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Biodegradable Stents in Resistant Peptic Oesophageal Stricture: Is It the Right Way to Go? 可生物降解支架治疗难治性消化性食管狭窄:这是正确的方法吗?
Pub Date : 2018-12-20 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218819492
Tom Richardson, Gerlin Naidoo, Namal Rupasinghe, Howard Smart, Sayantan Bhattacharya

Peptic oesophageal stricture can be considered as the end result of prolonged gastro-oesophageal reflux. The 'gold standard' treatment for peptic stricture is endoscopic dilatation with balloon or bougie. It is predicted that up to 40% of patients remain symptomatic with dysphagia due to refractory (resistant to treatment) or recurrent strictures, needing frequent interventions at short intervals. Such patients have poor nutritional status due to the primary disease and are susceptible to complications related to repeated endoscopic dilatation such as bleeding and perforation. This general review aims to analyse existing published evidence and address the role of biodegradable stents in resistant peptic strictures as an alternative treatment to provide long-term dysphagia-free intervals.

消化性食管狭窄可被认为是胃食管反流延长的最终结果。治疗消化性狭窄的“金标准”是内镜下球囊或肿胀扩张。据预测,高达40%的患者仍有吞咽困难的症状,原因是难治性(治疗抵抗)或复发性狭窄,需要在短时间间隔内频繁干预。这类患者因原发疾病营养状况较差,易发生反复内镜扩张引起的出血、穿孔等并发症。本综述旨在分析现有已发表的证据,并探讨可生物降解支架在耐药消化性狭窄中的作用,作为提供长期无吞咽困难间隔的替代治疗。
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引用次数: 1
Melanosis Coli: A Helpful Contrast Effect or a Harmful Pigmentation? 大肠黑素病:有益的对比效果还是有害的色素沉着?
Pub Date : 2018-12-04 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218817321
Fadi Abu Baker, Amir Mari, Dan Feldman, Muhammad Suki, Oren Gal, Yael Kopelman

Background: Melanosis coli, a brown discoloration of colonic mucosa, is considered as a benign condition mainly observed in patients under chronic anthranoid laxatives. Recent data link this condition with an increased adenoma detection rate. Moreover, its tumorigenic potential and possible association with the development of colorectal cancer remains uncertain. We conducted this study to compare the polyp detection rate and colorectal cancer diagnosis in patients with melanosis against matched control group without melanosis.

Patients and methods: A retrospective single-center study. Patients diagnosed with melanosis coli on colonoscopy over a 15-year period were included. Each melanosis coli patient was matched with three controls by age, gender, setting (inpatient/outpatient), and procedure's indication. Polyp detection rate and diagnosis of colorectal cancer were recorded and compared between the groups before and after adjustment for bowel preparation.

Results: A cohort of 718 patients with melanosis and 2154 controls were included. The polyp detection rates were 33.4% and 21.8% of melanosis and control groups, respectively (P < .001). Melanosis coli, however, was associated with less diagnosis of colorectal cancer than controls (0.3% vs 3.9%; P < .001). In multivariate analysis, melanosis diagnosis on endoscopy was significantly associated with higher polyp detection rate (odds ratio [OR] = 1.986, 95% confidence interval [CI]: 1.626-2.425; P value < .01).

Conclusions: Melanosis coli is not associated with increased diagnosis of colorectal cancer. It is associated, however, with enhanced polyp detection likely due to chromo-endoscopy-like effect.

背景:大肠黑素病是一种结肠粘膜的棕色变色,被认为是一种良性疾病,主要见于慢性类蒽酮泻药患者。最近的数据表明,这种情况与腺瘤检出率增加有关。此外,其致瘤潜能及其与结直肠癌发展的可能关联仍不确定。我们进行这项研究是为了比较黑色素瘤患者和对照组的息肉检出率和结直肠癌的诊断。患者和方法:回顾性单中心研究。15年以上结肠镜检查诊断为大肠黑素病的患者纳入研究。根据年龄、性别、环境(住院/门诊)和手术适应证,每个大肠黑素病患者与三个对照组相匹配。记录调整肠准备前后两组的息肉检出率和结直肠癌诊断率,并进行比较。结果:纳入了718例黑色素瘤患者和2154例对照。黑素病组和对照组的息肉检出率分别为33.4%和21.8% (P P P值)。结论:大肠黑素病与结直肠癌的诊断率升高无关。然而,它与可能由于色内窥镜样作用而增强的息肉检测相关。
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引用次数: 14
Understanding Therapeutic Concepts in Crohn's Disease. 理解克罗恩病的治疗概念。
Pub Date : 2018-12-03 DOI: 10.1177/1179552218815169
Gilles Rg Monif

For more than a decade, the therapeutic focus for Crohn's disease has remained fixed at temporary arrestment of symptomology. The Centers for Disease Control and Prevention (CDC) lists Crohn's disease as a disease entity without current cure. Biologics in combination with antibiotics can frequently achieve remissions. Without ongoing drug administration, these remissions tend to be of limited duration. Conceptual advancements in understanding the pathogenesis of Crohn's disease have identified treatment approaches, the focus of which goes beyond temporary remission. Concepts derived from Infectious Diseases Inc.'s 17 years of research with Mycobacterium avium subspecies paratuberculosis delineate how new knowledge can be integrated to achieve more sustained remissions.

十多年来,克罗恩病的治疗重点一直固定在暂时停止症状。美国疾病控制与预防中心(CDC)将克罗恩病列为目前尚无治愈方法的疾病。生物制品与抗生素相结合经常可以达到缓解的效果。如果没有持续的药物管理,这些缓解往往持续时间有限。在理解克罗恩病发病机制方面的概念进步已经确定了治疗方法,其重点不仅仅是暂时缓解。源自传染病股份有限公司17 多年来对禽分枝杆菌副结核亚种的研究描绘了如何整合新知识以实现更持久的缓解。
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引用次数: 8
The Benefits of Neuromuscular Electrical Stimulation in the Muscular and Functional Capacity of Patients With Liver Cirrhosis: Protocol for a Randomized Clinical Trial. 神经肌肉电刺激对肝硬化患者肌肉和功能能力的益处:一项随机临床试验方案。
Pub Date : 2018-11-26 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218811834
Carolina Luana de Mello, Thaís Martins Albanaz da Conceição, Tarcila Dal Pont, Catherine Corrêa Peruzzolo, Mariana Nunes Lúcio, Elaine Paulin

Cirrhosis causes systemic and metabolic changes that culminate in various complications, such as compromised pulmonary function, ascites, hepatic encephalopathy, weight loss, and muscle weakness with significant physical function limitations. Our aim is to evaluate the effects of training with neuromuscular electrical stimulation (NMES) on the muscular and functional capacity of patients with cirrhosis classified as Child-Pugh B and C. A total of 72 patients diagnosed with cirrhosis will be recruited and randomized to perform an NMES protocol for 50 minutes, 3 times a week, for 4 weeks. The evaluations will be performed at the beginning and after 12 sessions, and patients will be submitted to a pulmonary function test, an ultrasound evaluation of the rectus femoris, an evaluation of peripheral muscle strength, a submaximal exercise capacity test associated with an evaluation of peripheral tissue oxygenation, a quality of life evaluation, and orientation about monitoring daily physical activities. The evaluators and patients will be blinded to the allocation of the groups. Training Group will be treated with the following parameters: frequency of 50 Hz, pulse width of 400 μs, rise and fall times of 2 s, and on:off 1:1; Sham Group: 5 Hz, 100 μs, on:off 1:3. The data will be analyzed using the principles of the intention to treat. This study provides health professionals with information on the benefits of this intervention. In this way, we believe that the results of this study could stimulate the use of NMES as a way of rehabilitating patients with more severe cirrhosis, with the objective of improving these patients' functional independence.

肝硬化引起全身和代谢改变,最终导致各种并发症,如肺功能受损、腹水、肝性脑病、体重减轻和肌肉无力,并伴有明显的身体功能限制。我们的目的是评估神经肌肉电刺激(NMES)训练对Child-Pugh B级和c级肝硬化患者肌肉和功能能力的影响。我们将招募72名诊断为肝硬化的患者,并随机分配进行NMES方案,每次50分钟,每周3次,持续4周。评估将在开始和12个疗程后进行,患者将接受肺功能测试、股直肌超声评估、外周肌力评估、与外周组织氧合评估相关的亚最大运动能力测试、生活质量评估和日常身体活动监测指导。评估人员和患者将不知道分组的分配情况。训练组的处理参数为:频率50 Hz,脉宽400 μs,上升和下降时间2 s,开:关1:1;Sham组:5hz, 100 μs,开:关1:3。使用意向治疗原则对数据进行分析。这项研究为卫生专业人员提供了有关这种干预的好处的信息。因此,我们相信本研究的结果可以刺激使用NMES作为一种康复更严重肝硬化患者的方法,目的是提高这些患者的功能独立性。
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引用次数: 0
Impact of Video Aid on Quality of Bowel Preparation Among Patients Undergoing Outpatient Screening Colonoscopy. 视频辅助对门诊结肠镜筛查患者肠道准备质量的影响。
Pub Date : 2018-10-08 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218803304
Sanna Fatima, Deepanshu Jain, Christopher Hibbard

Aim: To investigate the effect of video aid on quality of bowel preparation.

Study: A retrospective study was done on patients undergoing outpatient screening colonoscopy. All subjects received educational video prior to colonoscopy in addition to the standard counseling. Patient charts were reviewed to collect data regarding quality of bowel preparation (adequate or inadequate). The study population was stratified into four groups according to viewing status: Group I 0% (control group), Group II <50%, Group III >50% to <75%, and Group IV watched ⩾75% of the video.

Results: A total of 338 patients with an average age of 59.1 years and 60.3% females were included in the final study cohort. Of the patients in Groups I, II, III, and IV, 94.3%, 90.9%, 100%, and 91.7%, respectively, had adequate preparation (P value = .827). Adenoma detection rate (ADR) for Groups I, II, III, and IV was 28.8%, 50%, 50%, and 22.6%, respectively (P value = .305). The mean cecal intubation time was 20.7, 16.4, 16.57, and 17 minutes for Groups I, II, III, and IV, respectively (P value = .041).

Conclusions: Video aid use for patients undergoing screening colonoscopy lacked a statistically significant impact on the quality of bowel preparation, ADR, and advanced adenoma detection rate when compared with standard practice.

目的:探讨视频辅助对肠准备质量的影响。研究:对门诊结肠镜筛查患者进行回顾性研究。所有受试者在结肠镜检查前除了接受标准咨询外,还接受了教育视频。回顾患者病历,收集有关肠道准备质量(适当或不充分)的数据。研究人群根据观看情况分为四组:组I 0%(对照组),组II 50%至结果:最终研究队列共纳入338例患者,平均年龄59.1岁,其中女性60.3%。I、II、III、IV组患者术前准备充分的比例分别为94.3%、90.9%、100%、91.7% (P值= 0.827)。ⅰ组、ⅱ组、ⅲ组、ⅳ组的腺瘤检出率(ADR)分别为28.8%、50%、50%、22.6% (P值= 0.305)。I、II、III、IV组平均盲肠插管时间分别为20.7、16.4、16.57、17分钟(P值= 0.041)。结论:与标准做法相比,在筛查性结肠镜检查患者中使用视频辅助对肠准备质量、不良反应和晚期腺瘤检出率没有统计学意义的影响。
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引用次数: 0
Pancreatic Extramedullary Plasmacytoma Presenting as a Pancreatic Mass. 胰腺髓外浆细胞瘤表现为胰腺肿块。
Pub Date : 2018-09-24 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218801603
Michelle Le, Balarama Krishna Surapaneni, Vardhmaan Jain, Rakesh Vinayek, Sudhir K Dutta

Extramedullary plasmacytomas (EMP) are a subcategory of plasma cell neoplasm that involves organs outside the bone marrow. Involvement of the pancreas is relatively rare, reported in only 2.3% of autopsies. Radiologic findings in plasmacytoma are nonspecific, but endoscopic ultrasound fine-needle aspiration is a fast and reliable technique to acquire a histologic sample for initial diagnosis. Recently, the use of fluorine-18 fluorodeoxyglucose PET/CT has been recommended in patients with active multiple myeloma and solitary plasmacytoma. We present an interesting case of primary EMP in the pancreatic body encasing the portal vein as well as the celiac artery, which was detected before the patient was diagnosed of multiple myeloma.

髓外浆细胞瘤(EMP)是浆细胞肿瘤的一个亚类,累及骨髓外器官。胰腺受累相对罕见,只有2.3%的尸检报告。浆细胞瘤的影像学表现是非特异性的,但内镜下超声细针穿刺是一种快速可靠的技术,可以获得组织学样本进行初步诊断。最近,在活动性多发性骨髓瘤和孤立性浆细胞瘤患者中推荐使用氟-18氟脱氧葡萄糖PET/CT。我们报告一个有趣的病例,原发性EMP在胰腺体中包裹门静脉和腹腔动脉,在患者被诊断为多发性骨髓瘤之前就被发现了。
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引用次数: 4
Gastroduodenal Tuberculosis: A Case Series and Review of Literature. 胃十二指肠结核:病例系列及文献回顾。
Pub Date : 2018-07-30 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218790566
Suhas Udgirkar, Ravindra Surude, Vinay Zanwar, Sanjay Chandnani, Qais Contractor, Pravin Rathi

Gastroduodenal tuberculosis is infrequently seen in day-to-day clinical practice with few cases reported in the literature. It is usually associated with features of gastric outlet obstruction. This is a case series of 4 patients with 2 of them having associated lower gastrointestinal involvement. One of them resembled a growth in the cardia of the stomach which responded to antitubercular drugs. Another had duodenal erosions with portal lymph node enlargement which responded to antitubercular drug treatment. None of the patients required surgical management. Gastroduodenal tuberculosis should be considered with a high degree of suspicion when patients present with gastric outlet obstruction or with endoscopic evidence of ulceronodular disease in areas endemic for tuberculosis.

胃十二指肠结核在日常临床实践中并不常见,文献报道的病例很少。它通常伴有胃出口梗阻的特征。这是一个4例患者的病例系列其中2例伴有下消化道受累。其中一个类似于对抗结核药物有反应的胃贲门的生长。另一例十二指肠糜烂伴门静脉淋巴结肿大,对抗结核药物治疗有反应。没有患者需要手术治疗。当患者出现胃出口梗阻或在结核病流行地区有胃溃疡结节病的内镜证据时,应高度怀疑胃十二指肠结核。
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引用次数: 16
Esophageal Adenocarcinoma: Opportunities for Targeted Prevention in Ohio. 食管腺癌:俄亥俄州针对性预防的机会。
Pub Date : 2018-07-30 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218791170
Julie A Stephens, James L Fisher, Jessica L Krok-Schoen, Ryan D Baltic, Holly L Sobotka, Electra D Paskett

Objective: The incidence of esophageal adenocarcinoma, one of the most lethal gastroenterological diseases, has been increasing since the 1960s. Prevention of esophageal adenocarcinoma is important because no early detection screening programs have been shown to reduce mortality. Obesity, gastroesophageal reflux disease, and tobacco smoking are risk factors for esophageal adenocarcinoma. Due to the high prevalence in Ohio of obesity (32.6%) and cigarette smoking (21.0%), this study sought to identify trends and patterns of these risk factors and esophageal adenocarcinoma in Ohio as compared with the United States.

Methods: Data from the Ohio Cancer Incidence Surveillance System, Surveillance Epidemiology and End Results Program (SEER), and Behavioral Risk Factor Surveillance System were used. Incidence rates overall, by demographics and by county, as well as trends in incidence of esophageal adenocarcinoma and the percent of esophageal adenocarcinoma among esophageal cancers were examined. Trends in obesity and cigarette smoking in Ohio, and the prevalence of each by county, were reported.

Results: There was an increasing trend in esophageal adenocarcinoma incidence in Ohio. Ohio's average annual esophageal adenocarcinoma incidence rate was higher than the SEER rate overall and for each sex, race, and age group in 2009 to 2013. There was also an increasing prevalence of obesity in Ohio. Although the prevalence of cigarette smoking has been stable, it was high in Ohio compared with the United States.

Conclusions: Health care providers and researchers should be aware of the esophageal adenocarcinoma incidence rates and risk factor patterns and tailor interventions for areas and populations at higher risk.

目的:食管腺癌是最致命的消化道疾病之一,自20世纪60年代以来,其发病率呈上升趋势。预防食管癌是很重要的,因为没有早期发现的筛查方案被证明可以降低死亡率。肥胖、胃食管反流病和吸烟是食管腺癌的危险因素。由于俄亥俄州肥胖(32.6%)和吸烟(21.0%)的高患病率,本研究试图确定这些危险因素和食管腺癌在俄亥俄州的趋势和模式,并将其与美国进行比较。方法:使用来自俄亥俄州癌症发病率监测系统、监测流行病学和最终结果计划(SEER)和行为风险因素监测系统的数据。总体发病率,按人口统计和按县,以及食管癌发病率的趋势以及食管癌中食管癌的百分比进行了检查。报告了俄亥俄州肥胖和吸烟的趋势,以及每个县的流行程度。结果:俄亥俄州食管癌发病率呈上升趋势。2009年至2013年,俄亥俄州食管癌的年平均发病率高于SEER总体发病率,也高于每个性别、种族和年龄组的SEER发病率。俄亥俄州的肥胖率也在上升。尽管吸烟的流行率一直保持稳定,但与美国相比,俄亥俄州的吸烟率很高。结论:卫生保健提供者和研究人员应了解食管癌的发病率和危险因素模式,并针对高危地区和人群量身定制干预措施。
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引用次数: 1
Plasma-Free Amino Acid Profiles in Crohn's Disease: Relationship With the Crohn Disease Activity Index. 克罗恩病血浆无氨基酸谱:与克罗恩病活动指数的关系
Pub Date : 2018-07-30 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218791173
Toshimi Chiba, Kazuyuki Suzuki, Takayuki Matsumoto

We aimed to clarify the relationship between plasma-free amino acid (PFAA) profiles and the Crohn's disease (CD) activity index (CDAI) in patients with CD.

Methods: We measured fasting PFAA concentrations in 29 patients with CD and their correlation with disease activity.

Results: In all patients, significant correlations were noted between CDAI and concentrations of valine, methionine, leucine, histidine, tryptophan, alanine, tyrosine, total amino acids (TAAs), nonessential amino acids (NEAAs), essential amino acids (EAAs), and branched-chain amino acids (BCAAs). In patients with the ileo-colonic type of CD, significant correlations were noted between CDAI and valine, histidine, tryptophan, glutamine, TAA, NEAA, EAA, and BCAA. In ileal type, significant correlations were observed between CDAI and threonine, valine, histidine, serine, and glycine. In colonic type, significant correlations were noted between CDAI and valine, histidine, tryptophan, TAA, NEAA, EAA, and BCAA.

Conclusions: In patients with CD, plasma amino acids appear to be associated with disease activity.

我们旨在阐明血浆游离氨基酸(PFAA)谱与克罗恩病(CD)活性指数(CDAI)之间的关系。方法:我们测量了29例CD患者的空腹PFAA浓度及其与疾病活性的相关性。结果:在所有患者中,CDAI与缬氨酸、蛋氨酸、亮氨酸、组氨酸、色氨酸、丙氨酸、酪氨酸、总氨基酸(TAAs)、非必需氨基酸(NEAAs)、必需氨基酸(EAAs)和支链氨基酸(BCAAs)浓度之间存在显著相关性。在回肠-结肠型CD患者中,CDAI与缬氨酸、组氨酸、色氨酸、谷氨酰胺、TAA、NEAA、EAA和BCAA之间存在显著相关性。在回肠型中,CDAI与苏氨酸、缬氨酸、组氨酸、丝氨酸和甘氨酸之间存在显著相关性。在结肠型中,CDAI与缬氨酸、组氨酸、色氨酸、TAA、NEAA、EAA和BCAA之间存在显著相关性。结论:在CD患者中,血浆氨基酸似乎与疾病活动性有关。
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引用次数: 9
An Evidence-Based Review of Statin Use in Patients With Nonalcoholic Fatty Liver Disease. 他汀类药物在非酒精性脂肪肝患者中应用的循证回顾。
Pub Date : 2018-07-10 DOI: 10.1177/1179552218787502
Meredith A Sigler, Lee Congdon, Krystal L Edwards

Background: Nonalcoholic fatty liver disease (NAFLD) is a common complication in patients with metabolic syndrome. The role of statin therapy specifically for the treatment of NAFLD remains unknown. The aim of this review is to discuss outcomes of recent articles analyzing statin therapy in patients with NAFLD.

Findings: A total of 12 trials met the inclusion criteria. Statins were not found to increase the prevalence of NAFLD once confounding variables were considered. Statins were also found to be beneficial in treating dyslipidemia and improving liver function. Histological liver outcomes in patients with NAFLD were controversial. One trial found a reduction in the incidence of hepatocellular carcinoma associated with the use of statins.

Conclusions: Overall, therapy with statins appears to be safe for use in patients with NAFLD. Several trials have validated the use of statins for the treatment of dyslipidemia; however, it remains unknown as to whether statins should be used to specifically treat NAFLD.

背景:非酒精性脂肪肝(NAFLD)是代谢综合征患者常见的并发症。他汀类药物治疗NAFLD的具体作用尚不清楚。这篇综述的目的是讨论最近分析他汀类药物治疗NAFLD患者的结果。结果:共有12项试验符合纳入标准。在考虑混杂变量后,未发现他汀类药物会增加NAFLD的患病率。他汀类药物也被发现对治疗血脂异常和改善肝功能有益。NAFLD患者的组织学肝脏结果存在争议。一项试验发现,使用他汀类药物可降低肝细胞癌的发病率。结论:总体而言,他汀类药物治疗NAFLD患者似乎是安全的。几项试验已经证实他汀类药物用于治疗血脂异常;然而,他汀类药物是否应该用于特异性治疗NAFLD仍然未知。
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引用次数: 36
期刊
Clinical Medicine Insights. Gastroenterology
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