Hasil untuk "Diseases of the digestive system. Gastroenterology"

David I. Fudman, Ryan A. McConnell, Christina Ha et al.

Rohit Loomba, Peter Chen-Yang Nikhil Daniel, Youxin Wang et al.

Shyam Sundar Sah, Abhishek Kumbhalwar

Ken Nakamura, Seiji Futagami, Shuhei Agawa et al.

Abstract Objectives Pancreatic fibrosis is one of the main pathological features of chronic pancreatitis (CP), suggesting a strong relationship between CP and pancreatic ductal cancer. There was no available data about pancreatic fibrosis and pancreatic dysfunction in the early CP (ECP) using endosonography (EUS). Methods Asymptomatic patients with pancreatic enzyme abnormalities (AP‐P; n = 56) and patients with ECP (n = 21) were determined by the absence of abnormal findings on upper gastrointestinal endoscopy, abdominal ultrasonography, and abdominal computed tomography. An Olympus EUS (GF‐UCT 260; Olympus) was used to perform EUS. Open software “Image J”, developed by NIH, was used to measure the surface area fraction of the designated elastic blue region. The maximum value among the pancreatic head, pancreatic body, and pancreatic tail was defined as the ELST‐blue score. The exocrine and endocrine pancreatic functions were evaluated using the N‐benzoyl‐l‐tyrosyl‐p‐aminobenzoic acid (BT‐PABA) test and homeostasis model assessment of β‐cell function (HOMA‐β) value, respectively. Results EUS score, lobularity, and hyperechoic foci/strands in patients with ECP were significantly (p < 0.001) higher than those in patients with AP‐P. In addition, there were no significant differences in the BT‐PABA test (73.1 ± 25.5, 68.5 ± 15.6) and HOMA‐β (93.1 ± 67.4, 73.5 ± 139.7) between patients with ECP and AP‐P. The ELST‐blue score measured by image J as the quantification tool in EUS strain elastography in patients with ECP was significantly higher (p = 0.002) than that in patients with AP‐P. Interestingly, the ELST‐blue score was significantly associated with HOMA‐β in patients with ECP. Conclusions The ELST‐blue score may be a useful tool for the evaluation of endocrine pancreatic dysfunction in the ECP.

Wendi Zhang, Yuwei Wu, Min Cheng et al.

Abstract The commensal microbiota is closely related to HBV infection and HBV-related liver diseases; however, how HBV and viral components dynamically affect the targeted organ liver microbiota is not well-known. In this study, an HBV-carrier mouse model established by HBsAg+ hepatocyte replacement in Fah −/− recipient mice, named HBs-HepR mice, was used to analyze the microbiota and metabolomics at the time of triggering the specific anti-HBV CD8+ T cell response in the liver. The composition and relative abundance of microbiota were both altered in the gut and liver of HBs-HepR mice. Particularly, increased Muribaculaceae and Alloprevotella, and decreased Lachnospiraceae-NK4A136 and Rikenella were observed in the gut; while increased Ralstonia and Geobacillus were observed in the liver of HBs-HepR mice. Furthermore, changes in microbial functions were revealed. There were no significant differences in the levels of SCFAs in fecal and serum; however, decreased propionic acid and acetic acid were detected in the livers of HBs-HepR mice, which was negatively related to the abundance of Geobacillus in the liver. Significantly decreased levels of 9 kinds of amino acids were detected in the feces of HBs-HepR mice, which was positively related to decreased Rikenella in the gut. A significant increase in L-glycine was observed in the liver and serum, positively related to the abundance of Geobaillus in the livers of HBs-HepR mice. In conclusion, chronic HBV infection imbalanced SCFA and amino acid metabolism by modulating microbiota in the liver, unlike in the gut, which was involved in the immune activation phase.

Daniel Q. Huang, Suzanne R. Sharpton, Maral Amangurbanova et al.

M. Garganese, Milena Pizzoferro

Pediatric gastrointestinal imaging plays a crucial role in evaluating and managing digestive system disorders in children. This comprehensive review dives into the nuances of pediatric gastrointestinal imaging techniques, focusing on three specific modalities: gastric emptying scintigraphy (GES), intestinal transit scintigraphy (ITS), and gastrointestinal bleeding scintigraphy. GES involves real-time monitoring of stomach emptying using radiotracers and gamma camera technology. While challenges exist in standardizing protocols due to age-specific meal compositions, GES remains pivotal in diagnosing motility disorders, gastroesophageal reflux, and abdominal pain in children. ITS, utilizing [67Ga], provides insights into gastrointestinal motility disorders such as Hirschsprung disease. It aids in whole-gut transit evaluation, guiding surgical interventions and improving long-term clinical outcomes. Gastrointestinal bleeding scintigraphy, employing [99mTc], assists in diagnosing conditions like Meckel's diverticulum and occult bleeding, offering continuous monitoring to pinpoint the bleeding site along the entire gastrointestinal tract. SPECT-CT improves the accuracy and the standards of care. Each technique's protocol details, clinical indications, and diagnostic capabilities are thoroughly discussed, highlighting the importance of these non-invasive, functional imaging modalities in pediatric gastroenterology.

Zia Mohy Ud Din, Muhammad Omar Cheema, Jahanzeb Gul et al.

Biopotential signal simulator is a device that mimics the electrical activity of the body organ. Simulators are used in calibration and maintenance to assure the quality and safety factor of the medical devices before using them on the patients. Electrogastrogram or EGG is the biopotential signal generated from the human stomach. This unique signal provides insights about the digestive system by producing normal and abnormal rhythms in case of proper and improper digestion of food respectively. In this paper, an EGG simulator has been designed and developed by integrating LabVIEW and DAQ Card. EGG rhythms during fasting and postprandial period have been simulated. Since collecting EGG data from subjects is a time-consuming and demanding operation, simulating EGG signals is crucial for evaluating newly designed EGG acquisition systems as it reduces the amount of time and money spent on data collection during preclinical trials of newly created devices. The EGG simulator can also be used to simulate certain rhythms, which can improve the accuracy of prediction algorithms used to distinguish between normal and pathological EGG rhythms. The EGG simulator has the potential to be integrated into medical manikins in the future, as it is currently unavailable on the market. It can also be used for testing and optimizing newly created EGG acquisition systems and disease detection algorithms, which will further research and development in the field of gastroenterology.

Yeliz Serin, Camilla Manini, Pasqualino Amato et al.

A healthy and balanced diet is a critical requirement for pregnant women as it directly influences both the mother’s and infant’s health. Poor maternal nutrition can lead to pregnancy-related complications with undesirable effects on the fetus. This requirement is equally important for pregnant women with celiac disease (CD) who are already on a gluten-free diet (GFD). Although the GFD is the sole treatment option for CD, it still presents some challenges and confusion for celiac women who wish to conceive. Poorly managed CD has been linked to miscarriages, preterm labor, low birth weight, and stillbirths. Current CD guidelines primarily focus on screening, diagnosis, treatment, and management but lack an evidence-based approach to determine appropriate energy requirements, recommended weight gain during pregnancy, target macronutrient distribution from the diet, the recommended intake of vitamins and minerals from diet and/or supplementation, timing for starting supplementation, and advised portions of gluten-free foods during pregnancy. We recommend and call for the development of such guidelines and/or authoritative papers in the future.

Akihisa Ohno, Nao Fujimori, Toyoma Kaku et al.

Background/Aims Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation. Methods We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records. Results Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods. Conclusions The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

Cokorde Istri Yuliandari Krisnawardani Kumbara, I. K. Mariadi, G. Somayana et al.

Background: Coronavirus Disease 2019 (COVID-19) can affect not only the respiratory system but also other organs such as the liver. Liver injury tends to occur in severe disease of COVID-19 patients and might contribute to clinical outcomes for patients. This study aimed to find the relationship between the severity of liver injury with clinical outcome and duration of hospitalizations.Methods: This study was a retrospective study of hospitalized COVID-19 patients period April 2020 to April 2021. The inclusion criteria were severe COVID-19 patients who developed a liver injury. The severity of the liver injury was classified into mild, moderate, and severe. The relationship between the severity of liver injury with clinical outcome and duration of hospitalization was analyzed. Univariate and logistic regression were used. Results: 90 samples fill the inclusion criteria. The liver injury severity was statistically significantly related to clinical outcome patients (p= 0.047), which is the increase in liver injury severity resulting in poor clinical outcomes. No significant relationship was found between the severity of liver injury with the duration of hospitalization.Conclusion: liver injury increases mortality in severe COVID-19 patients.

Kevin Tandarto, Kadek Ari Suyandi, Lily Chandrawati

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the most widespread global pandemic since the 1918 influenza pandemic. The consequences of the coronavirus disease 2019 (COVID-19) are devastating and become the current world major public health issue. Not only SARS-CoV-2 attack the respiratory system, but also can affect multiple organs. Clinical manifestation varies from asymptomatic to severe multiorgan dysfunctions. COVID-19 is typically associated with a set of comorbidities such as hypertension, diabetes, obesity, and/or advanced age, which significantly exacerbates the consequences of infection. During the early stages of the disease, SARS-CoV-2 can also cause gastrointestinal symptoms such as vomiting, diarrhea, or abdominal pain. Intestinal dysfunction alters intestinal microbes and increases inflammatory cytokines. As a result, diagnosing gastrointestinal symptoms that procede respiratory problems during COVID-19 infection may be required for better early diagnosis and treatment. Discovering the composition of the microbiota and its metabolic products in the context of COVID-19 can aid in the identification of novel disease biomarkers and therapeutic targets. In the context of COVID-19, elucidating changes to the microbiome as reliable biomarkers represents an overlooked piece of the disease puzzle that requires further investigation.

L. Baerg, D. Philpott, R. Mahadevan

Abstract Background Bacterial membrane vesicles (MVs) are bilipid nanoparticles secreted as a conserved method of intercellular communication. MVs from Gram-positive bacteria carry diverse bacterial products and represent a unique opportunity in the growing field of postbiotics. This native machinery for mediating microbe-host interactions makes MVs a promising tool for intestinal drug delivery in the context of Crohn’s disease (CD). CD is a chronic inflammatory bowel disease characterized by relapsing inflammation of the digestive tract. CD is associated with (1) loss of function mutations in the host gene encoding the nuclear-binding oligomerization domain 2 (NOD2) pattern recognition receptor and (2) a gut microbiome with reduced capabilities to generate NOD2 stimulating muropeptides from peptidoglycan. Nod2-/- mice have decreased barrier integrity and impaired epithelial restitution upon challenge. However, there are currently no therapeutic strategies targeting NOD2 for CD management. Aims The aims of this study were to (1) leverage MVs as a biological system for NOD2 ligand delivery to intestinal epithelial cells and (2) determine the roll of probiotic MVs and bacterial ligand synergy in wound re-epithelialization. Methods MVs were purified from B. subtilis through filtration and ultracentrifugation. MVs were characterized through nanoparticle tracking analysis using NanoSight300. WT and NOD2-/- HCT116 cells, a human colorectal carcinoma cell line, were utilized for IL-8 secretion quantification by ELISA, gene expression by qPCR, and in vitro scratch wound assay by Incucyte quantification. Results Here, we demonstrate for the first time that MVs from B. subtilis deliver NOD2 ligands in vitro. Treatment with isolated MVs induces IL8 secretion and CXCL1 expression in a NOD2-dependent manner. Furthermore, MVs promote re-epithelialization after in vitro scratch wounding. This effect was completely blunted by the addition of an inhibitor for RIPK2, a downstream transducer required for NOD2 signaling. Through bacterial pathogen-associated molecular patterns (PAMPs) screening, we found that wound re-epithelialization is promoted by PAMP synergy but dependent on RIPK2 signaling. Conclusions This work suggests that delivery of muropeptides by probiotic-derived MVs is a promising strategy to promote epithelial regeneration during injury through targeting NOD2. Future directions will work towards validating these findings in human ileal primary cells and murine models of intestinal injury. Funding Agencies CIHRMedicine by Design

D. Banerjee, P. Winocour, T. Chowdhury et al.

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

N. Hoertel, Katayoun Rezaei, M. Sánchez-Rico et al.

Prior evidence indicates the potential central role of the acid sphingomyelinase (ASM)/ceramide system in the infection of cells with SARS-CoV-2. We conducted a multicenter retrospective observational study including 72,105 adult patients with laboratory-confirmed SARS-CoV-2 infection who were admitted to 36 AP-HP (Assistance Publique–Hôpitaux de Paris) hospitals from 2 May 2020 to 31 August 2022. We examined the association between the ongoing use of medications functionally inhibiting acid sphingomyelinase (FIASMA), which reduces the infection of cells with SARS-CoV-2 in vitro, upon hospital admission with 28-day all-cause mortality in a 1:1 ratio matched analytic sample based on clinical characteristics, disease severity and other medications (N = 9714). The univariate Cox regression model of the matched analytic sample showed that FIASMA medication use at admission was associated with significantly lower risks of 28-day mortality (HR = 0.80; 95% CI = 0.72–0.88; p < 0.001). In this multicenter observational study, the use of FIASMA medications was significantly and substantially associated with reduced 28-day mortality among adult patients hospitalized with COVID-19. These findings support the continuation of these medications during the treatment of SARS-CoV-2 infections. Randomized clinical trials (RCTs) are needed to confirm these results, starting with the molecules with the greatest effect size in the study, e.g., fluoxetine, escitalopram, and amlodipine.

Harrison G. Zhang, J. Honerlaw, M. Maripuri et al.

The International Classification of Diseases (ICD)-10 code (U09.9) for post-acute sequelae of COVID-19 (PASC) was introduced in October of 2021. As researchers seek to leverage this billing code for research purposes in large scale real-world studies of PASC, it is of utmost importance to understand the functional use of the code by healthcare providers and the clinical characteristics of patients who have been assigned this code. To this end, we operationalized clinical case definitions of PASC using World Health Organization and Centers for Disease Control guidelines. We then chart reviewed 300 patients with COVID-19 from three participating healthcare systems of the 4CE Consortium who were assigned the U09.9 code. Chart review results showed the average positive predictive value (PPV) of the U09.9 code ranged from 40.2% to 65.4% depending on which definition of PASC was used in the evaluation. The PPV of the U09.9 code also fluctuated significantly between calendar time periods. We demonstrated the potential utility of textual data extracted from natural language processing techniques to more comprehensively capture symptoms associated with PASC from electronic health records data. Finally, we investigated the utilization of long COVID clinics in the cohort of patients. We observed that only an average of 24.0% of patients with the U09.9 code visited a long COVID clinic. Among patients who met the WHO PASC definition, only an average of 35.6% visited a long COVID clinic.

I. Koshurba, F. Hladkykh, M. Chyzh

Digestive diseases are the sixth leading cause of death in the world and accounted for more than 2.5 million deaths in 2019. In Ukraine, mortality from diseases of the digestive system is recorded as one of the highest in the world, and the leading place in the general structure of diseases of the digestive system is occupied by peptic ulcer disease (РUD). The aim of the study. Summarize current information on the etiology and the pathogenesis of РUD and characterize modern approaches to the treatment of patients with РUD and the prospects of biological therapy. Materials and methods. Publications were selected based on the PubMed, Clinical Key Elsevier, Cochrane Library, eBook Business Collection, and Google Scholar databases, which covered information on the etiology, pathogenesis, and approaches to the treatment of РUD. Results. Standard first-line anti-Helicobacter therapy consists of a proton pump inhibitor and two antibiotics, such as clarithromycin and amoxicillin or metronidazole. A promising direction in the treatment of РUD is the use of biological therapy. According to literature sources, the prophylactic use of cryoextract of the placenta in indomethacin gastric lesions has an anti-ulcer effect at the level of 69.1 % and 92.1 % in diclofenac sodium gastric lesions. In addition, the specified cryoextract is capable of leveling the gastrotoxic effect of acetylsalicylic acid, ibuprofen, stress factor and chemical ulcerogens. Conclusions. Today, there is a great need for cell therapy that could be put into practice in clinically relevant volumes. The most promising directions of biological therapy in gastroenterology are considered to be the use of mesenchymal stem cells and agents obtained from the fetoplacental complex.

H. Baş, S. Dışıbeyaz, E. Öztaş et al.

Background/Aims: Pancreatitis is one of the leading causes of digestive system-related hospital admissions, and it has a genetic background in a considerable portion of the patients. In this study, we aimed to investigate the genetic risk factors of idiopathic pancreatitis in Turkish patients and the contribution of copy number variations to the pathogenesis. Materials and Methods: Idiopathic pancreatitis is defined as failure to detect risk factors despite comprehensive clinical assessments. Next-generation sequencing and multiple ligand-dependent probe amplification of PRSS1, SPINK1, CTRC, and CFTR were performed. For further genotype–phenotype correlations, patients were also questioned for the age of onset, family history, and pancreatic divisum. Results: A total of 68 idiopathic pancreatitis cases were enrolled. Variants with potential clinical significance of PRSS1 were identified in 13.4%, SPINK1 in 6.3%, CTRC in 4.7%, and CFTR in 26.5% of the patients. No copy number variants were seen in any of these genes. At least 7.4% of the participants had complex genetic etiology involving 2 genes. Conclusions: At least 42.6% of the participants had a potential genetic risk factor. Five novel genetic variants were identified, and distinctive genetic risk factors of Turkish population were shown. The results showed that genetic etiology was frequent in pancreatitis and it was even more prominent in patients with early-onset disease. Considering that genetic risk factors may be informative for decision-making in the treatment options in addition to providing extensive prognostic value and familial genetic consultation; clinicians need to be more eager to offer genetic tests to pancreatitis patients.

Xiaotong Xu, Jinglan Jin, Yuwei Liu et al.

Abstract Background and aims To investigate the usefulness of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), protein C (PC), and thromboelastography (TEG) to serve as a predictor of portal vein thrombosis (PVT) in patients with liver cirrhosis. Additionally, we examined the clinical significance of the above indicators in terms of disease progression. Methods A total of 123 patients with liver cirrhosis were recruited from May 2021 to December 2021, according to the imaging findings. They were divided into the PVT group (n = 52) and the non-PVT group (n = 71). Furthermore, patients with PVT were divided into plasma transfusion groups (n = 13) and non-plasma transfusion groups (n = 39). The basic general information, past medical history, laboratory, and imaging examination data were collected and analyzed. Results In univariate analysis, there was no significant difference between the two groups in IL-6, PC, reaction time (R), alpha angle (Angle), maximum amplitude, or coagulation index (CI) (P > 0.05). TNF-α in the PVT group was significantly lower than that in the non-PVT group (P = 0.001). K-time (K) in the PVT group was significantly higher than that in the non-PVT group (P = 0.031). There was no significant difference in IL-6, TNF-α, PC, or TEG between different Child–Pugh classification groups (P > 0.05). There were no significant differences in TEG between the plasma transfusion group and the non-plasma transfusion group. In Binary logistic regression analysis, TNF-α (OR = 0.9881, 95%CI = 0.971, 0.990, P < 0.001), K(OR = 1.28, 95% = 1.053, 1.569, P = 0.014), activate partial thromboplastin time (APTT) (OR = 0.753, 95%CI = 0.656, 0.865, P < 0.001), portal vein diameter (OR = 1.310, 95%CI = 1.108, 1.549, P = 0.002)and the history of splenectomy or embolism (OR = 7.565, 95%CI = 1.514, 37.799, P = 0.014)were related to the formation of PVT. Conclusions TNF-α, K, APTT, portal vein diameter, and splenectomy or embolism history were associated with PVT formation, but IL-6 was not.

E. Dekker, B. Houwen, I. Puig et al.

Institutions 1 Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 2 Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain 3 Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain 4 Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain 5 Gastrointestinal Endoscopy Research Group, La Fe Health Research Institute, Valencia, Spain 6 Institut des Maladies de l’Appareil Digestif (IMAD), CHU Nantes, Université Nantes, Nantes, France 7 Gastroenterology Department, County Hospital Mures, Targu Mures, Romania 8 Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation 9 Department of Gastroenterology, Faculty of Additional Professional Education, Pirogov Russian National Research Medical University, Moscow, Russian Federation 10 Department of Medicine I, University Medical Center Mainz, Mainz, Germany 11 Department of Gastroenterology, University College London Hospitals, London, UK 12 Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal 13 Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal 14 Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal 15 Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK 16 Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Brussels, Belgium 17 Gastroenterology Division, Hôpital Edouard Herriot, Lyon, France 18 Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK 19 Oxford National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, UK 20 Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospital Leuven, Leuven, Belgium