Gastroenterology & Endoscopy最新文献

Background

Alcoholic Liver Disease (ALD) poses a significant global health threat, contributing to millions of deaths each year. Despite the well-established link between chronic alcohol consumption and liver damage, treatment options remain limited, emphasizing the need for innovative approaches.

Methods

An open-label, randomized controlled trial was conducted in India, involving 68 adult ALD patients over a 12-week period. The patients were randomized into two groups: one receiving standard therapy and the other receiving standard therapy along with BoozLiv™ syrup. Liver function tests, Model for End-Stage Liver Disease (MELD) scores, and safety parameters were assessed at various intervals.

Results

The study demonstrated that BoozLiv™ syrup, as an add-on therapy, significantly reduced total bilirubin, direct bilirubin, SGOT, SGPT, ALP, and GGT levels compared to standard therapy alone (p ​< ​0.05). The MELD score, indicative of liver function, showed a substantial improvement in the BoozLiv™ group (p ​< ​0.01). Safety analysis revealed that BoozLiv™ was well-tolerated, with only minor adverse effects such as nausea and vomiting reported.

Conclusion

BoozLiv™ syrup, used in conjunction with standard therapy, showed promising results in improving liver function and reducing liver damage markers in ALD patients. The safety profile was favorable and no patient has withdrawn their consent due to adverse events. Further long-term studies in larger populations are warranted to validate these findings and establish BoozLiv™ as a potential therapeutic option for ALD.

Extraskeletal mesenchymal chondrosarcoma (ESMC) metastasizing to the pancreas in isolation is a rare entity. We present a case of a 30-year-old gentleman who underwent surgery for chondrosarcoma of the left temporal region (2017) and was detected to have a space-occupying a lesion of the pancreas 6 years post-surgery. Distal pancreatectomy was performed, and the histopathological examination revealed features suggestive of an extraskeletal mesenchymal chondrosarcoma. ESMC have a long latency period before presentation and these patients have a good survival following surgery. We present this case owing to its rarity.

Objective

Radiofrequency (RF) therapy is a minimally invasive procedure used to treat gastroesophageal reflux disease (GERD). During the procedure, electrodes are meticulously inserted into the lower esophageal sphincter and cardiac muscle through a gastroscope. By applying heat at various layers and sites around the gastroesophageal junction, the treatment intends to augment the junction's pressure and reduce tissue compliance. This process may also desensitize the esophagus, thereby preventing reflux and relieving symptoms. RF therapy boasts a high success rate and a low risk of adverse effects, making it an increasingly popular choice. However, there is a lack of consensus regarding its indications, contraindications, and the evaluation processes for pre- and postoperative care. To enhance the precision of patient selection and the technical execution of RF therapy, it is imperative to consolidate and standardize its clinical application in China. This will ensure the therapy's safety and efficacy are optimized.

Methods

Between December 2022 and April 2024, a group of 25 Chinese endoscopists, each with experience in over 50 radiotherapy procedures, engaged in six rounds of consensus discussions. The discussions focused on several key aspects of the procedure. During these discussions, each item was put to a vote among the experts. A consensus was reached when an item received agreement from at least 80 ​% of the participants.

Results

The expert group, comprising 25 specialists from 22 different institutions, had an average experience of over 50 RF procedures. These experts engaged in comprehensive discussions on a total of eight critical items, covering the full spectrum of the procedure, including indications, contraindications, basic working conditions and preparation, preoperative preparation, surgical process and technical skills, postoperative management, therapeutic effects, complications and prevention. The group successfully reached a consensus on all these items, ensuring a standardized approach to RF procedures.

Conclusion

This consensus summarized and standardized the clinical application of anti-reflux RF therapy in China. Adoption of this consensus will improve the precision of patient selection and technical implementation, thereby enhancing the safety and effectiveness of anti-reflux radiofrequency therapy.

Atrial fibrillation (AF) affects a significant proportion of older individuals, with prevalence rates of 3.8 ​% in those over 60 and 9.0 ​% in those over 80 years old, posing a considerable risk of stroke. Radiofrequency ablation (RFA) has emerged as a popular treatment option. However, RFA is not without risks, with esophageal injury being a notable complication, as illustrated by our case study of a 67-year-old patient who developed an atrial-esophageal fistula post-RFA. Timely diagnosis is imperative due to the rarity and severe consequences such as esophageal perforation. While treatment strategies remain somewhat uncertain, initial stenting has given way to surgical intervention for improved outcomes. Our study emphasizes the critical importance of vigilance, early identification, and a multidisciplinary approach in managing this challenging complication.

A 38-year-old man was hospitalized on April 2, 2022, due to esophageal ulcer and stricture. No tumor cells were found in the pathological biopsy. Considering the diagnosis of benign esophageal stricture, he underwent an endoscopic esophageal stricture incision on April 6. By April 12, he was free from dysphagia, showed no signs of stricture via endoscopy, and was discharged from the hospital. However, after three weeks, the patient experienced dysphagia again, and gastroscopy revealed esophageal restenosis. On May 6, 2022, a second endoscopic esophageal stricture incision was performed, followed by ongoing endoscopic dilation to prevent further restenosis during the subsequent three-month follow-up. The patient did not report any further swallowing obstruction. During the eight-month follow-up post-operation, no esophageal stricture was observed, the ulcer had completely healed, and the patient's weight increased by 10 kg. Endoscopic incision for benign esophageal stricture is effective, yet some patients are susceptible to restenosis. Intermittent endoscopic dilation, as compared to balloon dilation and bougie dilation, may offer a cost-effective and efficient approach to prevent recurrence of esophageal stricture or post-ESD stricture in early esophageal cancer, particularly in primary medical units.

Esophageal squamous cell carcinoma (ESCC) is the most dangerous variant of esophageal cancer, and the most common in developing countries. Its ever-increasing incidence, due to cell resistance to available drugs and side effects, is prompting the scientific community to find new solutions. Alternatively, alkaloids are a large group of secondary metabolites found in plants and characterized by the presence of at least one nitrogen group in their structure. Thus, the aim of the research of is to thoroughly examine alkaloids that may offer an alternate course of treatment for esophageal squamous cell carcinoma. To achieve this, literature searches were conducted in databases such as Web of Science, PubMed/Medline, and Scopus to identify articles that explored the effect of alkaloids on esophageal squamous cell carcinoma as a primary or secondary objective. This methodology enabled us to obtain 7 studies and 6 alkaloids (neferine, matrine, tetrandine, d-dicentrine, synephrine, and 8-(4-(trifluoromethyl)benzyloxy)-1,2,3,4-tetrahydro-2-methylquin-oline or (83b1)). d-dicentrine (0.40 ​μM ​< ​IC50 ​< ​4.932 ​μM), and Matrine (1.50 ​mg/mL ​< ​IC50 ​< ​1.94 ​mg/mL) have significant activities on ESCC. They act by arresting cell cycle at the G2/M and G1/G0 phases respectively. Tetrandrine produces a synergistic effect when combined with cisplatin (IC₅₀ ​= ​4.57 ​μg/mL) and reverses the resistance of cisplatin-resistant ESCC cells by inhibiting MRP1. The others molecules have a moderate anti-ESCC effect. In conclusion, d-dicentrine, matrine and tetrandrine represent an important therapeutic avenue in the fight against esophageal squamous cell carcinoma. However, future research should focus on determining the toxicological potential of d-dicentrine.

Research on esophageal microbiota is now still a relatively new field though with certain message has been known. Previously, the esophagus was considered devoid of a significant bacterial population. Any bacteria present were considered to be transient, presumptively translocated from the oropharynx or from the stomach. Later, with the application of metagenomic approaches, the esophagus was found not a sterile site and did not simply contain a transient microbial population originating either from the oral cavity by swallowing or from the stomach by gastroesophageal reflux (GER), but was with its unique profile maps. Currently, knowledge about esophageal microbiota was mainly focused on the observational results of changes of the structure and richness of different microbiota under different local esophageal conditions. Studies involved in the causative relationships between dysbiosis or specific bacterial species and GERD-related or other esophageal diseases are few. Here, we provide an updated review of current knowledge on the esophageal microbiota in health and in different esophageal diseases and discuss the major challenges encountered in investigation of this topic, looking forward to helping future exploring.

Introduction

Gastro-esophageal Reflux Disease (GERD) is a significant global health issue affecting millions and placing a substantial burden on healthcare systems. This study investigates the prevalence and influencing factors of GERD among the urban population in Saudi Arabia, amidst rapid urbanization and lifestyle changes. The goal is to provide insights for targeted interventions and improved public health strategies.

Methodology

A cross-sectional study was conducted using a comprehensive methodology. A validated, bilingual questionnaire was used to collect data on demographics, awareness, psychosocial aspects, symptoms, and medical history. The study included 493 participants, and data were collected through an online survey. Statistical analysis was performed using SPSS and Excel, maintaining a statistical power of 80 ​%.

Results

The survey included 493 participants, revealing the following key findings: Gender distribution: 41.37 ​% male, 58.62 ​% female (p ​= ​0.053). Age categories: 18–25 (25.35 ​%), 26–40 (18.05 ​%), 41–55 (26.97 ​%), 56 and above (29.61 ​%) (p ​= ​0.055). Nationality: 51.92 ​% Saudi, 48.07 ​% non-Saudi (p ​= ​0.058). Other notable demographics: marital status, education levels, smoking habits, nutritional habits, BMI categories, and prevalence of bariatric surgery. GERD symptoms and psychological factors showed significant associations. Treatment preferences and lifestyle modifications varied widely. The data provide essential insights for tailored interventions and healthcare strategies.

Conclusion

This study highlights the complex demographic patterns and lifestyle factors associated with GERD in Saudi Arabia's urban population. The findings emphasize the importance of tailored interventions and inform healthcare, research, and policy decisions for effective GERD management in urban settings.