Hasil untuk "Diseases of the digestive system. Gastroenterology"

Serach Patterson, Jacqueline Emerson, HannahSofia Brown et al.

Background and Aims: Despite acknowledgment of the relationship between iron deficiency anemia (IDA) and Helicobacter pylori, consensus is lacking on clinical practice implications. This study sought to examine the association of iron deficiency and anemia with the precancerous lesion gastric intestinal metaplasia (GIM) in a cohort of patients with active H pylori infection. Methods: This retrospective cohort was assembled from adult patients diagnosed with H pylori at endoscopy at Duke University between 2015 and 2019. Data were collected from pathology reports and electronic health records. The relationship between iron deficiency status and GIM prevalence among 422 H pylori–positive individuals was examined using age-adjusted logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs), and stratified by diagnosis of H pylori before the diagnosis at study enrollment. Results: Of these 422 H pylori–positive patients, 48.6% had evidence of anemia and/or iron deficiency in the electronic health record. Compared to patients without anemia, those with IDA were more likely to have GIM (OR = 1.66; 95% CI, 1.02–2.69). Fifty-seven patients were previously positive for H pylori, treated, and remained positive for H pylori at the index endoscopy, of whom 40% had IDA. Among these patients, those with IDA had 4-fold increased odds of having GIM compared to patients without anemia (OR = 4.11; 95% CI, 1.10–15.32) Conclusion: In a cohort of H pylori–positive individuals at endoscopy, those with a history of IDA had greater odds of having GIM compared to patients without anemia. These results suggest the importance of close endoscopic evaluation and sampling of the gastric mucosa to evaluate for GIM in patients with IDA, and particularly those with a previous H pylori diagnosis.

Ankit V. Jain, Sandeep Gopal, Anurag J. Shetty et al.

Abstract Background Inflammatory bowel disease (IBD) is an idiopathic disorder characterized by repeated relapses and remissions. Endoscopy, the gold standard for diagnosis and monitoring of these patients is time consuming, expensive, and invasive. Hence, faecal calprotectin (FCP) has been suggested as marker to determine the degree of intestinal inflammation and predict relapse in IBD. Objective To use FCP as a predictor of clinical activity and endoscopic severity in IBD patients in a tertiary care hospital in Southern India. Methods Study subjects underwent clinical examination, endoscopy, blood tests and stool FCP. For Endoscopic activity simple endoscopic score for Crohn’s disease (SES-CD) and Ulcerative Colitis endoscopic index of severity (UCEIS) scores were used, and clinical activity was assessed by Crohn’s disease activity index (CDAI) and simple clinical colitis index (SCCAI) for CD and UC respectively. At six months, blood, and stool FCP test were repeated which were compared with endoscopic and clinical activity indices. Results The number of males was higher in both CD (13/8) and UC (19/14). At first visit and follow up, CDAI and FCP were positively correlated (r-0.689, p- 0.016) (r- 0.425, p-value < 0.05). In CD, the sensitivity and specificity of FCP in detecting active disease and remission were 93.8% and 80% respectively (AUC-0.869). At follow up, the sensitivity and specificity were 80% and 93.3% respectively (AUC-0.867). In patients with UC, SCCAI score and FCP levels positively correlated (r-0.231/0.387, p-value 0.001/0.001) at both the first and follow up visits. The sensitivity of FCP in detecting UC in active and remission states was 92.6% whereas the specificity was 83.3%. AUC was 0.88. At the time of follow up, the sensitivity of FCP in detecting UC in active and remission states was 89.9% whereas the specificity was 87.0% and AUC was 0.879. Conclusion This study confirmed that FCP level shows strong association with clinical and endoscopic activity indices in patients of IBD. Therefore, FCP levels could be used as a surrogate marker for monitoring mucosal status as well as predicting endoscopic remission in IBD patients.

Yazan Abboud, Imran Qureshi, Ayham Khrais et al.

ABSTRACT Rectal neuroendocrine tumors (NETs) are rare neoplasms that are usually asymptomatic and diagnosed incidentally. There are limited data on the presentation and management of high‐grade poorly differentiated large friable rectal NETs. We report the first case of an 87‐year‐old male who presented with chronic diarrhea and subsequently had severe hematochezia complicated by hemorrhagic shock and cardiac arrest and was diagnosed with a 7‐cm high‐grade friable rectal NET. Our case sheds light on the need to consider NETs in cases of chronic diarrhea and on the importance of endoscopy‐guided biopsy in the diagnosis and categorization, which can guide management.

Amanda Mandarino Alves, Chiara Lecchi, Sharon Lopez et al.

Colibactin is a recently characterized pro-carcinogenic genotoxin produced by pks+ Escherichia coli. We hypothesized that cystic fibrosis (CF)-associated dysfunctional mucus structure increases the vulnerability of host mucosa to colibactin-induced DNA damage. In this pilot study, we tested healthy-appearing mucosal biopsy samples obtained during screening and surveillance colonoscopies of adult CF and non-CF patients for the presence of pks+ E. coli, and we investigated the possibility of detecting a novel colibactin-specific DNA adduct that has not been yet been demonstrated in humans. While CF patients had a lower incidence of pks+ E. coli carriage (~8% vs 29%, p = 0.0015), colibactin-induced DNA adduct formation was detected, but only in CF patients and only in those who were not taking CFTR modulator medications. Moreover, the only patient found to have colon cancer during this study had CF, harbored pks+ E. coli, and had colibactin-induced DNA adducts in the mucosal samples. Larger studies with longitudinal follow-up should be done to extend these initial results and further support the development of colibactin-derived DNA adducts to stratify patients and their risk.

João Estorninho, Pedro Patrão, Maria José Temido et al.

Introduction: Parastomal variceal bleeding (PVB) is a recognized complication of ostomized patients in the presence of portal hypertension. However, since there are few reported cases, a therapeutic algorithm has not yet been established. Case Presentation: A 63-year-old man, who had undergone a definitive colostomy, recurrently presented to the emergency department hemorrhage of bright red blood from his colostomy bag, initially assumed to be caused by stoma trauma. Accordingly, temporary success on local approaches such as direct compression, silver nitrate application and suture ligation was achieved. However, bleeding recurred, requiring transfusion of red blood cell concentrate and hospitalization. The patient’s evaluation showed chronic liver disease with massive collateral circulation, particularly at the colostomy site. After a PVB with associated hypovolemic shock, the patient was submitted to a balloon-occluded retrograde transvenous obliteration (BRTO) procedure which stopped the bleeding successfully. The patient was subsequently proposed for a transjugular intrahepatic portosystemic shunt (TIPS) conjugated with percutaneous transhepatic obliteration (PTO). After an initial refusal by the patient, a new episode of self-limited PVB resulted in execution of the procedure. Four months later, in a routine consultation, the patient presented with grade II hepatic encephalopathy, successfully treated with medical therapy. After a 9-month follow-up, he remained clinically well and without further episodes of PVB or other adverse effects. Discussion: This report highlights the importance of a high index of suspicion when dealing with significant stomal hemorrhage. Portal hypertension as an etiology of this entity may compel to a specific approach to prevent recurrence of bleeding, including conjugation of endovascular procedures. The authors pre­sent a case of PVB, initially submitted to a variety of treatment options including BRTO, which was successfully addressed with conjugated treatment of TIPS and PTO.

Tirthadipa Pradhan-Sundd, Shweta Gudapati, Tomasz W. Kaminski et al.

Chronic liver disease is one of the leading causes of death in the United States. Coagulopathy is often a sequela of chronic liver disease, however, the role and regulation of coagulation components in chronic liver injury remain poorly understood. Clinical and experimental evidence indicate that misexpression of the procoagulant factor VIII (FVIII) is associated with chronic liver disease. Nevertheless, the molecular mechanism of FVIII-induced chronic liver injury progression remains unknown. This review provides evidence supporting a pathologic role for FVIII in the development of chronic liver disease using both experimental and clinical models.

Mohammad Bagher Jahantab, Amir Abbas Safaripour, Sajad Hassanzadeh et al.

Background. The occurrence of stones in the gallbladder or common bile duct and the symptoms and complications they cause is called gallstone disease. The symptoms of gallstone disease range from mild, nonspecific symptoms to a severe right quadrant abdominal pain. Characteristics of gallstone types in an Iranian population have not been well studied before and there are very limited studies on the demographic pattern of stone types in our country, so this study is one of the first studies on its kind on the epidemiology of gallstone types in Iran. As information on chemical components of the stone will help in the management and prevention of gallstones, in this study, we aimed to do chemical component analysis of gallstones including cholesterol, bilirubin, and calcium. Given the conflicting reports about the relationship between H. pylori infections and gallstone formation, this study aimed to investigate the relationship between H. pylori positivity in the bile specimen of Iranian patients with cholelithiasis and formation and type of stone. Methods. This prospective study reviewed a total of 196 patients who underwent cholecystectomy for symptomatic cholelithiasis at Shahid Beheshti Training and Research Hospital affiliated to the Yasuj University of Medical Sciences between September 2015 and May 2018. Chemical analysis of gallstone components performed using the colorimetry method. Microbiological analysis for H. pylori was done using the OnSite H. pylori Ag Rapid Test on the bile sample. For the validation test of bile, the H. pylori Rapid Stool Ag Test on stool was used, and Cohen’s Kappa statistical analysis was done next. Results. There were significant associations between the stone types and age, chemical composition of the stones such as calcium, cholesterol, and bilirubin levels, and also H. pylori positivity and cholesterol and bilirubin levels; however, no significant association was found between the stone types and sex, H. pylori positivity and age, sex, stone types, and calcium level. The main bile and validity tests were matched to the substantial agreement according to Cohen’s Kappa analysis. The most common drugs used were proton pump inhibitors, nonsteroidal anti-inflammatory drugs, antihypertensive drugs, and oral contraceptives. Conclusions. This study suggested that the chemical composition of the stones could predict the presence of bacteria, there is no correlation between H. pylori and gallstone formation, and some of the drugs could be predisposing factors for gallstones. This work provides an objective basis for further research into gallbladder stone formation; meanwhile, it has great significance in the treatment and prevention of gallbladder stones. Trial registration. The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID IR.YUMS.REC.1399.147 and date 2020.09.23, and this project is the result of a residency dissertation to obtain the specialty in general surgery, which has been registered with the research project number 960159 in the Vice Chancellor for Research and Technology Development of the Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=160634.

Ga-Yeong Shin, Hye Jin Cho, Jae Myung Park et al.

Abstract Background Recurrence risk is a major concern after endoscopic resection (ER) of gastric neoplasms. This study was to compare metachronous risk in patients with and without synchronous neoplasms after complete ER. Methods After ER for gastric neoplasms, patients were divided into those with and without synchronous neoplasm. The metachronous risk of gastric neoplasms was compared between the two groups. Results After ER of 678 cancers and 891 adenomas, synchronous neoplasm was found in 11.8% of cancers and 11.4% of adenomas. In the multiple (n = 182) and the single group (n = 1387), metachronous neoplasms occurred in 18.1 and 8.6%, respectively (HR 2.40; 95% CI, 1.62–3.34). When the pathology of the recurred lesion was limited to cancer, metachronous risk was also significantly higher in the multiple than in the single group (HR, 2.2; 95% CI, 1.17–3.85). In the recurred pathology of the multiple group, cancer development was frequently observed in patients with cancer compared to those with only adenomas in the synchronous lesion (67.0% vs. 13.0%, respectively; P = 0.023). Conclusions This study demonstrated that metachronous risk was significantly higher in patients with synchronous gastric neoplasms after ER. Therefore, meticulous examination is important in patients with synchronous neoplasm.

E. Grossi, F. Pace

The recent SARS-CoV-2 pandemic behaved like a tsunami for many healthcare systems worldwide, as for example in the USA, India and Europe. Restricting the observation angle to the field of gastroenterology, a great number of new relevant clinical data have been produced in an exceedingly short period of time, such as the observation that the disease, originally considered as a respiratory illness, commonly features a variety of gastrointestinal intestinal symptoms and that the digestive system appears to be involved in disease pathogenesis [1–3]. From the organizational site, endoscopy suites have been forced to suspend non-urgent procedures in order to re-allocate human resources to the care of COVID19 positive inpatients during the early phase of pandemic [4–6] and are now planning how to gradually return to preCOVID routine endoscopy activity [7]. The consequences of delaying the return to routine endoscopy are seriously impacting the health system; in the USA alone, a hypothetical suspension of elective endoscopy for 6 months is predicted to delay the diagnosis of over 2800 colorectal cancers and 22,000 adenomatous polyps with malignant potential [8]. The 6-month mortality rate for those eventually diagnosed with colorectal cancer is predicted to increase by 6.5% [9]. Nevertheless, the problem of re-starting nonurgent procedures while the COVID pandemic is ongoing with the need of maintaining protective measures and social distancing is present, the volume of procedures is going to overwhelm existing resources, resulting in a backlog of procedures. Thus, as Xiao et al. [10] propose in this issue of Digestive Diseases and Sciences, the policy of appropriately triaging and rescheduling endoscopic procedures, in particular screening and surveillance colonoscopy, should be based on specific and timely adopted new guidelines. Here probably lies one of the most important problems: which national or international guidelines should be adopted for the purpose? Recommendations have been changing rapidly and need to be updated, mainly due to the new development of worldwide sustained community transmission of COVID19 [11]; moreover, at least 21 specific recommendations are available for endoscopy during the COVID-19 pandemic elaborated by a pool of 93 international and national societies as identified in a recent review [12]. Xiao et al. adopted pre-COVID era guidelines, namely those of the US Multi-Society Task Force (USMSTF) published in 2017 [13] and updated in 2020 [14] as a guide to expanding access to endoscopy. In their single-center observational study of patients scheduled for open-access (OA) colonoscopy ordered by a primary physician over a six-week period during the COVID-19 pandemic, they found that up to one-fifth of colonoscopies can be rescheduled into a future year based on USMTSTF guidelines [14]. Interestingly enough, roughly 75% of these inappropriately scheduled colonoscopies were non-adherent to the above guidelines, whereas the remaining 25% was due to inappropriate use of family history by the primary care physician (PCP). Thus, the study confirms that: a) PCPs recommend repeat colonoscopy sooner than guidelines suggest [15, 16]; and b) a significant proportion of open access colonoscopies for colorectal cancer prevention are indeed inappropriate, confirming the figure of nearly 8% according to a recent review by Kapila et al. [17]. Thus, the question arises of how to improve the use of OA colonoscopy for CRC screening and surveillance, since this might reduce the volume of procedures without delaying CRC detection. Xiao et al. suggest that this can be accomplished by incorporating guidelines at two points of care, namely following the index colonoscopy and in the PCP’s office. Nonetheless, as authors admit, often the PCP simply follows inappropriate recommendations provided by the endoscopist, suggesting lack of awareness or disagreement with existing guidelines. Indeed, predictors for poor adherence to guidelines have been carefully examined and * Fabio Pace fabio.pace@unimi.it

B. Slama

María Reyes Bañeres-Visedo, A. Forero-Torres

J. Lindemann, J. Krige, U. Kotze et al.

BACKGROUND The South African healthcare system has an under-financed public sector serving most of the population and a better resourced private sector serving a small fraction of the population. This study evaluated management and outcome in patients with complex bile duct injuries (BDIs) after laparoscopic cholecystectomy referred from either private or public hospitals. METHOD The data of patients who underwent hepaticojejunostomy repair were retrieved from a prospectively maintained central departmental BDI database. Patients were treated either in the Surgical Gastroenterology Unit at Groote Schuur Hospital, University of Cape Town (UCT) or the Digestive Diseases Centre, UCT Private Academic Hospital by the same hepatobiliary surgical team. Relevant preoperative clinical data and postoperative complications and outcomes were compared between patients originating either in the public or private sector. RESULTS One hundred and twenty-five patients were included, 58 from the public and 67 from the private sector. The type of BDI, time to diagnosis, referral and repair were similar. Patients referred from the private sector underwent more percutaneous cholangiograms prior to referral (11.9% vs 1.7%, p = 0.037). Patients referred from the public sector underwent more CT examinations (p = 0.044) and endoscopic retrograde cholangiography (p = 0.038) after admission to our centre. There were no statistically significant differences in 30-day postoperative complications. Primary patency rates were similar for public and private referrals (90% vs 88%, respectively). There were two BDI-related mortalities at 90 days. CONCLUSION Despite differences in public and private healthcare system resources, patients were referred early and appropriately from both sectors and had similar postoperative outcomes when treated in a specialised unit.

Brielle Corrente

А. М. Запруднов, К. И. Григорьев, Л. А. Харитонова

The article shows the role and place of pediatric gastroenterology in modern pediatrics, emphasizes the ways of its formation and development: intensive and extensive. Specific features of diseases of the digestive system in children were determined, the importance  of medical introscopic methods, the relationship with such fundamental subjects as science of nutrition, clinical pharmacology and  pharmacotherapy are noted. The scientific and practical connection with other medical subjects, such as pulmonology, cardiology,  nephrology, etc. is considered.

Suresh K Angurana

E. Doğan, E. Sevinç, M. A. Goktas et al.

The protein loss from the digestive tract can result from many diseases, including inflammatory bowel disease, neoplasm, abnormalities of the lymphatic system, and infection such as tuberculosis, rotavirus. Primary intestinal lymphangiectasia is a rare protein-losing enteropathy caused by dilatation of lymph ducts in from the intestine. Differential diagnosis of protein losing enteropathy may be difficult in case of concurrent disorders of rotavirus infection and primary intestinal lymphangiectasy. Here we report the case of a 3-month-old male infant with protein-losing enteropathy caused by primary intestinal lymphangiectasia co-existing with rotavirus infection.

P. Jangouk, John J Chang, Avlin B. Imaeda