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Prevalence of Oral Helicobacter pylori Infection in an Indigenous Community in Southwest Mexico. 墨西哥西南部土著社区口腔幽门螺杆菌感染的患病率。
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-21 eCollection Date: 2023-01-01 DOI: 10.2147/CEG.S424559
Victor Hugo Urrutia-Baca, Karen Ivonne Gonzalez Brosig, Alina Abigail Salazar-Garza, Ricardo Gomez-Flores, Patricia Tamez-Guerra, Myriam Angelica De La Garza-Ramos

Purpose: Epidemiological studies have been conducted to improve the health and economic quality of life of indigenous communities in Mexico. These studies have found that infections cause frequent health problems. Helicobacter pylori are responsible for conditions ranging from gastritis to stomach cancer. This study determined the prevalence of H. pylori in families from Siltepec, Chiapas, Mexico.

Patient and methods: Ninety-nine dental plaque samples from 36 families were studied. Real-time PCR was performed to detect H. pylori using previously reported primers. The Mann-Whitney U-test was used for the statistical analysis. According to the family role of H. pylori-positive individuals, the VacA s1/m1 genotype and CagA gene correlated.

Results: The mother had the highest expression of VacA s1/m1-/cagA- with 19% (8/42), followed by the first child with 14.3% (6/42). The major roles for the vacA s1/m1+/cagA- were the mother and first child with 9.5% (4/42), followed by the remaining children with 4.8% (2/42). The vacA s1/m1-/cagA+ genotype was 7.1% (3/42) for the mother and 4.8% (2/42) for the father. Finally, the vacA s1/m1+/cagA+ genotype only appeared in the mother, son I, and son III with 2.4% (1/42).

Conclusion: The vacA s1/m1/cagA genotypes predominated in the mother, suggesting potential transmission between the mother and child during the first years of life.

目的:开展了流行病学研究,以改善墨西哥土著社区的健康和经济生活质量。这些研究发现,感染会导致频繁的健康问题。幽门螺杆菌导致了从胃炎到癌症的各种疾病。本研究确定了墨西哥恰帕斯州Siltepec家庭幽门螺杆菌的患病率。患者和方法:研究了36个家庭的99个牙菌斑样本。使用先前报道的引物进行实时PCR以检测幽门螺杆菌。Mann-Whitney U型检验用于统计分析。根据幽门螺杆菌阳性个体的家族作用,VacA s1/m1基因型和CagA基因相关。结果:母亲VacA s1/m1-/cagA-的表达最高,为19%(8/42),其次是第一个孩子,为14.3%(6/42)。vacA s1/m1+/cagA-的主要作用是母亲和第一个孩子,占9.5%(4/42),其次是其余孩子,占4.8%(2/42)。vacA s1/m1-/cagA+基因型母亲为7.1%(3/42),父亲为4.8%(2/42)。最后,vacA s1/m1+/cagA+基因型仅出现在母亲、儿子I和儿子III中,占2.4%(1/42)。
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引用次数: 0
Clinical Evaluation of Upadacitinib in the Treatment of Adults with Moderately to Severely Active Ulcerative Colitis (UC): Patient Selection and Reported Outcomes. 奥帕他替尼治疗中度至重度活动性溃疡性结肠炎(UC)成人患者的临床评估:患者选择与疗效报告。
IF 2.5 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-03-07 eCollection Date: 2023-01-01 DOI: 10.2147/CEG.S367086
Malcolm Irani, Christopher Fan, Kerri Glassner, Bincy P Abraham

This review addresses appropriate patient selection for upadacitinib, a Janus kinase inhibitor approved by the FDA and EMA for treatment of moderately to severely active ulcerative colitis (UC). Janus kinase molecules can contribute to the inflammatory pathway, so inhibiting certain of them may prove efficacious in treating UC and may reduce safety concerns. Upadacitinib is the newest Janus kinase inhibitor to be approved for UC, so it is timely and relevant to review patient selection and when to consider this medication. We will discuss efficacy and safety data from the pivotal clinical trials on upadacitinib. These data can be shared with patients and can inform the use of these agents in clinical practice.

奥达帕替尼是一种 Janus 激酶抑制剂,已获 FDA 和 EMA 批准用于治疗中度至重度活动性溃疡性结肠炎 (UC)。Janus 激酶分子能促进炎症通路,因此抑制其中某些分子可能被证明对治疗 UC 有疗效,并能减少安全性问题。乌达帕替尼是最新获批用于治疗 UC 的 Janus 激酶抑制剂,因此审查患者的选择和何时考虑使用该药物是非常及时和有意义的。我们将讨论乌达帕替尼关键临床试验的疗效和安全性数据。这些数据可与患者分享,并为临床实践中使用这些药物提供参考。
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引用次数: 0
Superior Mesenteric Artery Syndrome as a Rare Cause of Postoperative Intractable Vomiting: A Case Report. 肠系膜上动脉综合征是术后难治性呕吐的罕见原因:1例报告。
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S416391
Sanketh Edem, Aakansha Giri Goswami, Bibek Karki, Preeti Acharya, Udit Chauhan, Navin Kumar, Somprakas Basu

Background: Superior mesenteric artery syndrome is a very rare cause of proximal intestinal obstruction. The objective of this clinical case report is to highlight that this unusual condition can occur in the early postoperative period and medical management may completely cure the condition.

Clinical case: A middle-aged female who was being treated for pulmonary tuberculosis underwent exploratory laparotomy with limited ileal resection and a loop ileostomy for multiple ileal perforations. Postoperatively, she was restarted on anti-tubercular drugs (ATD) but developed a drug reaction, recurrent bilious vomiting, and jaundice and ATD had to be stopped. But her vomiting did not abate and she progressively developed septicemia. An abdominal CT scan diagnosed Wilkie's syndrome, and she was managed non-operatively by decubitus, parenteral nutrition, and nasojejunal tube feeding supplemented with prokinetics and antibiotics. But her sepsis did not resolve. Intraoperative histopathology suggested Candida infection, and she recovered only after systemic antifungal therapy.

Discussion: Debilitation conditions like tuberculosis cause weight loss and loss of intra-abdominal fat pad, which is known to precipitate SMA syndrome. However, its presentation in the early post-operative period is rare. Symptoms may vary from non-specific abdominal fullness and weight loss to features of acute bowel obstruction. CECT of whole abdomen can help in confirming the diagnosis. SMA syndrome is often not considered in differential diagnosis and can delay treatment. Medical management is the mainstay treatment option, although surgery is reserved for cases, which fail medical treatment.

Conclusion: High suspicion is needed to diagnose SMA syndrome in the postoperative period, which precipitates with intractable bilious vomiting. Medical management may be curative. The precipitating factor for SMA syndrome should also be addressed to improve the overall patient outcome.

背景:肠系膜上动脉综合征是一种非常罕见的近端肠梗阻的病因。本临床病例报告的目的是强调这种不寻常的情况可能发生在术后早期,医疗管理可能完全治愈这种情况。临床病例:1例中年女性肺结核患者,因多发回肠穿孔,行探查性剖腹手术+有限回肠切除术+回肠环状造口术。术后,患者重新开始使用抗结核药物(ATD),但出现药物反应,胆汁性呕吐复发,黄疸和ATD不得不停止。但她的呕吐并没有减轻,并逐渐发展为败血症。腹部CT扫描诊断为威尔基综合征,并对她进行非手术治疗,通过躺卧、肠外营养和鼻空肠管喂养补充原动力学和抗生素。但她的败血症并没有消失。术中组织病理学提示念珠菌感染,经全身抗真菌治疗后恢复。讨论:像肺结核这样的衰弱状况会导致体重减轻和腹内脂肪垫的减少,这是已知的SMA综合征的沉淀。然而,其在术后早期的表现是罕见的。症状可能从非特异性的腹胀和体重减轻到急性肠梗阻的特征不等。全腹CECT有助于确诊。肌萎缩侧索硬化症通常不被认为是鉴别诊断,并可能延误治疗。医疗管理是主要的治疗选择,虽然手术保留的情况下,药物治疗失败。结论:SMA综合征以顽固性胆汁性呕吐为主,术后需高度怀疑。药物治疗可以治愈。还应解决SMA综合征的诱发因素,以改善患者的整体预后。
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引用次数: 0
Hypertension and Histopathology Severity of Non-Alcoholic Fatty Liver Disease Among Adults with Obesity: A Cross-Sectional Study. 肥胖成人非酒精性脂肪性肝病的高血压和组织病理学严重程度:一项横断面研究
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S402498
Diego Chambergo-Michilot, Paola K Rodrigo-Gallardo, Mariella R Huaman, Angie Z Vasquez-Chavesta, Gustavo Salinas-Sedo, Carlos J Toro-Huamanchumo

Background: Cardiovascular diseases are responsible for the majority of deaths resulting from non-alcoholic fatty liver disease (NAFLD). NAFLD is associated with hypertension and this is a key predictor of severe liver outcomes and an indicator of nonspecific portal fibrosis.

Aim: To assess the association between hypertension and NAFLD severity.

Methods: We conducted a secondary analysis of data from Peruvian adults with obesity and NAFLD who attended a Peruvian bariatric center. The severity of NAFLD was assessed using the Fatty Liver Inhibition of Progression algorithm / Steatosis, Activity and Fibrosis score. Hypertension was determined by either being recorded in the medical records or if the patient had a systolic pressure ≥ 140 mmHg or diastolic pressure ≥ 90 mmHg. To evaluate the association of interest, we calculated crude and adjusted prevalence ratios (aPR) using Poisson generalized linear models with logarithmic link function and robust variances. For the multivariable models, we adjusted for age, sex, physical activity and smoking.

Results: Our study included 234 participants. The prevalence of hypertension was 19.2%, while the prevalence of severe NAFLD was 46.2%. After adjusting for confounders, the prevalence of hypertension was found to be significantly higher in the severe NAFLD group compared to the non-severe group (aPR = 1.33; 95% CI: 1.03-1.74). When stratified by the presence of metabolic syndrome (MetS), the association remained significant only in the group without MetS (aPR = 1.80; 95% CI: 1.05-3.11).

Conclusion: We found an association between hypertension and severe NAFLD in adults with obesity, particularly in those without MetS.

背景:心血管疾病是导致非酒精性脂肪性肝病(NAFLD)死亡的主要原因。NAFLD与高血压相关,这是严重肝脏结局的关键预测因子和非特异性门脉纤维化的指标。目的:探讨高血压与NAFLD严重程度的关系。方法:我们对秘鲁肥胖和NAFLD成年人在秘鲁减肥中心就诊的数据进行了二次分析。使用脂肪肝抑制进展算法/脂肪变性、活动性和纤维化评分来评估NAFLD的严重程度。高血压是通过记录在医疗记录或患者收缩压≥140 mmHg或舒张压≥90 mmHg来确定的。为了评估兴趣相关性,我们使用带对数链接函数和稳健方差的泊松广义线性模型计算了粗患病率和调整患病率(aPR)。对于多变量模型,我们调整了年龄、性别、身体活动和吸烟。结果:我们的研究包括234名参与者。高血压患病率为19.2%,重度NAFLD患病率为46.2%。在调整混杂因素后,发现重度NAFLD组的高血压患病率明显高于非重度NAFLD组(aPR = 1.33;95% ci: 1.03-1.74)。当根据代谢综合征(MetS)的存在进行分层时,只有在没有MetS的组中,这种关联仍然显著(aPR = 1.80;95% ci: 1.05-3.11)。结论:我们发现高血压与肥胖成人严重NAFLD之间存在关联,特别是那些没有MetS的成年人。
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引用次数: 1
Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management. 症状性无并发症憩室病(SUDD):临床管理的实践指导和挑战。
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S340929
Giacomo Calini, Mohamed A Abd El Aziz, Lucia Paolini, Solafah Abdalla, Matteo Rottoli, Giulio Mari, David W Larson

Symptomatic Uncomplicated Diverticular Disease (SUDD) is a syndrome within the diverticular disease spectrum, characterized by local abdominal pain with bowel movement changes but without systemic inflammation. This narrative review reports current knowledge, delivers practical guidance, and reveals challenges for the clinical management of SUDD. A broad and common consensus on the definition of SUDD is still needed. However, it is mainly considered a chronic condition that impairs quality of life (QoL) and is characterized by persistent left lower quadrant abdominal pain with bowel movement changes (eg, diarrhea) and low-grade inflammation (eg, elevated calprotectin) but without systemic inflammation. Age, genetic predisposition, obesity, physical inactivity, low-fiber diet, and smoking are considered risk factors. The pathogenesis of SUDD is not entirely clarified. It seems to result from an interaction between fecal microbiota alterations, neuro-immune enteric interactions, and muscular system dysfunction associated with a low-grade and local inflammatory state. At diagnosis, it is essential to assess baseline clinical and Quality of Life (QoL) scores to evaluate treatment efficacy and, ideally, to enroll patients in cohort studies, clinical trials, or registries. SUDD treatments aim to improve symptoms and QoL, prevent recurrence, and avoid disease progression and complications. An overall healthy lifestyle - physical activity and a high-fiber diet, with a focus on whole grains, fruits, and vegetables - is encouraged. Probiotics could effectively reduce symptoms in patients with SUDD, but their utility is missing adequate evidence. Using Rifaximin plus fiber and Mesalazine offers potential in controlling symptoms in patients with SUDD and might prevent acute diverticulitis. Surgery could be considered in patients with medical treatment failure and persistently impaired QoL. Still, studies with well-defined diagnostic criteria for SUDD that evaluate the safety, QoL, effectiveness, and cost-effectiveness of these interventions using standard scores and comparable outcomes are needed.

症状性无并发症憩室病(SUDD)是憩室疾病谱系中的一种综合征,其特征是局部腹痛伴排便改变,但无全身性炎症。这篇叙述性综述报告了当前的知识,提供了实用的指导,并揭示了SUDD临床管理的挑战。仍然需要就sud的定义达成广泛和共同的共识。然而,它主要被认为是一种影响生活质量(QoL)的慢性疾病,其特征是持续的左下腹腹痛伴排便改变(如腹泻)和低度炎症(如钙保护蛋白升高),但无全身性炎症。年龄、遗传易感性、肥胖、缺乏运动、低纤维饮食和吸烟被认为是危险因素。SUDD的发病机制尚不完全清楚。它似乎是由粪便微生物群改变、神经免疫肠道相互作用和与轻度局部炎症状态相关的肌肉系统功能障碍之间的相互作用引起的。在诊断时,必须评估基线临床和生活质量(QoL)评分,以评估治疗效果,理想情况下,将患者纳入队列研究、临床试验或登记。SUDD治疗的目的是改善症状和生活质量,防止复发,避免疾病进展和并发症。提倡一种全面健康的生活方式——体育锻炼和高纤维饮食,重点是全谷物、水果和蔬菜。益生菌可以有效减轻SUDD患者的症状,但其效用缺乏足够的证据。利福昔明联合纤维和美沙拉嗪在控制SUDD患者症状方面具有潜力,并可能预防急性憩室炎。药物治疗失败且生活质量持续受损的患者可考虑手术治疗。尽管如此,仍需要有明确的SUDD诊断标准的研究,使用标准评分和可比较的结果来评估这些干预措施的安全性、生活质量、有效性和成本效益。
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引用次数: 2
Efficacy of Neutrophil-to-Lymphocyte Ratio for Cancer-Specific Survival in Elderly Patients with Localized Colon Cancer: A Single Center Propensity Score-Matched Analysis. 中性粒细胞与淋巴细胞比值对老年局限性结肠癌患者癌症特异性生存率的影响:单中心倾向评分匹配分析
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S385207
Tetsuro Tominaga, Takashi Nonaka, Shosaburo Oyama, Yuma Takamura, Shintaro Hashimoto, Toshio Shiraishi, Terumitsu Sawai, Takeshi Nagayasu

Purpose: The prognostic value of neutrophil-to-lymphocyte ratio (NLR) has been studied for colorectal cancer. Elderly patients in general tend to have comorbidities and decreased organ function that potentially influence the NLR score. The aim of this study was to investigate the relationship between NLR and cancer-specific survival in elderly patients with colon cancer, using a propensity score-matched analysis.

Patients and methods: A total of 203 patients aged over 75 years who underwent curative resection for colon cancer and were diagnosed pathologically with stage II/III disease were eligible for entry to the study. Patients were divided into two groups according to NLR score: NLR-High (NLR≥4.5) group (NLR-H, n=60) and NLR-Low (NLR<4.5) group (NLR-L, n=143). After propensity score matching, 57 patients in each group were matched.

Results: Before matching, Charlson comorbidity index was significantly higher in the NLR-H group (4 vs 2, p<0.001). After matching, all factors were similar between the groups. The median follow-up period was 43 months (range, 1-160 months). Five-year relapse-free-survival (69.8% vs 87.3%, p=0.030) and cancer-specific survival (83.0% vs 96.0%, p=0.042) were significantly lower in the NLR-H group.

Conclusion: NLR appears to be a cancer-specific prognostic marker in elderly patients with colon cancer.

目的:探讨中性粒细胞与淋巴细胞比值(NLR)对大肠癌的预后价值。老年患者通常有合并症和器官功能下降,这可能会影响NLR评分。本研究的目的是通过倾向评分匹配分析,探讨老年结肠癌患者NLR与癌症特异性生存率之间的关系。患者和方法:203例75岁以上接受根治性结肠癌切除术且病理诊断为II/III期的患者符合入组研究条件。根据NLR评分将患者分为两组:NLR-高(NLR≥4.5)组(NLR- h, n=60)和NLR-低(NLR)组(NLR- h组,n=60)。结果:配对前,NLR- h组Charlson合病指数明显高于NLR- h组(4比2,p)。
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引用次数: 1
A Multicentre Study of the Clinical and Epidemiological Profile of Inflammatory Bowel Disease in Northeast Brazil. 巴西东北部炎症性肠病临床和流行病学多中心研究
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S411936
Carlos Alexandre Antunes de Brito, Lívia Medeiros Soares Celani, Marcelo Vicente Toledo de Araújo, Maurilio Toscano de Lucena, Graciana Bandeira Salgado Vasconcelos, Gustavo André Silva Lima, Fernando Jorge Firmino Nóbrega, George Tadeu Nunes Diniz, Norma Lucena-Silva, Germano Tose Toneto, João Victor de Carvalho Falcão, Pedro Martinelli Barbosa, Priscylla Rayanne Fernandes de Oliveira, Luan Samy Xavier Dantas, Luanna Karen Chagas Fernandes, Samara Amorim de Araújo, Valéria Ferreira Martinelli

Purpose: Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBDs) with multifactorial causes. They are becoming more prevalent in developing countries such as Brazil; however, relevant studies in poorer regions of the country are limited. Here, we report the clinical-epidemiological profile of patients with IBD treated at reference centers in three states of Northeast Brazil.

Patients and methods: This was a prospective cohort study involving patients at referral outpatient clinics for IBD from January 2020 through December 2021.

Results: Of 571 patients with IBD, 355 (62%) had UC, and 216 (38%) had CD. The patients were predominantly women (355, 62%) for both UC and CD. Extensive colitis was the pattern present in 39% of the UC cases. For CD, ileocolonic disease was the predominant manifestation (38%), with 67% of cases showing penetrating and/or stenosing behavior. The majority of patients were diagnosed between the ages of 17 and 40, corresponding to 60.2% in CD and 52.7% in UC. The median time between symptom onset and diagnosis was 12 months for CD and 8 months for UC (p=0.042). Joint involvement was the most frequent extraintestinal manifestation, with arthralgia and arthritis present in 41.9% and 18.6% of the patients, respectively. Biological therapy was prescribed to 73% of CD patients and 26% of UC patients. A progressive increase in new cases was observed in every 5-year interval over the last five decades, with 58.6% being diagnosed in the last 10 years.

Conclusion: More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD. A prolonged time to diagnosis may have contributed to these findings. A progressive increase in IBD incidence was observed and may be related to greater urbanization and better access to specialized outpatient clinics, resulting in improvements in diagnosis.

目的:溃疡性结肠炎(UC)和克罗恩病(CD)是多因素引起的炎症性肠病(IBDs)。它们在巴西等发展中国家变得越来越普遍;然而,在该国较贫穷地区进行的相关研究有限。在这里,我们报告了在巴西东北部三个州的参考中心治疗的IBD患者的临床流行病学概况。患者和方法:这是一项前瞻性队列研究,涉及2020年1月至2021年12月在IBD转诊门诊就诊的患者。结果:在571例IBD患者中,355例(62%)患有UC, 216例(38%)患有CD。同时患有UC和CD的患者主要是女性(3555例,62%)。39%的UC病例存在广泛结肠炎。对于CD,回肠结疾病是主要表现(38%),67%的病例表现为穿透和/或狭窄行为。大多数患者的诊断年龄在17 - 40岁之间,CD为60.2%,UC为52.7%。从症状出现到诊断的中位时间CD为12个月,UC为8个月(p=0.042)。关节受累是最常见的肠外表现,分别有41.9%和18.6%的患者存在关节痛和关节炎。73%的乳糜泻患者和26%的UC患者接受了生物治疗。在过去的50年里,每隔5年就会观察到新病例的逐渐增加,其中58.6%是在过去的10年里被诊断出来的。结论:UC以更广泛的疾病行为模式为主,而与并发症相关的形式在CD中普遍存在。诊断时间较长可能是导致这些发现的原因。观察到IBD发病率的逐渐增加,这可能与更大的城市化和更容易获得专门门诊诊所有关,从而导致诊断的改善。
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引用次数: 0
A Multicenter Randomized Phase II Trial Investigating the Effect of Polyglycolic Acid Sheet on the Prevention of Pancreatic Fistula After Gastrectomy with Prophylactic Lymph Node Dissection. 一项多中心随机II期试验,研究聚乙醇酸片预防胃切除术后预防性淋巴结清扫后胰瘘的效果。
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S421531
Dai Shimizu, Chie Tanaka, Mitsuro Kanda, Koki Nakanishi, Seiji Ito, Yachiyo Kuwatsuka, Masahiko Ando, Kenta Murotani, Michitaka Fujiwara, Yasuhiro Kodera

Pancreatic fistula after gastrectomy with lymph node dissection is associated with prolonged hospital stay and critical complications such as intra-abdominal bleeding and sepsis. Polyglycolic acid (PGA) sheets are absorbable suture reinforcement materials. A randomized Phase II trial has been planned to evaluate the effect of PGA sheets on preventing postoperative pancreatic fistula. A total of 320 patients will be recruited from thirteen institutions. Patients who are scheduled to undergo distal or total gastrectomy will be randomly allocated into the PGA group or control group, and the dissected area around the pancreas will be covered by the PGA sheet in the PGA group. The primary endpoint will be the maximum value of drain amylase concentration up to 5 days after surgery. The secondary endpoints will be as follows: transition of value of amylases of drain discharge, incidence of pancreatic fistula, incidence of intra-abdominal abscess, white blood cell count, value of C-reactive protein, incidence of postoperative complication, duration of antibiotic agents administration, duration of abdominal drainage, usage of octreotide, duration of hospital stay, incidence of bleeding in abdominal cavity, mortality, and incidence of reoperation.

胃切除术伴淋巴结清扫术后胰瘘与住院时间延长和腹内出血、败血症等严重并发症相关。聚乙二醇酸(PGA)片材是一种可吸收的缝合增强材料。一项随机II期试验计划评估PGA片预防术后胰瘘的效果。总共将从13个机构招募320名患者。将计划行远端或全胃切除术的患者随机分为PGA组和对照组,PGA组将胰腺周围的解剖区域覆盖PGA片。主要终点将是术后5天内引流淀粉酶浓度的最大值。次要终点为:排液淀淀酶值转换、胰瘘发生率、腹内脓肿发生率、白细胞计数、c反应蛋白值转换、术后并发症发生率、抗生素给药时间、腹腔引流时间、奥曲肽使用情况、住院时间、腹腔出血发生率、死亡率、再手术发生率。
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引用次数: 0
Tenapanor in the Treatment of Irritable Bowel Syndrome with Constipation: Discovery, Efficacy, and Role in Management. 泰那帕诺治疗肠易激综合征伴便秘:发现、疗效和管理作用。
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S384251
Anam Herekar, Dhanush Shimoga, Asad Jehangir, Dariush Shahsavari, Yun Yan, Tennekoon Buddhika Karunaratne, Amol Sharma

Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction (DGBI). IBS significantly impacts the quality of life of patients. Since its pathogenesis is unclear and can be multifactorial, it highlights the need for new and improved pharmaceutical drugs that not only improve bowel symptoms, but also address global IBS symptoms, such as abdominal pain. Tenapanor, a recently Food & Drug Administration (FDA)-approved medication for IBS with constipation (IBS-C), is a small molecule inhibitor of the sodium/hydrogen exchanger isoform 3 (NHE3) that inhibits the absorption of sodium and phosphate in the gastrointestinal tract, resulting in fluid retention and softer stool. Furthermore, tenapanor reduces intestinal permeability to improve visceral hypersensitivity and abdominal pain. Due to its recent approval, tenapanor was not included in the recent IBS guidelines, however, it may be considered for IBS-C patients failing first-line treatment of soluble fiber. In this review article, we aim to provide in-depth information to the reader regarding the design of tenapanor, its development through Phase I, II and III randomized clinical trials, and its role in the treatment of IBS-C.

肠易激综合征(IBS)是一种常见的肠脑相互作用(DGBI)疾病。肠易激综合征显著影响患者的生活质量。由于其发病机制尚不清楚,可能是多因素的,因此它强调需要新的和改进的药物,不仅可以改善肠道症状,还可以解决全身IBS症状,如腹痛。Tenapanor是美国食品和药物管理局(FDA)最近批准的用于IBS合并便秘(IBS- c)的药物,是一种钠/氢交换异构体3 (NHE3)的小分子抑制剂,可抑制胃肠道中钠和磷酸盐的吸收,导致液体潴留和大便变软。此外,tenapanor降低肠道通透性,改善内脏过敏和腹痛。由于最近的批准,tenapanor没有被纳入最近的IBS指南,然而,它可能被考虑用于可溶性纤维一线治疗失败的IBS- c患者。在这篇综述文章中,我们旨在为读者提供关于tenapanor的设计,通过I、II和III期随机临床试验的开发,以及它在治疗IBS-C中的作用的深入信息。
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引用次数: 2
Prediction of High-Risk Varices in Patients with Compensated Advanced Chronic Liver Disease in Saudi Arabia. 沙特阿拉伯代偿晚期慢性肝病患者高危静脉曲张的预测
IF 2.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.2147/CEG.S410041
Mona Ismail

Purpose: Liver stiffness and low platelet count can predict portal hypertension and high-risk varices (HRVs) in patients with cirrhosis. Thus, screening endoscopy may not be required for all patients with compensated advanced chronic liver disease (cACLD). However, data from Saudi Arabia are limited. This study aimed to validate the Baveno VI and expanded Baveno VI criteria for screening endoscopy and identify the risk factors associated with HRVs in patients with cACLD in Saudi Arabia.

Patients and methods: We analyzed data from 215 patients with cACLD diagnosed on transient elastography (LSM > 10 kPa) and had paired platelet count and screening upper endoscopy performed within one year of diagnosis. HRVs or varices needing treatment (VNTs) were defined as medium-to-large esophageal varices (EVs), small EVs with red flags, or gastric varices. Sensitivity, specificity, and area under the receiver operating characteristic curve were calculated. Univariate and multivariate logistic regression analyses identified HRV risk factors.

Results: The Baveno VI criteria spared 50.7% of endoscopies, missing 3.7% of VNTs, while the expanded Baveno VI criteria spared 63.7% of endoscopies, missing 5.1% VNTs. An LSM <20 kPa and platelet count > 150,000/µL were associated with HRV in 8.1% and 8.3%, respectively. While an LSM <25 kPa and platelet count > 110,000/µL were associated with HRV in 9.7% and 9%, respectively. The Baveno VI criteria had sensitivity and specificity of 76% and 55%, while the expanded criteria had 67% and 69%, respectively. Baveno VI criteria performed better in hepatitis C virus patients than nonalcoholic fatty liver disease patients. Multivariate logistic regression analysis revealed platelet count and LSM as predictors of HRV.

Conclusion: The Baveno VI criteria effectively identified HRVs in cACLD patients from Saudi Arabia, reducing unnecessary endoscopies. Although the expanded criteria avoided more endoscopies, it led to a higher rate of missed HRVs.

目的:肝硬度和低血小板计数可预测肝硬化患者门脉高压和高危静脉曲张(hrv)。因此,并非所有代偿性晚期慢性肝病(cACLD)患者都需要内窥镜筛查。然而,来自沙特阿拉伯的数据有限。本研究旨在验证Baveno VI和扩展的Baveno VI标准用于筛查内窥镜检查,并确定沙特阿拉伯cACLD患者中与hrv相关的危险因素。患者和方法:我们分析了215例通过瞬态弹性成像(LSM > 10 kPa)诊断为cACLD的患者的数据,这些患者在诊断一年内进行了配对血小板计数和筛查上内镜检查。hrv或需要治疗的静脉曲张(VNTs)被定义为中大型食管静脉曲张(EVs)、伴有红色信号的小EVs或胃静脉曲张。计算灵敏度、特异度和受试者工作特征曲线下面积。单因素和多因素logistic回归分析确定了HRV的危险因素。结果:Baveno VI标准免除了50.7%的内窥镜检查,遗漏了3.7%的vnt;扩展版Baveno VI标准免除了63.7%的内窥镜检查,遗漏了5.1%的vnt。LSM 150000 /µL与HRV的相关性分别为8.1%和8.3%。而LSM 110,000/µL与HRV的相关性分别为9.7%和9%。Baveno VI标准的敏感性和特异性分别为76%和55%,扩展标准的敏感性和特异性分别为67%和69%。Baveno VI标准在丙型肝炎患者中的表现优于非酒精性脂肪肝患者。多因素logistic回归分析显示血小板计数和LSM是HRV的预测因子。结论:Baveno VI标准可有效识别沙特阿拉伯cACLD患者的hrv,减少不必要的内窥镜检查。虽然扩大的标准避免了更多的内窥镜检查,但它导致了更高的hrv漏诊率。
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引用次数: 1
期刊
Clinical and Experimental Gastroenterology
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