Introduction: In Japan, the confirmed diagnosis of Crohn’s disease (CD) is based on a single, historically established set of clinical criteria. However, for patients who present with a perianal lesion (PL), the diagnostic pattern actually applied is unclear. Methods: We conducted a retrospective observational multicenter study among patients who presented with a PL without synchronous abdominal symptoms and were subsequently diagnosed with confirmed or probable CD according to the Japanese diagnostic criteria from May 1996 to April 2024. In total, 100 patients with confirmed CD and 10 with probable CD were identified and enrolled. Results: Among the 100 patients with confirmed CD, 72% met the criterion for the category “confirmed 1: main finding A (longitudinal ulcer) or B (cobblestone appearance).” In the same cohort, 35% met the criterion for the category “confirmed 2: main finding C (non-caseating epithelioid cell granuloma [NCEG]) with secondary finding a (extensive irregular-to-round ulcers or aphthae in the gastrointestinal tract) or b (characteristic anorectal lesions),” including 24% without the main finding A or B. Finally, 4% met the criterion for the category “confirmed 3: all secondary findings a, b, and c (characteristic gastric and duodenal lesions).” All 10 patients with probable CD were diagnosed based on secondary finding b only or secondary findings a and b. Conclusion: In cases of suspected CD due to initial PLs, histological investigation of NCEG and precise total gastrointestinal inspection should be conducted to confirm the diagnosis.
Diseases of the digestive system. Gastroenterology
Aim. To analyze medical prescriptions for patients with duodenal ulcer disease in hospital setting, to determine the compliance of the treatment with the current treatment protocols. Materials and methods. We used 102 case histories, medical prescriptions of the Gastroenterology Department of the Clinical Regional Hospital named after M.I. Pirogov, Unified Clinical Protocol of the primary and specialized medical care “Peptic ulcer of the stomach and duodenum in adults and children”, the State Formulary of Medicines of Ukraine, the nomenclature of drugs for the treatment of duodenal ulcer, the official online resource tabletki.ua. Statistical, analytical and comparative, systematic, logical, graphic and mathematical-statistical methods were applied. Results and discussion. As a result of the study conducted, an analysis of drug prescriptions for patients with duodenal ulcer was carried out at the premises of the Gastroenterology Department of the Clinical Regional Hospital named after M. I. Pirogov. Over a period of 1 year and 3 months, 102 patients with the main diagnosis of duodenal ulcer were treated. According to the data obtained from the histories of diseases, men (94 %) aged 30-40 years were most often ill. The average duration of bed days was 5 days. The most common concomitant diseases were pancreatitis, GERD (non-erosive, endoscopically positive), hepatitis, duodenal bile reflux, Oddi sphincter dysfunction (pancreatic type). Two groups of drugs were prescribed according to the ATC classification for pathogenetic and symptomatic treatment: group A – drugs affecting the digestive system and metabolism (71.43 %) and group J – antimicrobial drugs for systemic use (28.57 %). Among the producing countries, foreign-made drugs prevailed – 62.4 %. During the study period, doctors prescribed 63 active substances by INN and 109 drugs by TN. In accordance with the Unified Clinical Protocol, the number of INN drugs was 18, 39 drugs by TN, and the State Formulary included drugs of 48 INN and 80 TN. During the study period, 24 drugs by TN for the pathogenetic treatment (eradication therapy) and 18 drugs by TN for the symptomatic treatment were prescribed. The prescription of drugs for the pathogenetic and symptomatic treatment was scientifically substantiated and included in the current normative documentation for the provision of patients with duodenal ulcer. When conducting the eradication therapy the leading drugs were Omeprazole (66 prescriptions), De-nol (55 prescriptions), Ezonexa (29 prescriptions), Controlok (26 prescriptions), Pilobact Neo (24 prescriptions). To prevent dysbiosis, such drugs as Enterol (8 prescriptions), Enterogermina forte (7 prescriptions) were most often prescribed. To relieve the symptoms of duodenal ulcer, Mebsyn Retard (24 prescriptions), Trimspa (19 prescriptions), Neospastil (17 prescriptions) were applied. Conclusions. Therefore, the medical care of patients in hospital setting is expedient and corresponds to the current Treatment Protocols.
Rashk-e-Hinna, Muhammad Usman Munir, Mohteshim Manzoor
et al.
Background/Aim: The most commonly reported COVID-19 symptoms are high-grade fever, cough and body aches with atypical symptoms ie vomiting, diarrhoea and abdominal discomfort. The primary purpose of this research was to ascertain the frequency of gastrointestinal problems experienced by patients due to COVID-19. Goal was to determine whether or not there was a correlation between the severity of COVID-19 disease and the presence of gastrointestinal symptoms in studied individuals. Methods: The study was conducted at the Gastroenterology Department, PEMH Rawalpindi, Pakistan from January 2022 to January 2023. Confirmed inpatient cases of COVID-19 disease were recruited, referred to Pak Emirates Military Hospital Rawalpindi, Pakistan. Real-time polymerase chain reaction (RT-PCR) verified the presence of COVID-19 in the patients of this research study. Results: There were 345 patients (335 men and 10 women), with 116 patients exhibiting gastrointestinal symptoms and only 27 patients presented with severe disease. Diarrhoea and anorexia were the most frequently reported digestive symptoms with a frequency of 44 (12.8 %) and 34 (9.9 %), respectively. Clinical outcomes and disease severity were not significantly different between patients with and without digestive issues. Conclusion: The course of a COVID-19 infection seems to include gastrointestinal symptoms, which include, but are not limited to vomiting, diarrhoea, anorexia, etc. Numerous gastrointestinal symptoms are linked to COVID-19 infection even in the absence of respiratory symptoms. As a result, COVID-19 infection should be taken into account for individuals who primarily present with gastrointestinal symptoms. The establishment of personalised COVID-19 therapies will be aided by an understanding of the varying susceptibility of the individual gastrointestinal system to SARSCoV-2.
Camila Vieira Chiquetti, Victor Hugo de Araújo Gonçalves, Leonardo Carnielli Uliana
et al.
Introduction This article describes an unusual case of perianal Paget's Disease in a 42-year-old man, highlighting distinct characteristics about more typical cases.
Diseases of the digestive system. Gastroenterology
Introduction: Tuberculosis (TB) is a prevalent infectious illness and a leading cause of death globally. An alteration in the microbial communities heightens vulnerability to tuberculosis. The changes mentioned below are responsible for pulmonary disease, as well as a decrease in the body's ability to resist the invasion of harmful external microorganisms or the depletion of beneficial bacteria. Literature review: Adults diagnosed with pulmonary tuberculosis exhibited a stool microbiome that contained a greater abundance of anaerobic microorganisms. This was found to be linked to proinflammatory immunological pathways in the host and was also associated with the severity of tuberculosis. Relapsed tuberculosis was correlated with elevated Actinobacteria and Proteobacteria levels and decreased Bacteroidetes levels. The pathogenesis of Mycobacterium TB infection and the onset of tuberculosis symptoms may be influenced by changes in the gut-lung microbiome axis. Medication availability, efficacy, and adverse effects can be impacted by the gut flora in several ways. Currently, researchers recommend exploring the potential of combining TB medicine with gut-focused probiotics to improve treatment response and outcomes. Conclusion: The microbiome has the potential to be a modifiable risk factor for tuberculosis. The human microbiota may have a role in the development of M. tuberculosis and treatment for tuberculosis can disrupt the balance of microorganisms, leading to dysbiosis, which can in turn impact the host's immune system. Probiotics and postbiotics demonstrate anti-tuberculosis properties, suggesting their ability to address problems arising from the use of various antibiotics.Keywords: Tuberculosis, microbiome, gut-lung axis
Catalina Maldonado Gutiérrez, Diego Estupiñan, Mauricio Sepulveda Copete
et al.
El sarcoma de Kaposi es una neoplasia angioproliferativa asociada al virus del herpes humano 8. Según las características clínicas y el grado de inmunosupresión, son cuatro las formas epidemiológicas: clásica, endémica, iatrogénica y epidémica, esta última asociada al síndrome de inmunodeficiencia adquirida (SIDA) y con un 40% de compromiso gastrointestinal. Existe escasa evidencia epidemiológica, clínica y endoscópica de la enfermedad. Este estudio buscó caracterizar esta condición en una población colombiana y contrastar los hallazgos con publicaciones de otros países. Se revisaron 135 registros de pacientes que consultaron entre el 2011 y 2020 por sarcoma de Kaposi, de los cuales 24 tenían compromiso gastrointestinal. Se obtuvieron características epidemiológicas, clínicas, endoscópicas y tratamientos. Veintidós pacientes eran hombres. Hubo 21 pacientes infectados por virus de la inmunodeficiencia humana (VIH; 87,5%) y 19 recibían terapia antirretroviral (90%). El 33,3% tenía carga viral VIH > 100 000 copias/mL. El recuento de CD4+ fue < 50 cel/μL en el 28,6% de los casos, entre 50 y 100 cel/μL en el 19,0%, y entre 100 y 200 cel/μL en el 14,4%. La tasa de infecciones por otros oportunistas fue de 41,7%. Hubo síntomas gastrointestinales en el 33% de los pacientes y los más frecuentes fueron hematoquecia, dolor abdominal, náuseas y diarrea. La mayoría tuvo lesiones cutáneas concomitantes (70,8%). Las lesiones gastrointestinales se localizaron principalmente en la orofaringe (41,7%), estómago (20,8%) y colon (16,7%). El hallazgo endoscópico más común fue eritema maculopapular. Este artículo mostró una visión de la epidemiología local del sarcoma de Kaposi gastrointestinal. En contraste con estudios en otras poblaciones, en este, los síntomas gastrointestinales fueron más frecuentes y hubo diferencia en los hallazgos endoscópicos. Son necesarios estudios con poblaciones más grandes.
Diseases of the digestive system. Gastroenterology
Abstract Background Complications and diagnostic efficiency for liver biopsy are main concerns for clinicians. This study aimed to assess the safety and efficacy of transjugular liver biopsy (TJLB) compared with percutaneous liver biopsy (PLB) when patients had equal level of liver function and number of passes, using propensity score matching (PSM). Methods The clinical and pathological data of patients who received TJLB or PLB between January 2012 and October 2022 were collected. Matching factors included age, gender, cirrhosis, portal hypertension, liver function, creatinine, number of passes, hemodialysis, history of anti-coagulation and anti-platelet, and comorbidities. Coagulation indexes were not considered as matching factors due to different indications of the two techniques. Results 2711 PLBs and 30 TJLBs were evaluated. By PSM, 75 patients (50 PLBs, 25 TJLBs) were matched. The complication rates for TJLB and PLB were 4.0% (1/25) and 10.0% (5/50) (P > 0.05). Two PLBs had hepatic hemorrhage, one of which required only close monitoring (Grade 1) and the other needed hemostasis and rehydration therapy (Grade 2). The other 3 cases presented with mild abdominal pain (Grade 1). And only one TJLB presented with mild pain. The median number of complete portal tracts were 6.0 and 10.0 for TJLBs and PLBs (P < 0.05). Moreover, the median length of sample for TJLBs and PLBs were 10.0 and 16.5 mm (P < 0.05). The diagnostic efficiency of hepatopathy of unknown etiology of TJLB versus PLB groups before and after matching were 96.4% vs. 94.1% and 95.7% vs. 93.2%, respectively (P > 0.05). Conclusion TJLB is an effective invasive diagnostic procedure that expands indications for liver biopsy with reliable diagnostic quality.
Diseases of the digestive system. Gastroenterology
Liver organoids are three-dimensional cellular tissue models in which cells interact to form unique structures in culture. During the past 10 years, liver organoids with various cellular compositions, structural features, and functional properties have been described. Methods to create these advanced human cell models range from simple tissue culture techniques to complex bioengineering approaches. Liver organoid culture platforms have been used in various research fields, from modeling liver diseases to regenerative therapy. This review discusses how liver organoids are used to model disease, including hereditary liver diseases, primary liver cancer, viral hepatitis, and nonalcoholic fatty liver disease. Specifically, we focus on studies that used either of two widely adopted approaches: differentiation from pluripotent stem cells or epithelial organoids cultured from patient tissues. These approaches have enabled the generation of advanced human liver models and, more importantly, the establishment of patient-tailored models for evaluating disease phenotypes and therapeutic responses at the individual level.
Diseases of the digestive system. Gastroenterology
Colonic diverticulosis is one of the most common conditions of the digestive system and patients generally remain asymptomatic. However, about 20% of patients develop symptomatic diverticular disease such as acute diverticulitis or diverticular hemorrhage, and these have become a huge burden on healthcare systems worldwide. Recent understanding of the pathophysiology of diverticulosis and diverticular disease suggests the role of multiple factors including genetic and environment. Based on this understanding, a preventive strategy to reduce the risk factors of diverticulosis and diverticular disease is highly recommended. The diagnosis of the acute diverticulitis relies on imaging modalities such as an abdominal-pelvic CT scan together with symptoms and signs. Treatment of diverticular disease should be individualized and include modification of lifestyle, use of antibiotics, and surgery. Recent guidelines recommend pursuing less aggressive treatment for patients with acute diverticulitis. This review will provide an overview of both the existing and evolving understanding regarding colonic diverticulosis and diverticular disease and can help clinicians in the management of their patients with diverticular disease.
Background Area postrema syndrome (APS) as the isolated manifestation in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy has been rarely reported. Case presentation A 61-year-old male patient presented with intractable hiccup. He was first admitted to the department of Gastroenterology because he had no symptoms other than hiccup. Then he was diagnosed with possible digestive system disease and started on treatment. 2 weeks later, his symptom didn’t improve at all. After consultation, the patient was referred to our department. Cerebrospinal fluid (CSF) analysis revealed lymphocytes pleocytosis, elevated protein level. Cell-based assays demonstrated GFAP antibodies in blood and CSF. His symptom improved with steroid pulse therapy (methylprednisolone, 1 g for 5 days), followed by a gradual tapering of oral prednisolone. Three months after the initial presentation, he showed no relapses. Conclusions We report atypical manifestation of autoimmune GFAP astrocytopathy which presented as APS, suggesting that autoimmune GFAP astrocytopathy should be added to the list of possible cause of APS.
Simple Summary The purpose of modifying a tumor staging system is to incorporate already well-established prognostic factors, allowing one to stratify cases and leading to tailored treatment approaches. Although lymphovascular space invasion (LVSI) has been described as an independent risk-factor of recurrence in early-stage cervical cancer and defined intermediate and high-risk cervical cancer according to the ESGO (European Society of Gynaecological Oncology) guidelines, this factor remains controversial and was not included in the last revised 2018 International Federation of Gynecology and Obstetrics (FIGO) classification. The aim of the present study was to determine whether LVSI has an impact on the prognosis of IB1 patients according to 2018 FIGO classification through two French prospective multicentric cohorts. Our results highlighted that LVSI was associated with a significantly decreased 5-year DFS in IB1 2018 FIGO stage compared to negative LVSI. Particular attention should be paid to LVSI status in early-stage cervical cancer for a more precise risk assessment and we suggest that LVSI may be considered in the new 2018 FIGO classification. Abstract Background: The aim of this study was to assess the prognostic impact of Lymphovascular space invasion (LVSI) in IB1 stage of the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) classification for cervical cancer. Methods: A secondary analysis of two French prospective multicentric trials on Sentinel Lymph node biopsy for cervical cancer was performed. Patients with 2009 FIGO IB1 stage who underwent radical surgery between January 2005 and July 2012 from 28 French expert centers were included. The stage was modified retrospectively according to the new 2018 FIGO staging system. Results: According to the 2009 FIGO classification, 246 patients had IB1 disease stage and fulfilled the inclusion criteria. The median follow-up was 48 months (4–127). Twenty patients (8.1%) experienced a recurrence, and the 5-year Disease Free Survival (DFS) was 90.0%. Compared to 2018 IB1 staged patients, new IB2 had significantly decreased 5-year DFS, 78.6% vs. 92.9%, p = 0.006 whereas IIIC patients had similar 5-year DFS (91.7%, p = 0.95). In the subgroup of patients with FIGO 2018 IB1 stage, the presence of LVSI was associated with a significant decrease in DFS (82.5% vs. 95.8%, p = 0.04). Conclusions: LVSI is associated with decreased 5-year DFS in IB1 2018 FIGO stage and LVSI status should be considered in early-stage cervical cancer for a more precise risk assessment.
We read with interest the article “Clinical Characteristics of COVID-19 Patients With Digestive Symptoms” in The American Journal of Gastroenterology (1). In the article, the authors reported that patients with digestive symptoms were more likely to suffer liver injury because of the upregulation of angiotensin-converting enzyme 2 (ACE2) expression in the liver tissue. Liver cirrhosis is one of the most common digestive diseases in health care. Recent evidence indicates that cirrhosis significantly increases hepatic ACE2 expression (2). We reviewed the available literature (published in PubMed, EMBASE, and Web of Science up to April 30, 2020) and hypothesized that patients with cirrhotic may be vulnerable to the serious clinical consequences of severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) infection. ACE2 is a membrane-bound enzyme expressed in many organs (including the liver) that is thought to be involved in the SARS-CoV-2 infection. The mechanism of the SARS-CoV-2 infection involves a viral coat protein termed SPIKE (S protein) acting as a receptor-binding region that binds to the extracellular domain of ACE2 to gain cell entry. Liver impairment is relatively common among patients with coronavirus disease 2019 (COVID-19), and ACE2-expressing liver cells are potential targets for the SARS-CoV-2 infection. Studies have demonstrated that cirrhosis significantly increases hepatic ACE2 expression (2). In normal human livers, ACE2 staining was minimal and confined to the bile duct cells, vascular endothelium, and perivenular hepatocytes (2). By contrast, in cirrhotic livers, ACE2 was detected in most hepatocytes within cirrhotic nodules, as well as bile duct cells and vascular endothelial cells (2). Upregulation of hepatic ACE2 allows more SARS-CoV-2 entry into cells and may cause greater virulence of SARSCoV-2 in the liver. Therefore, compared with healthy individuals, patients with cirrhosis and COVID-19 may have a greater severity of hepatic dysfunction and even a higher risk of progression to liver failure. ACE2 internalization by SARS-CoV2 potentially results in the loss of ACE2 activity at the cell surface and voids a key pathway of angiotensin (Ang)-II metabolism and Ang-(1–7) generation (3). A recent study reported higher plasma levels of Ang II in patients with COVID19 than in healthy controls that would be consistent with lower ACE2 activity (4). Ang II is the key effector peptide in renin-angiotensin system, which mediates vasoconstriction, sustains renal sodium retention, and promotes hepatic fibrogenesis. The important role of ACE2 is likely to balance the renin-angiotensin system status by degrading Ang II and generating Ang-(1–7). Experimentally, Ang-(1–7) inhibits liver fibrogenesis and exerts natriuretic and portal hypotensive effects (5). Therefore, in patients with cirrhotic, the reduction in ACE2 by SARS-CoV-2-induced internalization would be predicted to aggravate liver fibrosis and portal hypertension, and exacerbate disease severity acutely and, perhaps, even in the long term. Besides, cell surface reduction of ACE2 contributes to widespread inflammation associated with COVID-19 (3). In summary, we speculate that COVID19 infection may specifically affect patients with decompensated cirrhosis, because these patients may overexpress the ACE2 enzyme, leading to higher levels of SARS-CoV-2 infection in a group of patientswho are already at a greater risk of microbial infection.
Purpose: Pancreatic cancer is one of the most lethal of solid tumors and is associated with aggressive cancer biology. The purpose is to review the role of trypsin and effect on molecular and cellular processes potentially explaining the aggressive biology in pancreatic cancer. Methods: A narrative literature review of studies investigating trypsin and its effect on protease systems in cancer, with special reference to pancreatic cancer biology. Results: Proteases, such as trypsin, provides a significant advantage to developing tumors through the ability to remodel the extracellular matrix, promote cell invasion and migration, and facilitate angiogenesis. Trypsin is a digestive enzyme produced by the exocrine pancreas that is also related to mechanisms of proliferation, invasion and metastasis. Several of these mechanisms may be co-regulated or influenced by activation of proteinase-activated receptor 2 (PAR-2). The current role in pancreatic cancer is not clear but emerging data suggest several potential mechanisms. Trypsin may act as a Trojan horse in the pancreatic gland, facilitating several molecular pathways from the onset, which leads to rapid progression of the disease. Pancreatic cancer cell lines containing PAR-2 proliferate upon exposure to trypsin, whereas cancer cell lines not containing PAR-2 fail to proliferate upon trypsin expression. Several mechanisms of action include a proinflammatory environment, signals inducing proliferation and migration, and direct and indirect evidence for mechanisms promoting invasion and metastasis. Novel techniques (such as organoid models) and increased understanding of mechanisms (such as the microbiome) may yield improved understanding into the role of trypsin in pancreatic carcinogenesis. Conclusion: Trypsin is naturally present in the pancreatic gland and may experience pathological activation intracellularly and in the neoplastic environment, which speeds up molecular mechanisms of proliferation, invasion, and metastasis. Further investigation of these processes will provide important insights into how pancreatic cancer evolves, and suggest new ways for treatment.