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Successful Endoscopic Treatment of Post-esophagectomy Refractory Reflux Using OverStitch: The First Clinical Case. 内镜下成功治疗食管切除术后难治性反流:第一例临床病例。
Pub Date : 2018-07-03 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218784946
Hirotsugu Nagase, Makoto Yamasaki, Yoshitomo Yanagimoto, Takashi Kanemura, Shigeyoshi Higashi, Kota Momose, Ryo Kato, Yasuhiro Miyazaki, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Hiroshi Miyata, Shuji Takiguchi, Masaki Mori, Yuichiro Doki, Kiyokazu Nakajima

Aims: The reflux of duodeno-gastric contents into the remnant esophagus (gastric tube-esophageal reflux: GTER) is a significant issues in long-term esophageal cancer survivors after radical esophagectomy. We attempted endoscopic valve (funnel) creation for prevention for GTER using OverStitch endoscopic suturing system.

Methods: The OverStitch was mounted onto a standard double-channel endoscope. Under general anesthesia, the funnel creation was attempted by placing semi-full thickness sutures on the gastric wall, at 3 cm distal to the primary esophago-gastric anastomosis. The postoperative outcomes were also evaluated.

Results: In total, 4 sutures were needed and the operating time was 62 minutes without complication. The endoscopic and swallowing studies, as well as pH profile, were all improved postoperatively. The patient's quality of life was dramatically improved with complete disappearance of night-time reflux in spine position.

Conclusions: Endoscopic antireflux funnel creation was feasible and safe. This procedure may become a useful treatment for patients with severe GTER after esophagectomy.

目的:十二指肠胃内容物返流到残食道(胃管-食管返流:GTER)是食管癌根治性食管切除术后长期存活患者的一个重要问题。我们尝试使用OverStitch内窥镜缝合系统创建内窥镜瓣膜(漏斗)以预防GTER。方法:将OverStitch安装在标准双通道内窥镜上。在全身麻醉下,在初级食管-胃吻合口远端3cm处的胃壁上放置半全厚度的缝合线,尝试建立漏斗。同时对术后结果进行评估。结果:共缝合4次,手术时间62分钟,无并发症。内镜和吞咽检查,以及pH值,都在术后得到改善。患者的生活质量显著改善,夜间脊柱位置反流完全消失。结论:内镜下造抗反流漏斗是可行且安全的。对于食管切除术后出现严重GTER的患者,这种方法可能成为一种有效的治疗方法。
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引用次数: 3
A Case of Acute Severe Hepatotoxicity and Mild Constriction of Common Bile Duct Associated With Ingestion of Green Tea Extract: A Clinical Challenge. 1例与摄入绿茶提取物相关的急性严重肝毒性和胆总管轻度收缩:一个临床挑战。
Pub Date : 2018-06-05 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218779970
Balarama Krishna Surapaneni, Michelle Le, Julian Jakobovits, Rakesh Vinayek, Sudhir Dutta

Consumption of herbal and dietary supplements (HDS) has increased worldwide as potential treatment for weight reduction and metabolic enhancement. However, it has been reported that HDS can cause liver injury which accounts for 20% of hepatotoxicity in the United States. Prevention of HDS induced liver injury remains a challenge due to difficulties in identifying the hepatotoxins in these preparations and lack of federal regulations for dietary supplements. We report a case of acute severe hepatic necrosis presumably due to consumption of nutritional supplement advertised to boost vitality and stem cells in human body.

草药和膳食补充剂(HDS)的消费在世界范围内增加,作为减肥和促进代谢的潜在治疗方法。然而,据报道,HDS可引起肝损伤,占美国肝毒性的20%。预防HDS引起的肝损伤仍然是一个挑战,因为很难识别这些制剂中的肝毒素,并且缺乏联邦法规对膳食补充剂。我们报告一例急性严重肝坏死,可能是由于消耗营养补充剂宣传,以促进活力和干细胞在人体。
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引用次数: 4
Gastrointestinal Lesions in African American Patients With Iron Deficiency Anemia. 非洲裔美国人缺铁性贫血患者的胃肠道病变。
Pub Date : 2018-05-18 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218778627
Hassan Brim, Anahita Shahnazi, Mehdi Nouraie, Dilhana Badurdeen, Adeyinka O Laiyemo, Tahmineh Haidary, Ali Afsari, Hassan Ashktorab

Background: Iron deficiency anemia (IDA) is a frequent disorder that is associated with many serious diseases. However, the findings of an evaluation of IDA-associated gastrointestinal disorders are lacking among African American patients.

Aim: To determine the most prevalent gastrointestinal lesions among African American patients with IDA especially in young men.

Methods: We reviewed medical records (n = 422) of patients referred for evaluation of IDA from 2008 to 2012. Iron deficiency anemia was diagnosed using clinical laboratory tests. The results of esophagogastroduodenoscopy, colonoscopy, and pathology specimens along with demographic data were abstracted and analyzed using Stata.

Results: The mean age was 61.9 years, and 50.5% were women. In total, 189 patients (45%) had gross gastrointestinal (GI) bleeding. The most frequent diagnoses were gastritis (40%), benign colonic lesions (13%), esophagitis (9%), gastric ulcer (6%), and duodenitis (6%). GI bleeding was significantly more frequent in men (P = 0.001). Benign and malignant colonic lesions were significantly more present among older patients: 16% vs 6% (P = .005) and 5% vs 0% (P = .008), respectively. Colitis was more prevalent in younger patients (⩽50): 11% vs 2% (P = .001). In patients with gross lower GI bleeding, the top diagnoses were gastritis (25%), benign colon tumors (10%), and duodenitis (6%). Colon cancer was diagnosed among 15 patients, and all these patients were older than 50 years of age.

Conclusions: Gastritis and colonic lesions are most common associated lesions with IDA among African Americans. So bidirectional endoscopy is required for unrevealing of the cause of IDA in asymptomatic patients.

背景:缺铁性贫血(IDA)是一种与许多严重疾病相关的常见病。然而,在非裔美国患者中缺乏ida相关胃肠道疾病的评估结果。目的:确定非裔美国人尤其是年轻男性IDA患者中最常见的胃肠道病变。方法:我们回顾了2008年至2012年转诊进行IDA评估的患者的病历(n = 422)。缺铁性贫血是通过临床实验室检查诊断的。将食管胃十二指肠镜、结肠镜检查结果、病理标本以及人口学资料进行提取,并使用Stata进行分析。结果:平均年龄61.9岁,女性占50.5%。总共有189名患者(45%)发生胃肠道出血。最常见的诊断是胃炎(40%)、良性结肠病变(13%)、食管炎(9%)、胃溃疡(6%)和十二指肠炎(6%)。胃肠道出血在男性中更为常见(P = 0.001)。良性和恶性结肠病变在老年患者中明显更多:分别为16%对6% (P = 0.005)和5%对0% (P = 0.008)。结肠炎在年轻患者中更为普遍(≥50):11% vs 2% (P = 0.001)。在下消化道出血患者中,诊断最多的是胃炎(25%)、良性结肠肿瘤(10%)和十二指肠炎(6%)。15例患者被诊断为结肠癌,这些患者的年龄都在50岁以上。结论:在非裔美国人中,胃炎和结肠病变是IDA最常见的相关病变。因此,对于无症状的IDA患者,需要双向内窥镜检查来发现病因。
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引用次数: 6
Orbital Inflammatory Complications of Crohn's Disease: A Rare Case Series. 克罗恩病的眼眶炎症并发症:罕见病例系列
Pub Date : 2018-02-20 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218757512
Tanya M Monaghan, Giorgio Albanese, Philip Kaye, James D Thomas, Lorraine C Abercrombie, Gordon W Moran

Orbital inflammatory disease is a rare ophthalmic manifestation of Crohn's disease. Inflammation is characteristically nonspecific, involving one or multiple structures of the orbit. Mechanisms of disease and optimal methods of treatment are poorly understood. The aim of this report is to present 3 cases of orbital involvement in Crohn's disease. A retrospective case note review of patients with orbital inflammatory disease and Crohn's disease was performed at our academic center to determine the clinical, imaging, and histopathologic features of this condition and its relationship to intestinal Crohn's disease. Three patients were identified with orbital inflammatory manifestations complicating Crohn's disease. All patients described were women with active intestinal disease and had a history of treatment with immunosuppressive therapies. Similarities were observed in clinical presentations with variance noted in radiologic and histopathologic findings. In all cases, symptoms improved with oral corticosteroids or nonsteroidal drugs in combination with anti-tumor necrosis factor agents. Inflammatory bowel disease-related orbital complications are rare but potentially vision-threatening. It is important to consider mimics of orbital inflammatory disease such as systemic inflammatory disease, malignancy, congenital malformations, infection, and trauma when formulating a comprehensive differential diagnosis. Therapeutic intervention is directed toward preservation of vision and orbital function and reducing the acute inflammatory process. Corticosteroids are typically the initial treatment of choice for moderate-to-severe disease, although several classes of immunomodulatory agents have been variably useful in treating this condition. Heightened awareness and close cooperation between gastroenterologists and ophthalmologists are mandatory.

眼窝炎是克罗恩病罕见的眼部表现。炎症的特征是非特异性的,可累及眼眶的一个或多个结构。疾病的机制和最佳治疗方法尚不清楚。本报告的目的是提出3例眼窝受累在克罗恩病。在我们的学术中心对眼眶炎症性疾病和克罗恩病患者进行回顾性病例回顾,以确定该疾病的临床、影像学和组织病理学特征及其与肠道克罗恩病的关系。3例患者被确定为眼窝炎症表现并发克罗恩病。所有描述的患者均为患有活动性肠道疾病的女性,并有免疫抑制治疗史。临床表现相似,但放射学和组织病理学表现不同。在所有病例中,口服皮质类固醇或非甾体类药物联合抗肿瘤坏死因子药物可改善症状。炎症性肠病相关的眼眶并发症是罕见的,但潜在的视力威胁。在制定全面的鉴别诊断时,重要的是要考虑眼眶炎性疾病的模拟物,如全身性炎性疾病、恶性肿瘤、先天性畸形、感染和创伤。治疗干预的目的是保护视力和眼眶功能,减少急性炎症过程。皮质类固醇通常是中重度疾病的首选初始治疗,尽管有几种类型的免疫调节剂对治疗这种疾病有不同的作用。胃肠病学家和眼科医生之间必须提高认识并密切合作。
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引用次数: 6
Saccharomyces boulardii CNCM I-745 Improves Intestinal Enzyme Function: A Trophic Effects Review. 博氏酵母菌CNCM I-745改善肠道酶功能:营养效应综述
Pub Date : 2018-02-09 eCollection Date: 2018-01-01 DOI: 10.1177/1179552217752679
Margret I Moré, Yvan Vandenplas

Several properties of the probiotic medicinal yeast Saccharomyces boulardii CNCM I-745 contribute to its efficacy to prevent or treat diarrhoea. Besides immunologic effects, pathogen-binding and anti-toxin effects, as well as positive effects on the microbiota, S boulardii CNCM I-745 also has pronounced effects on digestive enzymes of the brush border membrane, known as trophic effects. The latter are the focus of this review. Literature has been reviewed after searching Medline and PMC databases. All relevant non-clinical and clinical studies are summarized. S. boulardii CNCM I-745 synthesizes and secretes polyamines, which have a role in cell proliferation and differentiation. The administration of polyamines or S. boulardii CNCM I-745 enhances the expression of intestinal digestive enzymes as well as nutrient uptake transporters. The signalling mechanisms leading to enzyme activation are not fully understood. However, polyamines have direct nucleic acid-binding capacity with regulatory impact. S. boulardii CNCM I-745 induces signalling via the mitogen-activated protein kinase pathway. In addition, effects on the phosphatidylinositol-3 kinase (PI3K) pathway have been reported. As an additional direct effect, S. boulardii CNCM I-745 secretes certain enzymes, which enhance nutrient acquisition for the yeast and the host. The increased availability of digestive enzymes seems to be one of the mechanisms by which S. boulardii CNCM I-745 counteracts diarrhoea; however, also people with certain enzyme deficiencies may profit from its administration. More studies are needed to fully understand the mechanisms of trophic activation by the probiotic yeast.

益生菌药用酵母博氏酵母菌CNCM I-745的一些特性有助于其预防或治疗腹泻的功效。除了免疫作用、病原体结合和抗毒素作用以及对微生物群的积极作用外,博氏弧菌CNCM I-745还对刷缘膜消化酶具有显著的影响,称为营养效应。后者是本综述的重点。通过检索Medline和PMC数据库对文献进行了综述。总结了所有相关的非临床和临床研究。博氏弧菌CNCM I-745合成并分泌多胺,多胺在细胞增殖和分化中起作用。多胺或博氏弧菌CNCM I-745可增强肠道消化酶和营养摄取转运蛋白的表达。导致酶激活的信号机制尚不完全清楚。然而,多胺具有直接的核酸结合能力,具有调控作用。博氏弧菌CNCM I-745通过丝裂原激活蛋白激酶途径诱导信号传导。此外,对磷脂酰肌醇-3激酶(PI3K)途径的影响也有报道。作为一个额外的直接效应,博氏弧菌CNCM I-745分泌某些酶,促进酵母和宿主的营养获取。消化酶可用性的增加似乎是博氏沙门氏菌CNCM I-745对抗腹泻的机制之一;然而,某些酶缺乏的人也可能从服用中受益。需要更多的研究来充分了解益生菌酵母的营养激活机制。
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引用次数: 35
A Randomized Controlled Trial Comparing the Depth of Maximal Insertion Between Anterograde Single-Balloon Versus Spiral Enteroscopy. 一项随机对照试验比较了前行单球囊与螺旋肠镜的最大插入深度。
Pub Date : 2018-01-24 eCollection Date: 2018-01-01 DOI: 10.1177/1179552218754881
Robert A Moran, Sindhu Barola, Joanna K Law, Stuart K Amateau, Daniil Rolshud, Erin Corless, Vandhana Kiswani, Vikesh K Singh, Anthony N Kalloo, Mouen A Khashab, Anne Marie Lennon, Patrick I Okolo, Vivek Kumbhari

Background: Three device-assisted deep endoscopic platforms presently exist and are available for clinical use: double-balloon enteroscopy, single-balloon enteroscopy (SBE), and spiral enteroscopy (SE). In a retrospective study, SE was associated with a greater depth of maximal insertion (DMI) with similar diagnostic yields and procedure time as compared with SBE.

Aims: This was a prospective, randomized comparison of SE and SBE with respect to DMI, diagnostic yield, procedure time, and rate of adverse events.

Methods: Patients were prospectively randomized to undergo either anterograde SE or SBE. Patient demographics, indication for procedure, DMI, procedure time, therapeutic procedure time, adverse event, diagnostic findings, and therapeutic interventions were prospectively recorded. The primary outcome was DMI. Secondary outcomes included: procedure time; diagnostic yield; therapeutic yield and adverse event rates.

Results: During the study period, 30 patients underwent deep enteroscopy (SE 13, SBE 17). The most common indication was gastrointestinal bleeding in both groups. There was no significant difference in the DMI between SE and SBE (330.0 ± 88.2 cm vs 285.3 ± 80.8 cm, P = .16). There was no difference between SE and SBE in procedure time (37.0 ± 10.5 vs 38.3 ± 12.4, P = .76), diagnostic yield (SE = 9 [69%] vs SBE = 7 [41%], P = .16), or therapeutic yield (SE = 6 [46%] vs SBE = 4 [24%], P = .26). There were no major adverse events in either group.

Conclusions: Spiral enteroscopy and SBE are similar with respect to DMI, diagnostic yield, therapeutic yield, procedure time, and rate of adverse events. Small numbers prevent giving a definitive judgment and future adequately powered prospective study is required to confirm these findings.

背景:目前有三种设备辅助的深部内窥镜平台可供临床使用:双气囊肠镜、单气囊肠镜(SBE)和螺旋肠镜(SE)。目的:这是一项前瞻性随机比较 SE 和 SBE 在最大插入深度(DMI)、诊断率、手术时间和不良事件发生率方面的研究:对患者进行前瞻性随机分组,让他们接受顺行前列腺电切术或逆行前列腺电切术。前瞻性地记录了患者的人口统计学特征、手术指征、DMI、手术时间、治疗过程时间、不良事件、诊断结果和治疗干预。主要结果是 DMI。次要结果包括:手术时间、诊断率、治疗率和不良事件发生率:研究期间,30 名患者接受了深部肠镜检查(SE 13 例,SBE 17 例)。两组患者最常见的适应症都是消化道出血。SE 和 SBE 的 DMI 无明显差异(330.0 ± 88.2 厘米 vs 285.3 ± 80.8 厘米,P = .16)。SE 和 SBE 在手术时间(37.0 ± 10.5 vs 38.3 ± 12.4,P = .76)、诊断率(SE = 9 [69%] vs SBE = 7 [41%],P = .16)或治疗率(SE = 6 [46%] vs SBE = 4 [24%],P = .26)方面没有差异。两组患者均未发生重大不良事件:结论:螺旋肠镜和 SBE 在 DMI、诊断率、治疗率、手术时间和不良事件发生率方面相似。由于人数较少,无法做出明确的判断,因此需要在未来进行有充分支持的前瞻性研究来证实这些发现。
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引用次数: 0
The Morbidity and Mortality of Laparoscopic Appendectomy in Patients with Cirrhosis. 肝硬化患者腹腔镜阑尾切除术的发病率和死亡率。
Pub Date : 2018-01-01 DOI: 10.1177/1179552217746645
Yasir Al-Azzawi, Yasir Al-Abboodi, Matthew Fasullo, Tarek Najuib

Introduction: The perioperative mortality is significantly higher in patients with cirrhosis undergoing certain surgical procedures. In this study, we examined the inpatient perioperative mortality and morbidities in cirrhotic people who underwent laparoscopic appendectomy.

Methods: We performed a retrospective analysis using the National Inpatient Sample database for 2010. Inclusion criteria were all race and sex who are 18 years or older. Those who have laparoscopic appendectomy and have a history of liver cirrhosis were assigned to case group. An equal random number of appendectomy-related admissions and those who have no history of liver cirrhosis were selected and placed in the control group. A binary logistic regression statistical test was used to examine the odds ratio for the mortality difference and postoperative complication including pneumonia, urinary tract infection (UTI), surgical site infection, postoperative bleeding. IBM SPSS statistics was used to execute the analysis. A confidence interval of 95% and P value less than .05 were determined to define the statistical significance.

Result: A total of 754 appendectomy-related admissions were identified-376 appendectomy-related admissions and history of cirrhosis and 378 admissions with appendectomy and no history of cirrhosis. Control group was not found to be statistically different from the case group when it comes to age, race, and sex. Of 754, 520 were white (73.5%), 334 (44.3%) were men. The mean age was 43.75 years for the case group and 46.68 years for the control group. Comparing cirrhotic with noncirrhotic group, the mean length of stay was 1.1 vs 1.52 days, inpatient mortality was 2 (0.5%) vs 1 (0.3%) (P = .56), pneumonia 8 (2.1%) vs 3 (0.8%) (P = .142), surgical site infection 3 (0.8%) vs 2 (0.5%) (P = .652), UTI 18 (4.8%) vs 12 (3.2%) (P = .26), and postoperative bleeding 3 (0.8%) vs 2 (0.5%) (P = .65).

Conclusions: Appendectomy-related morbidity and mortality in cirrhotic patients are not different from noncirrhotic patients.

导读:肝硬化患者接受某些外科手术的围手术期死亡率明显较高。在这项研究中,我们调查了肝硬化患者行腹腔镜阑尾切除术的围手术期死亡率和发病率。方法:我们使用2010年全国住院患者样本数据库进行回顾性分析。纳入标准是所有年龄在18岁或以上的种族和性别。那些做过腹腔镜阑尾切除术并有肝硬化病史的人被分配到病例组。随机选择同等数量的阑尾切除术相关入院患者和无肝硬化病史的患者作为对照组。采用二元logistic回归统计检验检验两组死亡率差异及肺炎、尿路感染、手术部位感染、术后出血等术后并发症的比值比。采用IBM SPSS统计软件进行分析。以95%的置信区间和P值小于0.05来定义统计学显著性。结果:共有754例与阑尾切除术相关的住院患者,其中376例与阑尾切除术相关且有肝硬化史,378例有阑尾切除术且无肝硬化史。在年龄、种族和性别方面,对照组与病例组没有统计学差异。其中白人520人(73.5%),男性334人(44.3%)。病例组平均年龄43.75岁,对照组平均年龄46.68岁。肝硬化组与非肝硬化组比较,平均住院时间1.1天vs 1.52天,住院死亡率2 (0.5%)vs 1 (0.3%) (P = 0.56),肺炎8 (2.1%)vs 3 (0.8%) (P = 0.142),手术部位感染3 (0.8%)vs 2 (0.5%) (P = 0.652), UTI 18 (4.8%) vs 12 (3.2%) (P = 0.26),术后出血3 (0.8%)vs 2 (0.5%) (P = 0.65)。结论:肝硬化患者阑尾切除术相关的发病率和死亡率与非肝硬化患者没有差异。
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引用次数: 9
A Case of Gastric Ulcer With Mucosal Bridge. 胃溃疡伴粘膜桥1例。
Pub Date : 2017-12-20 eCollection Date: 2017-01-01 DOI: 10.1177/1179552217749206
Tomoyuki Kitagawa, Ryo Masaoka, Yasumi Katayama, Masaya Tamano

Endoscopic images of the mucosal bridge with gastric ulcer are unusual. The mucosal bridge is presumed to have changed to a special form based on repeated development of gastric ulcer. The clinical course of mucosal bridge is unclear.

胃溃疡粘膜桥的内镜图像是罕见的。假定粘膜桥因胃溃疡的反复发展而改变为一种特殊形式。粘膜桥的临床病程尚不清楚。
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引用次数: 1
Adaptive Returns of Deficient Systemic Plasma Immunoglobulin G Levels as Rehabilitation Biomarker After Emergency Colectomy for Fulminant Ulcerative Colitis. 全身血浆免疫球蛋白 G 水平不足的适应性回归,作为治疗暴发性溃疡性结肠炎的紧急结肠切除术后的康复生物标记物。
Pub Date : 2017-12-13 eCollection Date: 2017-01-01 DOI: 10.1177/1179552217746692
Alexander T Hawkins, Jun W Um, Amosy E M'Koma

Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for ulcerative colitis (UC). Emergency colectomies are performed for fulminant colitis (ie, toxic megacolon, profuse bleeding, perforation, or sepsis). The RPC and IPAA involve manipulation of the proximal ileum, which may influence the essential physiological function of gut-associated lymphoid tissues. Circulating plasma immunoglobulin G (p-IgG) deficiency is observed in patients with fulminant UC. In addition, increased levels have been reported in colonic tissues of active UC compared with quiescent disease. We aimed to examine levels of p-IgG for clinical evaluation following emergency colectomies in patients with fulminant UC compared with patients with quiescent disease having elective RPC operations. In total 45 patients received an ileoanal pouch (IAP) due to UC. In all, 27 patients were men and 18 were women. The mean age was 34 years (range: 18-55). Because of fulminant UC, 26 patients had emergency subtotal colectomies with terminal ileostomy (TI). During second operation, the rectum was excised, and an IAP with diverting loop ileostomy (DLI) was performed. Nineteen patients had elective operations and had colectomies performed in conjunction with the pouch operation. Mucosectomy was performed in all groups. As a last procedure, the DLI was closed. Blood samples for immunoglobulin G (IgG) analyses were collected from each patient before the colectomy, after the colectomy with TI (before construction of the pouch), during the period with pouches (prior to DLI closure), and at 1, 2, and 3 years and at mean 13.7 years (range: 10-20) after DLI closure. Immunoglobulin G was determined by immunonephelometric assay technique. The statistics were analyzed by analysis of variance and linear regression. Preoperatively, p-IgG was significantly lower in the patients who had emergency operations compared with the group that had elective operations, 9.9 ± 3.0 vs 11.5 ± 3.3 g/L (P < .03). During the manipulative period with TI and/or DLI, the p-IgG levels were increased in both points, but the increase was not statistically significant (P = .26 and P = .19). During functional IAP at 1, 2, and 3 years and at mean 13.7 years (range: 10-20), there was a statistical increase in p-IgG levels (P < .002, P < .005, P < .005, and P < .0001) compared with preoperative levels. These changes did not correlate with episodes of pouchitis (P = .51). In patients having elective operations, p-IgG did not change preoperatively. After 12 months with functional pouches, the p-IgG levels were similar in both groups to the elective patient group preoperatively. In conclusion, p-IgG was found to be significantly lower in the emergency surgery patients compared with the elective surgery group preoperatively. This difference was probably due to increased losses and impaired gut lymphoid tissue production

带回肠袋-肛门吻合术(IPAA)的恢复性直肠结肠切除术(RPC)是溃疡性结肠炎(UC)的标准外科治疗方法。急诊结肠切除术适用于暴发性结肠炎(即中毒性巨结肠、大量出血、穿孔或败血症)。RPC 和 IPAA 涉及回肠近端操作,可能会影响肠道相关淋巴组织的基本生理功能。在暴发性 UC 患者中可观察到循环血浆免疫球蛋白 G(p-IgG)缺乏。此外,有报道称活动性 UC 结肠组织中的 p-IgG 水平高于静止期疾病。我们的目的是在急诊结肠切除术后检测 p-IgG 的水平,以便对暴发性 UC 患者与接受选择性 RPC 手术的静止期患者进行临床评估。共有 45 名 UC 患者接受了回肠肛门袋 (IAP)。其中男性 27 人,女性 18 人。平均年龄为 34 岁(18-55 岁不等)。由于暴发性尿路结石,26 名患者接受了紧急结肠次全切除术,并进行了末端回肠造口术(TI)。在第二次手术中,切除了直肠,并进行了 IAP 和憩室回肠造口术(DLI)。19名患者接受了选择性手术,在进行肠袋手术的同时还进行了结肠切除术。所有组别都进行了黏膜切除术。作为最后一项手术,DLI 被关闭。在结肠切除术前、结肠切除术和 TI 术后(建立肠袋前)、建立肠袋期间(DLI 关闭前)、DLI 关闭后 1 年、2 年、3 年和平均 13.7 年(10-20 年),采集了每位患者的血液样本,用于免疫球蛋白 G (IgG) 分析。免疫球蛋白 G 通过免疫浊度测定技术进行测定。统计分析采用方差分析和线性回归法。术前,急诊手术患者的 p-IgG 明显低于择期手术组(9.9 ± 3.0 vs 11.5 ± 3.3 g/L)(P = .26 和 P = .19)。在 1 年、2 年、3 年和平均 13.7 年(范围:10-20)的功能性 IAP 期间,p-IgG 水平呈统计学增长(P P P P P = .51)。在接受择期手术的患者中,p-IgG 在术前没有变化。使用功能袋 12 个月后,两组患者的 p-IgG 水平与择期手术患者组术前相似。总之,与择期手术组相比,急诊手术患者术前的 p-IgG 水平明显较低。这种差异可能是由于在 UC 急性暴发期,肠道淋巴组织产生的 IgG 损失增加和受损所致。DLI封闭12个月后,急诊手术组和择期手术组之间不再存在显著差异。RPC 术后 p-IgG 水平的恢复和升高可能是为了弥补切除术前的较低值而产生的夸大反应,可被解释为一种康复生物标志物。
{"title":"Adaptive Returns of Deficient Systemic Plasma Immunoglobulin G Levels as Rehabilitation Biomarker After Emergency Colectomy for Fulminant Ulcerative Colitis.","authors":"Alexander T Hawkins, Jun W Um, Amosy E M'Koma","doi":"10.1177/1179552217746692","DOIUrl":"10.1177/1179552217746692","url":null,"abstract":"<p><p>Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for ulcerative colitis (UC). Emergency colectomies are performed for fulminant colitis (ie, toxic megacolon, profuse bleeding, perforation, or sepsis). The RPC and IPAA involve manipulation of the proximal ileum, which may influence the essential physiological function of gut-associated lymphoid tissues. Circulating plasma immunoglobulin G (p-IgG) deficiency is observed in patients with fulminant UC. In addition, increased levels have been reported in colonic tissues of active UC compared with quiescent disease. We aimed to examine levels of p-IgG for clinical evaluation following emergency colectomies in patients with fulminant UC compared with patients with quiescent disease having elective RPC operations. In total 45 patients received an ileoanal pouch (IAP) due to UC. In all, 27 patients were men and 18 were women. The mean age was 34 years (range: 18-55). Because of fulminant UC, 26 patients had emergency subtotal colectomies with terminal ileostomy (TI). During second operation, the rectum was excised, and an IAP with diverting loop ileostomy (DLI) was performed. Nineteen patients had elective operations and had colectomies performed in conjunction with the pouch operation. Mucosectomy was performed in all groups. As a last procedure, the DLI was closed. Blood samples for immunoglobulin G (IgG) analyses were collected from each patient before the colectomy, after the colectomy with TI (before construction of the pouch), during the period with pouches (prior to DLI closure), and at 1, 2, and 3 years and at mean 13.7 years (range: 10-20) after DLI closure. Immunoglobulin G was determined by immunonephelometric assay technique. The statistics were analyzed by analysis of variance and linear regression. Preoperatively, p-IgG was significantly lower in the patients who had emergency operations compared with the group that had elective operations, 9.9 ± 3.0 vs 11.5 ± 3.3 g/L (<i>P</i> < .03). During the manipulative period with TI and/or DLI, the p-IgG levels were increased in both points, but the increase was not statistically significant (<i>P</i> = .26 and <i>P</i> = .19). During functional IAP at 1, 2, and 3 years and at mean 13.7 years (range: 10-20), there was a statistical increase in p-IgG levels (<i>P</i> < .002, <i>P</i> < .005, <i>P</i> < .005, and <i>P</i> < .0001) compared with preoperative levels. These changes did not correlate with episodes of pouchitis (<i>P</i> = .51). In patients having elective operations, p-IgG did not change preoperatively. After 12 months with functional pouches, the p-IgG levels were similar in both groups to the elective patient group preoperatively. In conclusion, p-IgG was found to be significantly lower in the emergency surgery patients compared with the elective surgery group preoperatively. This difference was probably due to increased losses and impaired gut lymphoid tissue production ","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":"10 ","pages":"1179552217746692"},"PeriodicalIF":0.0,"publicationDate":"2017-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/bb/10.1177_1179552217746692.PMC5734426.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35687082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage? 所有疑似结肠憩室出血的患者都应进行急诊内镜检查吗?
Pub Date : 2017-09-06 eCollection Date: 2017-01-01 DOI: 10.1177/1179552217728906
Takeshi Uehara, Satohiro Matsumoto, Hiroyuki Miyatani, Hirosato Mashima

Objective: We attempted to develop a scoring system for facilitating decision making regarding the performance of emergency endoscopy in patients with colonic diverticular hemorrhage.

Methods: This study involved analysis of the data of 178 patients who presented with hematochezia and were diagnosed as having colonic diverticular hemorrhage by colonoscopy. The patients were divided into 2 groups depending on whether the bleeding source was identified or not at the initial endoscopy (source-identified and source-not-identified groups), and on the basis of the results obtained, we established a scoring system for predicting successful identification of the bleeding source.

Results: The percentages of patients on oral anticoagulant therapy or with a Charlson comorbidity index of ≥6, serum C-reactive protein level of ≥1 mg/dL, or extravasation of contrast medium visualized on contrast-enhanced computed tomographic (CT) images were all significantly higher in the identified than in the nonidentified group. Multivariate analysis identified extravasation of contrast medium on contrast-enhanced CT images (odds ratio [OR]: 10.6; 95% confidence interval [CI]: 2.7-42.2) and use of anticoagulants (OR: 4.5; 95% CI: 1.5-13.5) as independent predictors of successful identification of the bleeding source at the initial endoscopy in patients with colonic diverticular hemorrhage. On the basis of these results, we established a scoring system, which showed a sensitivity of 80% and specificity of 81% for successful identification of the bleeding source at the initial endoscopy.

Conclusions: Herein, we propose a scoring system as a useful tool for determining whether emergency endoscopy is indicated in individual patients with suspected colonic diverticular hemorrhage.

目的:我们试图建立一个评分系统,以促进对结肠憩室出血患者进行急诊内窥镜检查的决策。方法:本研究分析了178例经结肠镜检查诊断为结肠憩室出血的便血患者的资料。根据初次内镜检查时是否识别出出血源,将患者分为两组(识别出出血源组和未识别出出血源组),并根据所获得的结果建立预测出血源成功识别的评分系统。结果:确诊组接受口服抗凝治疗或Charlson合并症指数≥6、血清c反应蛋白水平≥1mg /dL、CT增强显像显示造影剂外渗的患者比例均显著高于未确诊组。多因素分析在增强CT图像上发现造影剂外渗(优势比[OR]: 10.6;95%可信区间[CI]: 2.7-42.2)和抗凝剂的使用(OR: 4.5;95% CI: 1.5-13.5)作为结肠憩室出血患者初次内镜检查成功识别出血源的独立预测因素。在此基础上,我们建立了一个评分系统,该评分系统在初次内镜检查时成功识别出血源的敏感性为80%,特异性为81%。结论:在此,我们提出一个评分系统作为一个有用的工具来确定是否需要急诊内窥镜检查个别疑似结肠憩室出血的患者。
{"title":"Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage?","authors":"Takeshi Uehara,&nbsp;Satohiro Matsumoto,&nbsp;Hiroyuki Miyatani,&nbsp;Hirosato Mashima","doi":"10.1177/1179552217728906","DOIUrl":"https://doi.org/10.1177/1179552217728906","url":null,"abstract":"<p><strong>Objective: </strong>We attempted to develop a scoring system for facilitating decision making regarding the performance of emergency endoscopy in patients with colonic diverticular hemorrhage.</p><p><strong>Methods: </strong>This study involved analysis of the data of 178 patients who presented with hematochezia and were diagnosed as having colonic diverticular hemorrhage by colonoscopy. The patients were divided into 2 groups depending on whether the bleeding source was identified or not at the initial endoscopy (source-identified and source-not-identified groups), and on the basis of the results obtained, we established a scoring system for predicting successful identification of the bleeding source.</p><p><strong>Results: </strong>The percentages of patients on oral anticoagulant therapy or with a Charlson comorbidity index of ≥6, serum C-reactive protein level of ≥1 mg/dL, or extravasation of contrast medium visualized on contrast-enhanced computed tomographic (CT) images were all significantly higher in the identified than in the nonidentified group. Multivariate analysis identified extravasation of contrast medium on contrast-enhanced CT images (odds ratio [OR]: 10.6; 95% confidence interval [CI]: 2.7-42.2) and use of anticoagulants (OR: 4.5; 95% CI: 1.5-13.5) as independent predictors of successful identification of the bleeding source at the initial endoscopy in patients with colonic diverticular hemorrhage. On the basis of these results, we established a scoring system, which showed a sensitivity of 80% and specificity of 81% for successful identification of the bleeding source at the initial endoscopy.</p><p><strong>Conclusions: </strong>Herein, we propose a scoring system as a useful tool for determining whether emergency endoscopy is indicated in individual patients with suspected colonic diverticular hemorrhage.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":"10 ","pages":"1179552217728906"},"PeriodicalIF":0.0,"publicationDate":"2017-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552217728906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35355953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
期刊
Clinical Medicine Insights. Gastroenterology
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