Gastroenterology & Endoscopy最新文献

Background

Measurement of colonic transit time (CTT) of different colon segments can help to find the subtype of constipation and the appropriate treatment. This study aimed to estimate the segmental and total CTT in patients with refractory chronic constipation who attended gastrointestinal clinics.

Methods

A cross-sectional study was done in patients with refractory chronic constipation according to ROME IV criteria with normal colonoscopy. Patients with underlying diseases, including diabetes, hypoparathyroidism, hypothyroidism, anemia, past intestinal surgery, metabolic disorders, and recent medication use with constipation complications, were excluded. Every patient took a gelatin capsule containing ten 1–3 ​mm angiographic catheters for six consecutive days. On the seventh day, an upright abdominal x-ray was performed. The remaining markers were counted in three divided colonic segments, and the total CTT using radio-opaque markers was measured subsequently.

Results

40 patients were eventually included in this study. Twenty-eight were female (70%), and 55% of patients had standard body mass index (BMI). The mean age of patients was 43 years with a standard deviation of 18 years, while the mean total CTT was 37.05 ​h with a standard deviation of 24 ​h. Additionally, 60% had a normal CTT (≤45 ​h), and 40% had abnormal and prolonged CTT.

Conclusion

Constipation as a complaint is more common in women than men. Total CTT is slightly higher in men than women, but there is no significant difference. CTT may be normal in patients with refractory constipation despite all investigations. Additionally, there was no correlation between BMI and prolonged total CTT.

Celiac disease, triggered by gluten, rarely manifests as cirrhotic portal hypertension. We present the case of a 35-year-old male with concurrent cirrhosis and celiac disease, highlighting their complex relationship. The patient presented with diarrhea, fatigue, and anemia. Clinical examination revealed hepatosplenomegaly and cardiovascular abnormalities. Diagnostic assessments confirmed cirrhosis secondary to celiac disease. The patient received nutritional supplementation, intravenous therapies, and adhered to a gluten-free diet. Significant improvement was observed after three months. Celiac disease's extraintestinal manifestations include liver abnormalities, progressing to cirrhotic portal hypertension. Gluten removal is crucial for hepatic dysfunction resolution. This case emphasizes the rare occurrence of cirrhotic portal hypertension in celiac disease. A multidisciplinary approach and adherence to a gluten-free diet are pivotal for managing such cases. Understanding this intricate relationship is essential for comprehensive clinical assessments.

Background

Revealing out the hot zone and feature of early gastric cancers (EGCs) and dysplasia frequently developed is important for endoscopic screening and surveillance. This study aimed to investigate the distribution and location characteristics of EGCs and dysplasia.

Methods

A total of 503 pathological diagnosed EGCs and dysplasia from 445 patients were reviewed retrospectively. The distribution of EGCs and dysplasia in stomach was mapped, and its associated clinicopathological findings were analyzed.

Results

EGCs and dysplasia were predominately in the lesser curvature transversely, and vertical distributed frequently in lower third (51.7%) of stomach. In addition, lesions in upper third is associated with older age (p ​= ​0.014), male sex (p ​= ​0.002), smaller size (p < 0.001) and more differentiated EGCs, but fewer low-grade dysplasia and undifferentiated EGCs (p < 0.001). Moreover, most (461/503, 91.7%) lesions were found in endoscopy diagnosed atrophic mucosa, and are predominately differentiated EGCs and dysplasia (384/461, 83.3%). For the lesions in endoscopy diagnosed non-atrophic mucosa, more than half (23/42, 54.8%) are undifferentiated EGCs, which predominantly in middle (52.2%) and lower third (39.1%) of stomach. Whereas, differentiated EGCs accounts for 23.8% (10/42), and mainly (90%) located in the upper third of the stomach.

Conclusions

The distribution of dysplasia, differentiated and undifferentiated EGCs was associated to location and atrophic mucosa. Those location characteristics are useful for endoscopic screening and surveillance.

Introduction

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal tract disorder. Bacillus coagulans (BC) is a potent spore-forming probiotic that has been proposed as a potent supplement that can improve gastrointestinal tract dysbiosis and relieve IBS symptoms. We aim to assess the effect of BC on different IBS symptoms severity among other IBS-related symptoms.

Methods

We searched seven databases for RCTs that compare the use of BC versus placebo in the management of IBS symptoms.

Results

Our search finally retrieved seven RCTs after extensive screening. Our analysis revealed that BC significantly improved the severity of IBS symptoms such as urgency {MD: −1.05, 95% CI: −1.33; −0.77}, bowel habit satisfaction {MD: −1.40, 95% CI: −1.68; −1.13}, straining {MD: −1. 22, 95% CI: −1.61; −0.82}, the passage of gas {MD: −1.25, 95% CI: −1.51; −0.99}, incomplete evacuation {MD: −1.06, 95% CI: −1.55; −0.57}, and the total score of symptom severity {MD: −10.13, 95% CI: −11.61; −8.66, (P ​< ​0.00001)}. We also found a significant improvement in the physician’s global assessment score at 8 weeks {MD: 1.61, 95% CI: 0.61; 2.60, (P ​= ​0.002)}; however, results were not significant at 4 weeks (P ​= ​0.48). Moreover, our results indicate a significant decrease in the discomfort score after 4 and 8 weeks, the bloating score after 2, 4, 8, and 11 weeks and the vomiting score. Regarding abdominal pain, BC significantly lowered pain score after 2, 4, 8, and (11–13) weeks.

Conclusion

BC is a very effective probiotic in reducing the severity of IBS symptoms and abdominal pain with no serious adverse events. Future studies are needed to assess the use of BC as a long-term regimen and compare different subspecies of BC.

COVID-19 vaccines have significantly reduced the virus's spread, but they may impact liver function. Although most individuals tolerate the vaccines well, rare cases of liver injury have been reported. Healthcare providers should closely monitor patients' liver function before and after vaccination and educate them about potential signs of liver dysfunction. Further research is needed to understand the long-term effects of COVID-19 vaccines on liver health. It is also crucial to consider the overall health of individuals with pre-existing liver conditions before administering the vaccines. By closely monitoring liver function and conducting thorough studies, healthcare professionals can ensure the safety and efficacy of COVID-19 vaccines for patients with various liver conditions, contributing to ongoing efforts to combat the pandemic and protect public health.

Phlegmonous Gastritis (PG) is a rare and swiftly progressing disease that is often fatal. It typically involves severe invasion of the gastric wall by bacteria. Due to its vague symptoms, diagnosis is often delayed. When suspicious, CT abdomen and endoscopy will be helpful for early diagnosis. We describe a case of a 45-year-old patient admitted with gastroenteritis symptoms and rapidly progressed to severe septic shock; CT abdomen showed features of PG, which were further confirmed by endoscopy. He underwent a life-saving open salvage total gastrectomy, feeding jejunostomy, and oesophagostomy. Gastric pathology showed fungal gastritis (candidiasis) with mucosal infarction and transmural ischemic changes. Early diagnosis, surgical intervention, and antifungals saved our patient.

Background and aims

Non-tunneling and submucosal tunneling endoscopic resection (STER) techniques are the most frequent treatments for cardial submucosal tumor (SMT). Here, we analyzed common machine learning (ML) algorithms and compared them with traditional regression models in surgical decision-making for cardial SMTs.

Methods

Using key baseline predictive factors, ML algorithms and logistic regression (LR) were conducted in 246 patients. For the ML algorithms, gradient boosting machines (GBM), artificial neural networks (ANN), random forests (RF), and support vector machines (SVM), were included. For small sample-sized data, a technique for k-fold cross-validation was exploited to avoid over-fitting. Meanwhile, we tuned the parameters through several replications. Then, we quantified the discrimination (area under the curve, AUC) and predictive ability (Brier score, F1 score, specificity, sensitivity, and accuracy) of models. We divided patients (n ​= ​246) into STER-treated (n ​= ​97) and non-tunneling endoscopic resection (NTER)-treated (n ​= ​149) groups.

Results

LR outperformed among all groups (Brier score ​= ​0.1398, F1 score ​= ​0.7391, AUC ​= ​0.8729, and predictive accuracy ​= ​80.65 ​%). In comparison to ML algorithms, an outperformance of the traditional regression approach was also found in a low-dimensional setting for surgical decision prediction of cardial SMTs.

Conclusions

The traditional regression approach outperformed ML algorithms for the prediction of the best surgical method in patients with SMTs.

Background

Chronic anal fissure is recognized for its profound impact on quality of life and the propensity for treatment relapse, underscoring the need to explore safe and alternative clinical interventions. Unani medicine offers a wealth of therapeutic approaches for anal fissures, yet empirical evidence remains limited.

Objective

This study aimed to assess the efficacy of the Unani formulation Marham Safeda Kafoori in treating chronic anal fissures.

Methods

Seven patients with chronic anal fissures underwent a 14-day treatment with Marham Safeda Kafoori. Concurrently, two Unani interventions, namely Habb-e-Bawaseer Amya and Habb-e-Muqil, were administered for the management of constipation. Therapeutic response was assessed using a 100mm Visual Analog Scale for anal pain and burning sensations, alongside evaluating non-hemorrhoidal rectal bleeding and fissure healing status.

Results

Following a two-week follow-up, pain and burning decreased significantly. Similarly, all the cases were healed completely with no instances of rectal bleeding.

Conclusion

The trial formulation demonstrated promising efficacy in the management of anal fissures, with no observed adverse effects. Nevertheless, it is prudent to recommend rigorous prospective clinical investigations to validate its scientific soundness.

Introduction

Pain is almost the main problem after surgery, effective pain management is crucial for recovery, since poorly managed pain can have detrimental effects on a patient's physical functioning, mental health, interpersonal connections, and productivity.

Objective

Our study compares LA and OA to evaluate post-operative pain in 42 ​h using the Visual Analouge Scale (VAS) with the goal decreasing the requirement for opioids to address postoperative pain.

Methods

A retrospective analysis of patients with an appendicitis diagnosis who were admitted to the Department of General Surgery at General Hospital University of Muhammadiyah Malang between January 2018 and June 2019. 258 individuals with acute appendicitis, with 137 undergoing open appendectomy (OA) and 121 undergoing laparoscopic appendectomy (LA).

Result

We reported patients who obtained OA surgery experienced significant pain on first day, compared with patients who underwent LA operation, who reported light pain (P ​= ​0.000). On second day Thirteen patients who underwent OA surgery reported a reduction in pain levels from moderate to mild (P ​= ​0.000). Patients who underwent LA procedure, 59 participants had a significant reduction of pain level, 54 patients reduced from mild to no pain. and moderate pain to light pain reported in 5 patients, whereas the remaining 62 had no change level of pain (P ​= ​0.000).

Conclusion

In terms of post-operative pain, the LA operation is a reliable surgical technique and is preferable to an OA appendectomy.

Aim

This study aims to investigate the efficacy of nab-paclitaxel mono-chemotherapy as a second-line treatment for previously treated adenocarcinoma patients.

Methods

We conducted a systematic review and meta-analysis of prospective single-arm clinical studies that tested nab-paclitaxel monotherapy for treating gastric carcinoma. The review was conducted in accordance with PRISMA.

Results

We included 6 studies with a total of 271 patients. The pooled analysis of response rate, overall survival, and progression-free survival were 0.21 (95% CI: [0.16,0.28]), 11.65 (95% CI: [10.56, 12.75]), and 2.983 (95% CI: [2.625, 3.342]), respectively. There was no statistically significant difference between the doses regarding response rate and progression-free survival. However, the overall survival of the 150 ​mg/m² dose was statistically significantly higher than the 260 ​mg/m² dose. The treatment was associated with manageable toxicity profiles.

Conclusion

Nab-paclitaxel mono-chemotherapy is an effective treatment option for previously treated and recurrent gastric cancer with a manageable toxicity profile. Future studies should aim to compare Nab-paclitaxel to other agents in direct head-to-head comparison.