Sheth SG, LaMont JT. Toxic megacolon. Lancet. 1998 Feb 14. 351(9101):509-13. [QxMD MEDLINE Link].
Marshak RH, Lester LJ. Megacolon a complication of ulcerative colitis. Gastroenterology. 1950 Dec. 16(4):768-72. [QxMD MEDLINE Link].
Moulin V, Dellon P, Laurent O, Aubry S, Lubrano J, Delabrousse E. Toxic megacolon in patients with severe acute colitis: computed tomographic features. Clin Imaging. 2011 Nov-Dec. 35(6):431-6. [QxMD MEDLINE Link].
Autenrieth DM, Baumgart DC. Toxic megacolon. Inflamm Bowel Dis. 2012 Mar. 18(3):584-91. [QxMD MEDLINE Link].
Mostafazadeh B, Farzaneh E, Paeezi M, Nikkhah F. Toxic megacolon as a rare complication following atropine therapy due to organophosphate poisoning: A case report. Med Leg J. 2017 Dec. 85(4):221-3. [QxMD MEDLINE Link].
Khasanov R, Schaible T, Wessel LM, Hagl CI. The surgical treatment of toxic megacolon in Hirschsprung disease. Pediatr Emerg Care. 2016 Nov. 32(11):785-8. [QxMD MEDLINE Link].
Mourelle M, Casellas F, Guarner F, et al. Induction of nitric oxide synthase in colonic smooth muscle from patients with toxic megacolon. Gastroenterology. 1995 Nov. 109(5):1497-502. [QxMD MEDLINE Link]. [Full Text].
Mourelle M, Vilaseca J, Guarner F, Salas A, Malagelada JR. Toxic dilatation of colon in a rat model of colitis is linked to an inducible form of nitric oxide synthase. Am J Physiol. 1996 Mar. 270(3 pt 1):G425-30. [QxMD MEDLINE Link].
Guslandi M. Nitric oxide and inflammatory bowel diseases. Eur J Clin Invest. 1998 Nov. 28(11):904-7. [QxMD MEDLINE Link].
Schworer H, Bohn M, Waezsada SY, Raddatz D, Ramadori G. Successful treatment of megacolon associated with colitis with a nitric oxide synthase inhibitor. Am J Gastroenterol. 2001 Jul. 96(7):2273-4. [QxMD MEDLINE Link].
Kwok WC, Tam TCC, Lam DCL. First reported case of afatinib-associated toxic megacolon. Respirol Case Rep. 2018 Oct. 6(7):e00360. [QxMD MEDLINE Link]. [Full Text].
Tariq S, Farooq A, Ali I, Wijesinghe H. Toxic colonoscopy--how investigating active inflammatory bowel disease can lead to the serious complication of toxic megacolon. BMJ Case Rep. 2015 Jul 22. 2015:[QxMD MEDLINE Link]. [Full Text].
Roy MA. Inflammatory bowel disease. Surg Clin North Am. 1997 Dec. 77(6):1419-31. [QxMD MEDLINE Link].
Grieco MB, Bordan DL, Geiss AC, Beil AR Jr. Toxic megacolon complicating Crohn's colitis. Ann Surg. 1980 Jan. 191(1):75-80. [QxMD MEDLINE Link]. [Full Text].
Chaudhuri A, Bekdash BA. Toxic megacolon due to Salmonella: a case report and review of the literature. Int J Colorectal Dis. 2002 Jul. 17(4):275-9. [QxMD MEDLINE Link].
McGuire E, Tiberi S, Ciesielczuk H, Melzer M. Shigellosis and toxic megacolon secondary to Shigella flexneri serotype 3a: The challenges of laboratory diagnosis. Int J Infect Dis. 2018 May. 70:104-6. [QxMD MEDLINE Link]. [Full Text].
Kwok M, Maurice A, Lisec C, Brown J. Campylobacter colitis: Rare cause of toxic megacolon. Int J Surg Case Rep. 2016. 27:141-3. [QxMD MEDLINE Link]. [Full Text].
Bartlett JG, Perl TM. The new Clostridium difficile--what does it mean?. N Engl J Med. 2005 Dec 8. 353(23):2503-5. [QxMD MEDLINE Link].
Arumilli BR, Koneru P, Fayyaz I. Toxic megacolon from hypervirulent Clostridium difficile infection (ribotype 027) following elective total knee replacement: an emerging challenge in modern health care. BMJ Case Rep. 2010. 2010:[QxMD MEDLINE Link]. [Full Text].
Sayedy L, Kothari D, Richards RJ. Toxic megacolon associated Clostridium difficile colitis. World J Gastrointest Endosc. 2010 Aug 16. 2(8):293-7. [QxMD MEDLINE Link]. [Full Text].
McGregor A, Brown M, Thway K, Wright SG. Fulminant amoebic colitis following loperamide use. J Travel Med. 2007 Jan-Feb. 14(1):61-2. [QxMD MEDLINE Link]. [Full Text].
Sidebotham EL, Sepkowitz K, Price AP, Steinherz PG, La Quaglia MP, Kayton ML. Eradication of cryptosporidium from a defunctionalized colon limb by refeeding stoma effluent. J Pediatr Surg. 2010 Jan. 45(1):E33-6. [QxMD MEDLINE Link].
Shimada Y, Iiai T, Okamoto H, et al. Toxic megacolon associated with cytomegalovirus infection in ulcerative colitis. J Gastroenterol. 2003. 38(11):1107-8. [QxMD MEDLINE Link].
Hung CW, Wu WF, Wu CL. Rotavirus gastroenteritis complicated with toxic megacolon. Acta Paediatr. 2009 Nov. 98(11):1850-2. [QxMD MEDLINE Link].
Mohite U, Kell J, Haj MA, et al. Invasive aspergillosis localised to the colon presenting as toxic megacolon. Eur J Haematol. 2007 Mar. 78(3):270-3. [QxMD MEDLINE Link].
Wodzinski MA, Snowden JA, Reilly JT. Toxic megacolon complicating chemotherapy for acute myeloid leukaemia. Postgrad Med J. 1994 Dec. 70(830):921-3. [QxMD MEDLINE Link].
Hayes-Lattin BM, Curtin PT, Fleming WH, et al. Toxic megacolon: a life-threatening complication of high-dose therapy and autologous stem cell transplantation among patients with AL amyloidosis. Bone Marrow Transplant. 2002 Sep. 30(5):279-85. [QxMD MEDLINE Link].
Fitzgerald SC, Conlon S, Leen E, Walsh TN. Collagenous colitis as a possible cause of toxic megacolon. Ir J Med Sci. 2009 Mar. 178(1):115-7. [QxMD MEDLINE Link].
Bains S, Lloyd GM, Sutton CD, West K, Miller AS. A case of toxic megacolon in a patient with collagenous colitis. Tech Coloproctol. 2009 Jun. 13(2):165-6. [QxMD MEDLINE Link].
Umehara Y, Kudo M, Kawasaki M. Endoscopic findings of intestinal Behçet's disease complicated with toxic megacolon. Endoscopy. 2010. 42 Suppl 2:E173-4. [QxMD MEDLINE Link].
Adorian C, Khoury G, Tawil A, Sharara A. Behçet's disease complicated by toxic megacolon. Dig Dis Sci. 2003 Dec. 48(12):2366-8. [QxMD MEDLINE Link].
Atherton LD, Leib ES, Kaye MD. Toxic megacolon associated with methotrexate therapy. Gastroenterology. 1984 Jun. 86(6):1583-8. [QxMD MEDLINE Link].
Tschudin-Sutter S, Tamma PD, Naegeli AN, et al. Distinguishing community-associated from hospital-associated Clostridium difficile infections in children: implications for public health surveillance. Clin Infect Dis. 2013 Dec. 57(12):1665-72. [QxMD MEDLINE Link].
Doshi R, Desai J, Shah Y, Decter D, Doshi S. Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States. Intern Emerg Med. 2018 Sep. 13(6):881-7. [QxMD MEDLINE Link].
Ciccocioppo R, Corazza GR. In-hospital mortality for toxic megacolon. Intern Emerg Med. 2018 Sep. 13(6):837-8. [QxMD MEDLINE Link].
Desai J, Elnaggar M, Hanfy AA, Doshi R. Toxic megacolon: background, pathophysiology, management challenges and solutions. Clin Exp Gastroenterol. 2020. 13:203-10. [QxMD MEDLINE Link]. [Full Text].
Ausch C, Madoff RD, Gnant M, et al. Aetiology and surgical management of toxic megacolon. Colorectal Dis. 2006 Mar. 8(3):195-201. [QxMD MEDLINE Link].
Strauss RJ, Flint GW, Platt N, Levin L, Wise L. The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature. Ann Surg. 1976 Dec. 184(6):682-8. [QxMD MEDLINE Link]. [Full Text].
Ahmed N, Kuo YH. Early colectomy saves lives in toxic megacolon due to Clostridium difficile infection. South Med J. 2020 Jul. 113(7):345-9. [QxMD MEDLINE Link].
Cheng YW, Fischer M. Fecal microbiota transplantation: redefining surgical management of refractory Clostridium difficile infection. Clin Colon Rectal Surg. 2020 Mar. 33(2):92-7. [QxMD MEDLINE Link].
Danovitch SH. Fulminant colitis and toxic megacolon. Gastroenterol Clin North Am. 1989 Mar. 18(1):73-82. [QxMD MEDLINE Link].
Jodorkovsky D, Young Y, Abreu MT. Clinical outcomes of patients with ulcerative colitis and co-existing Clostridium difficile infection. Dig Dis Sci. 2010 Feb. 55(2):415-20. [QxMD MEDLINE Link].
Jalan KN, Sircus W, Card WI, et al. An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology. 1969 Jul. 57(1):68-82. [QxMD MEDLINE Link].
Gan SI, Beck PL. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol. 2003 Nov. 98(11):2363-71. [QxMD MEDLINE Link].
Lee JC, Hung YP, Tsai BY, Tsai PJ, Ko WC. Severe Clostridium difficile infections in intensive care units: diverse clinical presentations. J Microbiol Immunol Infect. 2020 Aug 12. [QxMD MEDLINE Link].
Trudel JL, Deschenes M, Mayrand S, Barkun AN. Toxic megacolon complicating pseudomembranous enterocolitis. Dis Colon Rectum. 1995 Oct. 38(10):1033-8. [QxMD MEDLINE Link].
Nwachuku E, Shan Y, Senthil-Kumar P, et al. Toxic Clostridioides (formerly Clostridium) difficile colitis: no longer a diarrhea associated infection. Am J Surg. 2021 Jan. 221(1):240-2. [QxMD MEDLINE Link].
Caprilli R, Vernia P, Colaneri O, Torsoli A. Blood pH: a test for assessment of severity in proctocolitis. Gut. 1976 Oct. 17(10):763-9. [QxMD MEDLINE Link]. [Full Text].
Hokama A, Ohira T, Kishimoto K, Kinjo F, Fujita J. Impending megacolon: small bowel distension as a predictor of toxic megacolon in ulcerative colitis. Intern Emerg Med. 2012 Oct. 7(5):487-8. [QxMD MEDLINE Link].
Maconi G, Sampietro GM, Ardizzone S, et al. Ultrasonographic detection of toxic megacolon in inflammatory bowel diseases. Dig Dis Sci. 2004 Jan. 49(1):138-42. [QxMD MEDLINE Link].
Imbriaco M, Balthazar EJ. Toxic megacolon: role of CT in evaluation and detection of complications. Clin Imaging. 2001 Sep-Oct. 25(5):349-54. [QxMD MEDLINE Link].
Dieterich DT, Rahmin M. Cytomegalovirus colitis in AIDS: presentation in 44 patients and a review of the literature. J Acquir Immune Defic Syndr (1988). 1991. 4 Suppl 1:S29-35. [QxMD MEDLINE Link].
Dickinson RJ, Ashton MG, Axon AT, Smith RC, Yeung CK, Hill GL. Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology. 1980 Dec. 79(6):1199-204. [QxMD MEDLINE Link].
Present DH. Toxic megacolon. Med Clin North Am. 1993 Sep. 77(5):1129-48. [QxMD MEDLINE Link].
Panos MZ, Wood MJ, Asquith P. Toxic megacolon: the knee-elbow position relieves bowel distension. Gut. 1993 Dec. 34(12):1726-7. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019 Mar. 114(3):384-413. [QxMD MEDLINE Link].
Lawlor G, Moss AC. Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander?. Inflamm Bowel Dis. 2010 Sep. 16(9):1620-7. [QxMD MEDLINE Link].
Sager K, Alam S, Bond A, Chinnappan L, Probert CS. Review article: cytomegalovirus and inflammatory bowel disease. Aliment Pharmacol Ther. 2015 Apr. 41(8):725-33. [QxMD MEDLINE Link]. [Full Text].
McCurdy JD, Jones A, Enders FT, et al. A model for identifying cytomegalovirus in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2015 Jan. 13(1):131-7; quiz e7. [QxMD MEDLINE Link].
Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994 Jun 30. 330(26):1841-5. [QxMD MEDLINE Link]. [Full Text].
Bressler B, Law JK, Al Nahdi Sheraisher N, et al. The use of infliximab for treatment of hospitalized patients with acute severe ulcerative colitis. Can J Gastroenterol. 2008 Nov. 22(11):937-40. [QxMD MEDLINE Link]. [Full Text].
Halpin SJ, Hamlin PJ, Greer DP, Warren L, Ford AC. Efficacy of infliximab in acute severe ulcerative colitis: a single-centre experience. World J Gastroenterol. 2013 Feb 21. 19(7):1091-7. [QxMD MEDLINE Link]. [Full Text].
Laharie D, Bourreille A, Branche J, et al. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial. Lancet. 2012 Dec 1. 380(9857):1909-15. [QxMD MEDLINE Link].
Ogata H, Kato J, Hirai F, et al. Double-blind, placebo-controlled trial of oral tacrolimus (FK506) in the management of hospitalized patients with steroid-refractory ulcerative colitis. Inflamm Bowel Dis. 2012 May. 18(5):803-8. [QxMD MEDLINE Link].
[Guideline] McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and Children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19. 66(7):e1-e48. [QxMD MEDLINE Link]. [Full Text].
Sawada K, Egashira A, Ohnishi K, et al. Leukocytapheresis (LCAP) for management of fulminant ulcerative colitis with toxic megacolon. Dig Dis Sci. 2005 Apr. 50(4):767-73. [QxMD MEDLINE Link].
Kuroki K, Masuda A, Uehara H, Kuroki A. A new treatment for toxic megacolon. Lancet. 1998 Sep 5. 352(9130):782. [QxMD MEDLINE Link].
Shetler K, Nieuwenhuis R, Wren SM, Triadafilopoulos G. Decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe pseudomembranous colitis. Surg Endosc. 2001 Jul. 15(7):653-9. [QxMD MEDLINE Link].
Shah PJ, Vakil N, Kabakov A. Role of intravenous immune globulin in streptococcal toxic shock syndrome and Clostridium difficile infection. Am J Health Syst Pharm. 2015 Jun 15. 72(12):1013-9. [QxMD MEDLINE Link].
Beaugerie L, Ngo Y, Goujard F, et al. Etiology and management of toxic megacolon in patients with human immunodeficiency virus infection. Gastroenterology. 1994 Sep. 107(3):858-63. [QxMD MEDLINE Link].
Davidson T, Allen-Mersh TG, Miles AJ, et al. Emergency laparotomy in patients with AIDS. Br J Surg. 1991 Aug. 78(8):924-6. [QxMD MEDLINE Link].
Truelove SC, Willoughby CP, Lee EG, Kettlewell MG. Further experience in the treatment of severe attacks of ulcerative colitis. Lancet. 1978 Nov 18. 2(8099):1086-8. [QxMD MEDLINE Link].
Anderson JB, Turner GM, Williamson RC. Fulminant ulcerative colitis in late pregnancy and the puerperium. J R Soc Med. 1987 Aug. 80(8):492-4. [QxMD MEDLINE Link]. [Full Text].
Gallo G, Kotze PG, Spinelli A. Surgery in ulcerative colitis: When? How?. Best Pract Res Clin Gastroenterol. 2018 Feb - Apr. 32-33:71-8. [QxMD MEDLINE Link].
Randall J, Singh B, Warren BF, Travis SP, Mortensen NJ, George BD. Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications. Br J Surg. 2010 Mar. 97(3):404-9. [QxMD MEDLINE Link].
Hartman C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol. 2009 Jun 7. 15(21):2570-8. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Lochs H, Dejong C, Hammarqvist F, et al, for the ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clin Nutr. 2006 Apr. 25(2):260-74. [QxMD MEDLINE Link]. [Full Text].
Khoury-Hanold W, Yordy B, Kong P, et al. Viral spread to enteric neurons links genital HSV-1 infection to toxic megacolon and lethality. Cell Host Microbe. 2016 Jun 8. 19(6):788-99. [QxMD MEDLINE Link].
Greenstein AJ, Sachar DB, Gibas A, et al. Outcome of toxic dilatation in ulcerative and Crohn's colitis. J Clin Gastroenterol. 1985 Apr. 7(2):137-43. [QxMD MEDLINE Link].
Grant CS, Dozois RR. Toxic megacolon: ultimate fate of patients after successful medical management. Am J Surg. 1984 Jan. 147(1):106-10. [QxMD MEDLINE Link].
Present DH, Wolfson D, Gelernt IM, et al. Medical decompression of toxic megacolon by "rolling." A new technique of decompression with favorable long-term follow-up. J Clin Gastroenterol. 1988 Oct. 10(5):485-90. [QxMD MEDLINE Link].
Actis GC, Ottobrelli A, Pera A, et al. Continuously infused cyclosporine at low dose is sufficient to avoid emergency colectomy in acute attacks of ulcerative colitis without the need for high-dose steroids. J Clin Gastroenterol. 1993 Jul. 17(1):10-3. [QxMD MEDLINE Link].
Sriram PV, Reddy KS, Rao GV, Santosh D, Reddy DN. Infliximab in the treatment of ulcerative colitis with toxic megacolon. Indian J Gastroenterol. 2004 Jan-Feb. 23(1):22-3. [QxMD MEDLINE Link].
van Geenen EJ, Sachar DB. Infliximab in Crohn's disease-associated toxic megacolon. J Clin Gastroenterol. 2012 Apr. 46(4):321-3. [QxMD MEDLINE Link].
Pascu M, Muller AR, Wiedenmann B, Dignass AU. Rescue therapy with tacrolimus in a patient with toxic megacolon. Int J Colorectal Dis. 2003 May. 18(3):271-5. [QxMD MEDLINE Link].
Tapani MJ, Olavi KH. Surgical management of toxic megacolon. Hepatogastroenterology. 2014 May. 61(131):638-41. [QxMD MEDLINE Link].
Heppell J, Farkouh E, Dube S, et al. Toxic megacolon. An analysis of 70 cases. Dis Colon Rectum. 1986 Dec. 29(12):789-92. [QxMD MEDLINE Link].
Lee EC, Truelove SC. Proctocolectomy for ulcerative colitis. World J Surg. 1980. 4(2):195-201. [QxMD MEDLINE Link].
Leppkes M, Ganslmayer M, Strauss R, Neurath MF. [Toxic megacolon] [German]. Med Klin Intensivmed Notfmed. 2015 Oct. 110(7):500-5. [QxMD MEDLINE Link].
Moura FA, de Andrade KQ, Dos Santos JC, Araujo OR, Goulart MO. Antioxidant therapy for treatment of inflammatory bowel disease: Does it work?. Redox Biol. 2015 Dec. 6:617-39. [QxMD MEDLINE Link].
Neumann H, Neurath MF, Atreya R. Endoscopic therapy in inflammatory bowel diseases. Viszeralmedizin. 2015 Aug. 31(4):280-6. [QxMD MEDLINE Link]. [Full Text].
Siow VS, Bhatt R, Mollen KP. Management of acute severe ulcerative colitis in children. Semin Pediatr Surg. 2017 Dec. 26(6):367-72. [QxMD MEDLINE Link].
McConnie R, Kastl A. Clostridium difficile, colitis, and colonoscopy: pediatric perspective. Curr Gastroenterol Rep. 2017 Aug. 19(8):34. [QxMD MEDLINE Link].
Nayar DM, Vetrivel S, McElroy J, Pai P, Koerner RJ. Toxic megacolon complicating Escherichia coli O157 infection. J Infect. 2006 Apr. 52(4):e103-6. [QxMD MEDLINE Link].

Media Gallery

Toxic Megacolon. A 22-year-old man presented with abdominal pain, passage of blood and mucus per rectum, abdominal distention, fever, and disorientation. Findings from sigmoidoscopy confirmed ulcerative colitis. Abdominal radiographs obtained 2 days apart show mucosal edema and worsening of the distention in the transverse colon. The patient's clinical condition deteriorated over the next 36 hours despite steroid and antibiotic therapy, and the patient had to undergo a total colectomy and ileostomy.
Toxic Megacolon. A 72-year-old woman presented with vomiting and abdominal distention. The supine (right) and erect (left) plain abdominal radiographs show gross dilatation of the colon with multiple air-fluid levels. On further questioning, the patient revealed that she was taking diuretics for hypertension. Blood biochemical tests revealed markedly lowered potassium levels. After potassium replacement therapy, the patient's pseudo-obstruction completely resolved.
Toxic Megacolon. Gross pathology specimen from a case of pseudomembranous colitis demonstrating characteristic yellowish plaques.
Toxic Megacolon. Computed tomography scan from a patient with pseudomembranous colitis demonstrating the classic accordion sign.
Toxic Megacolon. Plain abdominal radiograph from a patient with known ulcerative colitis who presented with an acute exacerbation of his symptoms. This image shows thumbprinting in the region of the splenic flexure of the colon.
Toxic Megacolon. Increased postrectal space is a known feature of ulcerative colitis.
Toxic Megacolon. A 45-year-old woman presented with acute pain and colitis of uncertain etiology. The radiograph shows an increase in gaseous distention of the distal transverse colon, now measuring up to 80 mm in diameter (it was 60 mm 2 days previous). The transverse colon and sigmoid colon are both featureless, consistent with severe colitis. There is fecal loading in the right side of colon. No evidence of free gas or pneumatosis intestinalis is noted. The appearance is concerning for toxic megacolon. Courtesy of Craig Hacking, MBBS, Associate Professor, Royal Brisbane and Women’s Hospital (Radiopaedia.org, rID: 79194).

of 7

Author

Fadi Alali, MD Fellow, Department of Gastroenterology, Ascension Providence Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC

Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Burt Cagir, MD, FACS Professor of Surgery, Geisinger Commonwealth School of Medicine (GCSOM); Director, General Surgery Residency Program, Executive Director, Donald Guthrie Foundation for Research and Education, Guthrie Robert Packer Hospital; Medical Director, Guthrie/RPH Skills and Simulation Lab; Associate in Surgery, Guthrie Robert Packer Hospital and Corning Hospital

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, Association of Program Directors in Surgery, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Clifford Y Ko, MD, MS Professor, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine

Clifford Y Ko, MD, MS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, California Medical Association, New York Academy of Sciences

Disclosure: Nothing to disclose.

George Y Wu, MD, PhD Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine

George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, Association of American Physicians

Disclosure: Nothing to disclose.

Lisa M Rossi, MD Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine

Disclosure: Nothing to disclose.

Deepika Devuni, MD Assistant Professor of Gastroenterology, University of Massachusetts Medical School

Deepika Devuni, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Association of Physicians of Indian Origin, American College of Gastroenterology, American Gastroenterological Association, American Society of Transplantation

Disclosure: SIte PI for: Sequana Medical .

Brian Lin New York College of Osteopathic Medicine

Brian Lin is a member of the following medical societies: American College of Osteopathic Family Physicians, American College of Osteopathic Internists, American College of Physicians, American Medical Student Association/Foundation, Asian Pacific American Medical Student Association, Student Osteopathic Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Terence David Lewis, MBBS, FRACP, FRCPC, FACP Program Director, Internal Medicine Residency, & Assistant Chairman, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center

Terence David Lewis, MBBS, FRACP, FRCPC, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, and Sigma Xi

Disclosure: Nothing to disclose.

Jerome H Liu, MD Staff Physician, Department of Surgery, University of California at Los Angeles Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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