observation pathway. In this fol ... Full text Link to item Cite

Evaluation of Opioid Use in Acute Pancreatitis in Absence of Chronic Pancreatitis: Absence of Opioid Dependence an Important Feature.

Journal Article Am J Med · October 2020 BACKGROUND: Chronic opioid use and dependence is common in patients with chronic pancreatitis. Patients with acute pancreatitis are frequently treated with opioids, but their risk for ongoing use is not well known. The aim of our study is to characterize o ... Full text Link to item Cite

Bone disease in chronic pancreatitis.

Journal Article World J Clin Cases · May 6, 2020 Bone disease (osteopenia or osteoporosis) is a highly prevalent condition in society and presents a tremendous, preventable public health burden. Screening procedures, such as, dual-energy X-ray absorptiometry scans, have allowed early identification and i ... Full text Link to item Cite

Preventing Hospitalization in Mild Acute Pancreatitis Using a Clinical Pathway in the Emergency Department.

Journal Article J Clin Gastroenterol · September 2018 GOALS: We created an observation pathway with close outpatient follow-up for patients with mild acute pancreatitis (AP) to determine its effect on admission rates, length of stay (LOS), and costs. BACKGROUND: AP is a common reason for hospitalization costi ... Full text Link to item Cite

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Journal Article Gastroenterology Report · August 1, 2018 Background and aims: Patients in the intensive care unit (ICU) with acute pancreatitis (AP) are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay. We sought to determine the rate of extra-pancreatic complica ... Full text Cite

The Impact of Risk Factors of Chronic Pancreatitis on Secretin Pancreatic Function Testing: Results of a 20-Year Study.

Journal Article Pancreas · August 2017 OBJECTIVES: The aim of this study was to determine the effect of established risk factors on the outcome of secretin pancreatic function testing (sPFT) in patients undergoing work-up for suspected chronic pancreatitis. METHODS: We completed a retrospective ... Full text Link to item Cite

Comparison of Combined Endoscopic Ultrasonography and Endoscopic Secretin Testing With the Traditional Secretin Pancreatic Function Test in Patients With Suspected Chronic Pancreatitis: A Prospective Crossover Study.

Journal Article Pancreas · July 2017 OBJECTIVE: We aimed to determine the feasibility and accuracy of a combined endoscopic ultrasonography (EUS) with a shortened pancreatic function testing (sEUS) for structural and functional assessment using a single instrument in patients with suspected c ... Full text Link to item Cite

An open-access endoscopy screen correctly and safely identifies patients for conscious sedation

Journal Article Gastroenterology Report · November 1, 2016 Background and aims: Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies. Preprocedural screening addresses sedation requirements; however, procedural safety may be compromised if screening is inaccurate. We sought to ... Full text Cite

A Longitudinal Study of Adenoma Detection Rate in Gastroenterology Fellowship Training.

Journal Article Dig Dis Sci · October 2016 BACKGROUND: Current guidelines suggest that a gastroenterology fellow in training needs to perform 140 colonoscopies to achieve competency. Data are limited regarding adenoma detection rate (ADR) in fellowship. AIMS: To assess how fellow ADR correlates wit ... Full text Link to item Cite

Impact of EGF, IL28B, and PNPLA3 polymorphisms on the outcome of allograft hepatitis C: a multicenter study.

Journal Article Clin Transplant · April 2016 Hepatitis C virus (HCV) infection is accelerated following liver transplantation (LT). Single nucleotide polymorphisms (SNPs) near the epidermal growth factor (EGF) (rs4444903), IL28B (rs12979860), and PNPLA3 (rs738409) loci are associated with treatment r ... Full text Link to item Cite

Fellowship Colonoscopy Training and Preparedness for Independent Gastroenterology Practice.

Journal Article J Clin Gastroenterol · January 2016 GOALS: To objectively assess when gastroenterology (GI) fellows achieve technical competency to perform colonoscopy independently. BACKGROUND: New guidelines to assess the procedural competency of GI fellows in training have been developed. Although compre ... Full text Link to item Cite

Noninvasive markers in the assessment and management of autoimmune liver diseases.

Journal Article Eur J Gastroenterol Hepatol · October 2014 Historically, liver biopsy has been used to determine the etiology of liver disease, the degree of inflammation, the stage of liver fibrosis, and the response to treatments. In the last decade, the advent of noninvasive tests has improved the diagnosis and ... Full text Link to item Cite

Hepatosplenic alpha/beta T-cell lymphoma masquerading as cirrhosis

Journal Article Journal of Gastrointestinal Oncology · January 1, 2013 A 59-year-old man with diabetes mellitus, prior hepatitis B infection and recently diagnosed cirrhosis with prior Babesiosis presented to our institution from an outside hospital with six months of worsening abdominal pain, myalgias and fevers. On admissio ... Full text Cite