Clinical Medicine Insights. Gastroenterology最新文献

英文中文

Diagnostic Performance of Ultrafast 3-Dimensional Ultrasound on the Small Bowel: Single Center Experience 超快三维超声对小肠的诊断性能:单中心体验

Clinical Medicine Insights. Gastroenterology

Pub Date : 2011-01-01 DOI: 10.4137/CGast.S8143

S. Elwagdy, M. Ramadan, M. Farag, M. Farag, S. Eladawy, Hosni A-Karim, Gamal M M Soliman, Ali Ibrahim, S. Salah, Abdel Hamid Elgargani

Background Increased speed and resolution of ultrasound have made it a first-line modality for the abdominal examination. During the last 5 years trans-abdominal ultrasonography has been used increasingly, for assessment of patients with small bowel (SB) diseases. Around 350 such examinations are performed annually in the diagnostic imaging department at Azhar University Hospital. Hence, the aim is to determine if the ultrafast three-dimensional ultrasound (U3D US) is potent for optimal examination of SB diseases. Patients and Methods Tap-water intake has been used to distend the SB. All patients have been examined in supine position. The U3D US data of 198 patients with SB diseases were assessed. The proximal and distal SB image quality along with the evaluation of bowel distention, motility and lesions were reported. Results Image quality was good in all examinations. Adequate demonstration of the proximal and distal SB was obtained in all of U3D US examinations. The inclusive diagnostic accuracy of U3D US was precise in 92.3%. Proximal SB was, however, less frequently involved, particularly in patients below the age of 30 years (P = 0.050). Conclusion The diagnostic accuracy of U3D US enterography is valuable for detecting SB lesions. This modality is widely available, inexpensive and easy technique, can be used as an initial investigation in the evaluation of patients with SB disorders.

超声的速度和分辨率的提高使其成为腹部检查的一线方式。在过去的5年里，经腹超声检查越来越多地用于小肠疾病患者的评估。爱资哈尔大学医院影像诊断科每年进行约350次此类检查。因此，目的是确定是否超快速三维超声(U3D US)是有效的最佳检查SB疾病。患者和方法:采用自来水吸入扩大脑脊液。所有患者均采用仰卧位检查。对198例SB病患者的U3D US数据进行了评估。报告了近端和远端SB图像质量以及肠膨胀，运动和病变的评估。结果各项检查图像质量良好。在所有U3D超声检查中均获得了近端和远端SB的充分显示。U3D超声的诊断准确率为92.3%。然而，近端SB的发生频率较低，特别是在30岁以下的患者中(P = 0.050)。结论U3D超声小肠造影对SB病变的诊断具有较高的准确性。该方法应用广泛，价格低廉，技术简便，可作为评价SB疾病患者的初步调查方法。

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引用次数: 1

Azathioprine and Infliximab: Monotherapy or Combination Therapy in the Treatment of Crohn's Disease 硫唑嘌呤和英夫利昔单抗:单药或联合治疗克罗恩病

Clinical Medicine Insights. Gastroenterology

Pub Date : 2011-01-01 DOI: 10.4137/CGast.S5256

B. Love, Lisa S. Smith, S. Sarbah, F. Fowler

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract often resulting in complications resulting in decreased quality of life. Several classes of medications are available to clinicians including mesalamine, budesonide, systemic corticosteroids, thiopurine derivatives, and monoclonal antibodies which target tumor necrosis factor (TNF). Guidelines generally recommend reserving TNF-antagonists for patients who have failed other first-line therapies; however, emerging data suggests there may be some benefit in combining TNF-antagonists, specifically infliximab, with azathioprine. The purpose of this review is to compare the benefits and risks of combination therapy, and identify patients who may benefit most from this approach.

克罗恩病是一种慢性胃肠道炎症性疾病，常导致并发症，导致生活质量下降。临床医生可使用的几种药物包括美沙拉明、布地奈德、全身皮质类固醇、硫嘌呤衍生物和靶向肿瘤坏死因子(TNF)的单克隆抗体。指南一般建议对其他一线治疗失败的患者保留tnf拮抗剂;然而，新出现的数据表明，tnf拮抗剂(特别是英夫利昔单抗)与硫唑嘌呤联合使用可能会有一些益处。本综述的目的是比较联合治疗的益处和风险，并确定可能从这种方法中获益最多的患者。

引用次数: 1

Three Patients with Viral Breakthrough during Pegylated Interferon Alpha-2b and Ribavirin Therapy: A Case Series 聚乙二醇化干扰素α -2b和利巴韦林治疗期间病毒突破的3例患者:病例系列

Clinical Medicine Insights. Gastroenterology

Pub Date : 2011-01-01 DOI: 10.4137/CGast.S6264

Daigo Kon, T. Goto, Kouichi Miura, Shigetoshi Ohshima, T. Shibuya, E. Kataoka, Wataru Sato, Takahiro Dohmen, Yumiko Anezaki, H. Ishii, Ikuhiro Yamada, Kentaro Kamada, H. Ohnishi

Introduction A viral breakthrough occurs when a patient achieves a response while on interferon (IFN) therapy and then loses the response despite continued IFN therapy. The cause of viral breakthroughs is not well understood. We encountered three cases with viral breakthrough during treatment with pegylated interferon (PEG-IFN) and ribavirin (RBV). Case presentation The three cases were all late virological responders. They did not express anti-IFN alpha-2b antibodies after PEG-IFN and RBV therapy. We analyzed amino acid substitutions of core 70, core 91, and interferon sensitivity-determining region (ISDR), which significantly influence sustained virological response (SVR). Their amino acid substitutions of core 91 were mutant in two cases. Amino acid substitutions of ISDR were wild pattern in two cases. PEG-IFN adherence was above 80% in three cases, and RBV adherence was below 80% in two cases. Conclusion During PEG-IFN and RBV therapy, we should watch for viral breakthrough in late virological responders with mutant type of amino acid substitutions of core 91, wild pattern of amino acid substitution of ISDR, and decrease of RBV adherence. Viral breakthrough is an important problem in PEG-IFN and RBV therapy for chronic hepatitis C. Therefore, it should be investigated more thoroughly in more cases.

当患者在接受干扰素(IFN)治疗时达到应答，然后在继续干扰素治疗后失去应答时，就会发生病毒突破。病毒突破的原因尚不清楚。我们在使用聚乙二醇化干扰素(PEG-IFN)和利巴韦林(RBV)治疗期间遇到了3例病毒突破。3例均为晚期病毒学应答者。在PEG-IFN和RBV治疗后，他们没有表达抗ifn α -2b抗体。我们分析了core70、core91和干扰素敏感性决定区(ISDR)的氨基酸取代，它们显著影响持续病毒学反应(SVR)。其中2例91号核的氨基酸置换发生突变。2例ISDR的氨基酸置换为野生模式。3例PEG-IFN依存度在80%以上，2例RBV依存度在80%以下。结论在PEG-IFN和RBV治疗过程中，应注意病毒在核心91突变型氨基酸取代、ISDR野生型氨基酸取代和RBV依从性降低的晚期病毒学应答中是否出现病毒突破。病毒突破是PEG-IFN和RBV治疗慢性丙型肝炎的重要问题，需要在更多病例中进行更深入的研究。

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引用次数: 1

Endoscopic Sclerotherapy for Bleeding Oesophageal Varices: Experience in Gezira State, Sudan 内镜硬化疗法治疗食管静脉曲张出血:苏丹Gezira州的经验

Clinical Medicine Insights. Gastroenterology

Pub Date : 2011-01-01 DOI: 10.4137/CGast.S7146

M. Mohammed

Introduction Bleeding due to oesophageal varices is the most common cause of upper gastrointestinal tract haemorrhage in Gezira State, Central Sudan. Endoscopic injection sclerotherapy (EST) is a valuable therapeutic modality for the management of variceal bleeding. Other options for treatment such as variceal band ligation are either expensive or unavailable. Objectives A retrospective study to evaluate the outcome of (EST) in the management of bleeding oesophageal varices due to portal hypertension in Gezira State, the centre of a developing country, Sudan. Methods A total of 1073 patients, during 2001-2010, were carefully selected particularly those with bleeding oesophageal varices consequent to portal hypertension. EST was performed using a standard technique and ethanolamine oleate (5%) was utilized as sclerosing agent. Results There were 777 males (72.4%) and 296 females (27.6%) in a ratio of 2.6. The causes of portal hypertension were found to be schistosomal periportal fibrosis (PPF) in 1001 (93.3%) patients, liver cirrhosis in 60 (5.5%) mixed PPF and cirrhosis in seven (0.7%) and portal vein thrombosis in five (0.5%) patients. Full obliteration of varices required a mean of four sessions with a range of 2-6. In the present study 350 (32.6%) patients have been followed up until complete sclerosis of varices. Conclusion This study provides evidence that endoscopic injection sclerotherapy is an important component in the management of bleeding oesophageal varices caused by hypertension. It is a safe and effective procedure.

在苏丹中部Gezira州，食管静脉曲张引起的出血是上消化道出血最常见的原因。内镜注射硬化疗法(EST)是治疗静脉曲张出血的一种有价值的治疗方式。其他治疗方法，如静脉曲张绑扎，要么价格昂贵，要么无法获得。目的回顾性研究评价(EST)在发展中国家苏丹Gezira州治疗门静脉高压引起的食管静脉曲张出血的疗效。方法对2001 ~ 2010年收治的食道静脉曲张出血患者1073例进行回顾性分析。EST采用标准技术，以5%的油酸乙醇胺为硬化剂。结果男性777例(72.4%)，女性296例(27.6%)，男女比例为2.6。门静脉高压症的病因为血吸虫门脉周围纤维化(PPF) 1001例(93.3%)，肝硬化60例(5.5%)，PPF合并肝硬化7例(0.7%)，门静脉血栓形成5例(0.5%)。完全消除变幅平均需要四次疗程，范围为2-6。在本研究中，350例(32.6%)患者随访至静脉曲张完全硬化。结论内镜下注射硬化疗法是治疗高血压性食管静脉曲张出血的重要手段。这是一种安全有效的方法。

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引用次数: 4

Once-Daily MMX Mesalamine in the Management of Ulcerative colitis 每日一次MMX美沙拉明治疗溃疡性结肠炎

Clinical Medicine Insights. Gastroenterology

Pub Date : 2011-01-01 DOI: 10.4137/CGast.S4276

W. Blonski, A. Buchner, G. Lichtenstein

Mesalamine (5-ASA) has been the mainstay therapy of mild to moderate active ulcerative colitis both as an induction and maintenance treatment. Multimatrix system (MMX) 5-ASA is a recently developed formulation of 5-ASA allowing for slow and gradual release of 5-ASA throughout the entire colon. This review article discusses the structure, pharmacokinetics, efficacy and safety of this new 5-ASA formulation.

美沙拉明(5-ASA)作为诱导和维持治疗已成为轻中度活动性溃疡性结肠炎的主要治疗方法。多基质系统(MMX) 5-ASA是最近开发的5-ASA配方，允许5-ASA在整个结肠缓慢和逐渐释放。本文综述了5-ASA新制剂的结构、药动学、疗效和安全性。

引用次数: 2

Microscopic colitis and Medication Use. 显微镜下结肠炎和药物使用。

Clinical Medicine Insights. Gastroenterology

Pub Date : 2010-05-18 DOI: 10.4137/cgast.s4469

Monina F Pascua, Prashant Kedia, Mark G Weiner, John Holmes, Jonas Ellenberg, James D Lewis

BACKGROUND: The incidence of microscopic colitis (MC) is increasing, but its etiology remains unknown. Case reports and limited controlled data suggest that commonly prescribed drugs may be triggers. The aim of this study was to evaluate the prevalence of selected medication use [Proton pump inhibitors (PPIs), HMG-CoA reductase inhibitors (statins), and Selective serotonin reuptake inhibitors (SSRIs)] in patients with MC compared to 'random controls' and 'diarrhea controls.' METHODS: All patients were selected from primary care practices of a university health system during 2002 to 2007. Patients with biopsy proven lymphocytic or collagenous colitis were identified as cases. Diarrhea controls consisted of a 10:1 random sample of patients with chronic diarrhea and normal colon biopsies. Ten random controls were matched to each case on sex and index date (date of biopsy proven diagnosis). Drugs prescribed within the year prior to the index date were collected from the electronic medical record system. RESULTS: 26 cases (median age 68.9 yrs), 259 random, and 259 diarrhea controls were identified. The adjusted ORs for PPI, SSRI, and statin prescription within 12 months of diagnosis of MC between cases and diarrhea controls were 0.28 (0.07-1.07), 0.87 (0.28-2.64), 1.12 (0.34-3.71) respectively. Use of PPI and statins was less common in MC patients than in random controls (p<0.05 for both comparisons). CONCLUSIONS: While prior data suggest that PPIs, statins, and SSRIs may be etiologically related to MC, our study found no increased association with these drugs.

背景:显微镜下结肠炎(MC)的发病率正在上升，但其病因尚不清楚。病例报告和有限的对照数据表明，常用处方药可能是诱发因素。本研究的目的是评估与“随机对照”和“腹泻对照”相比，MC患者中选择药物使用[质子泵抑制剂(PPIs)， HMG-CoA还原酶抑制剂(他汀类药物)和选择性5 -羟色胺再摄取抑制剂(SSRIs)]的患病率。方法:所有患者均选自2002 - 2007年一所大学卫生系统的初级保健实践。活检证实为淋巴细胞性或胶原性结肠炎的患者被确定为病例。腹泻对照组由10:1随机抽样的慢性腹泻患者和正常结肠活检患者组成。每个病例按性别和索引日期(活检证实诊断的日期)匹配10个随机对照。从电子病历系统中收集索引日期前一年内的处方药物。结果:确定了26例(中位年龄68.9岁)，259例随机对照和259例腹泻对照。病例与腹泻对照组诊断为MC的12个月内PPI、SSRI和他汀类药物处方调整后的or分别为0.28(0.07-1.07)、0.87(0.28-2.64)、1.12(0.34-3.71)。与随机对照相比，MC患者使用PPI和他汀类药物的情况较少

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引用次数: 53

Constipation, IBs and the 5-HT4 Receptor: What Role for Prucalopride? 便秘、肠易激和5-HT4受体:普芦卡必利的作用是什么?

Clinical Medicine Insights. Gastroenterology

Pub Date : 2010-01-01 DOI: 10.4137/CGast.S4136

G. Sanger, E. Quigley

After the problems associated with the non-selective 5-HT4 receptor agonists cisapride and tegaserod, the 5-HT4 receptor is now beginning to come in from the cold. Thus, prucalopride is now the first of a new class of drug defined by selectivity and high intrinsic activity at the 5-HT4 receptor. Prucalopride has been developed for treatment of chronic constipation rather than constipation-predominant irritable bowel syndrome (IBS). This follows the trend of first evaluating new gastrointestinal (GI) prokinetic drugs in disorders where disrupted GI motility is known to exist, rather than in a functional bowel disorder where changes in motility are uncertain. If prucalopride is not progressed towards the IBS indication, it has at least shown the way for other selective 5-HT4 receptor agonists. Most notable among these is TD-5108 (velusetrag), also characterized by good selectivity at the 5-HT4 receptor, high intrinsic activity and efficacy in patients with chronic constipation.

在与非选择性5-HT4受体激动剂西沙必利和泰加塞罗德相关的问题之后，5-HT4受体现在开始从寒冷中进来。因此，普芦卡必利是目前第一类以选择性和5-HT4受体的高内在活性为特征的新型药物。普芦卡必利已被开发用于治疗慢性便秘，而不是便秘为主的肠易激综合征(IBS)。这遵循了一种趋势，即首先在已知存在胃肠道运动紊乱的疾病中评估新的胃肠道(GI)促运动药物，而不是在运动变化不确定的功能性肠病中评估新的胃肠道(GI)促运动药物。如果普卡必利没有朝着IBS适应症发展，它至少已经为其他选择性5-HT4受体激动剂指明了道路。其中最值得注意的是TD-5108 (velusetrag)，也具有对5-HT4受体的良好选择性，对慢性便秘患者具有高的内在活性和疗效。

引用次数: 13

Hepatitis B screening compliance and non-compliance among Chinese, Koreans, Vietnamese and Cambodians 中国人、韩国人、越南人和柬埔寨人的乙肝筛查依从性和不依从性

Clinical Medicine Insights. Gastroenterology

Pub Date : 2010-01-01 DOI: 10.4137/CGast.S3732

G. Ma, Yin Tan, M. Wang, Ying Yuan, Wang G. Chae

Objective The purpose of this community-based study was to determine factors associated with hepatitis B virus (HBV) screening compliance and non-compliance among Chinese, Korean, Vietnamese and Cambodian adults with varying levels of English language proficiency. Methods A cross-sectional design was used consisting of a sample of 1,603 Asian adult men and women. Results Overall, 71.4% of the sample reported having never been screened and 28.6% reported being screened for HBV Demographic, acculturation, and barrier factors were differentially associated with screening rates among the subgroups. Demographic factors associated with never-screened were: lower education, younger age, being male, and no insurance for Chinese; lower education, lower income and no insurance for Cambodians; younger age and unmarried for Koreans; and no health insurance for Vietnamese; Acculturation factors associated with never-screened were: not speaking English for Chinese; not speaking English, not reading newspapers in English, and watching TV in one's native language for Cambodians; not speaking English for Koreans; while no significant factors were found for Vietnamese. All barriers were associated with never-screened for Cambodians and Chinese. Those who lacked knowledge about HBV and had language and transportation barrier were more likely to be never-screened for Koreans. There were no significant relationships between the barriers and the screening status for Vietnamese. Conclusions High incidence of HBV and liver cancer in Asian Americans mandates a more vigorous and more culturally and linguistically appropriate educational effort to increase screening and vaccination for HBV in these underserved and mostly uninsured populations.

目的:本以社区为基础的研究旨在确定不同英语水平的中国、韩国、越南和柬埔寨成年人乙型肝炎病毒(HBV)筛查依从性和不依从性的相关因素。方法采用横断面设计，包括1603名亚洲成年男性和女性。总体而言，71.4%的样本报告从未接受过筛查，28.6%的样本报告接受过HBV人口统计学、文化适应和屏障因素的筛查，这些因素与亚组之间的筛查率存在差异。与未筛查相关的人口统计学因素有:受教育程度低、年龄小、为男性、无保险;柬埔寨人受教育程度低，收入低，没有保险;韩国人年龄较小，未婚;越南人没有医疗保险;与未筛查相关的文化适应因素有:不讲英语;不讲英语，不读英语报纸，不用柬埔寨人的母语看电视;不为韩国人讲英语;而在越南人身上没有发现显著的影响因素。所有障碍都与柬埔寨人和中国人从未接受过筛查有关。对HBV缺乏了解、语言和交通有障碍的人更有可能从未接受过筛查。障碍与筛查状况之间无显著关系。结论:亚裔美国人HBV和肝癌的高发病率要求在这些服务不足和大多数没有保险的人群中进行更积极和更文化和语言上适当的教育工作，以增加HBV筛查和疫苗接种。

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引用次数: 15

Endoscopic Needle Knife Precut Papillotomy for Inaccessible Bile Duct following Failed Pancreatic Duct Access 内镜下针刀预切乳头状切开术治疗胰管进入失败后无法进入的胆管

Clinical Medicine Insights. Gastroenterology

Pub Date : 2009-01-01 DOI: 10.4137/CGast.S1120

H. Miyatani, Y. Yoshida

Aims To evaluate the safety, effectiveness, success rate and complications of needle knife precut papillotomy for inaccessible bile duct after failed pancreatic ducts access. Methods Selective common bile duct cannulation was required for 582 patients from November 2004 to May 2008. Precut sphincterotomy was performed in 28 patients (16 male, 12 female; mean age 71). When standard bile duct cannulation was unsuccessful after more than 20 minutes, the bile duct was considered inaccessible. Group A consisted of patients where pancreatic duct access was possible and transpancreatic papillary septotomy was performed (20 patients). If pancreatic duct cannulation also failed, needle knife precut method was performed and these patients belonged to group B (8 patients). The success and complication rates of the two groups were compared using the Chi-square test. Results The success rates were 85% and 87.5% respectively. Of the 28 patients in group A, 6 had mild to moderate pancreatitis and one patient had mild bleeding. The complication rates were 35% and 0% respectively and the differences were not significant. Conclusion Needle knife precut papillotomy is useful and acceptable in patients after failed pancreatic duct access.

目的评价针刀预切乳头状切开术治疗胰管通路失败后无法连通胆管的安全性、有效性、成功率及并发症。方法2004年11月至2008年5月对582例患者行选择性胆总管插管。28例患者行预切括约肌切开术，其中男16例，女12例;平均年龄71岁)。当标准胆管插管超过20分钟仍未成功时，认为胆管不可达。A组为可进入胰管并行经胰腺乳头状中隔切开术的患者(20例)。若胰管插管也失败，则采用针刀预切法，这些患者属于B组(8例)。采用卡方检验比较两组患者的成功率和并发症发生率。结果手术成功率分别为85%和87.5%。A组28例患者中，轻至中度胰腺炎6例，轻度出血1例。并发症发生率分别为35%和0%，差异无统计学意义。结论针刀预切乳头切开术对胰管进入失败的患者是有效且可接受的。

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引用次数: 4

Fulminant Hepatic Failure Caused by Diffuse Liver Metastases following Gastrointestinal Stromal Tumor Resection 胃肠道间质瘤切除术后弥漫性肝转移引起暴发性肝衰竭

Clinical Medicine Insights. Gastroenterology

Pub Date : 2009-01-01 DOI: 10.4137/CGast.S3221

A. Zeina, A. Nachtigal, E. Vlodavsky, J. Naschitz

Metastatic tumors to the liver resulting in fulminant hepatic failure are a rare occurrence and have not been previously described in patients with gastrointestinal stromal tumor (GIST). A 70 year-old man was referred to hospital with postprandial discomfort. On examination a 19.5 cm large epithelioid GIST of the stomach was diagnosed. The mass exhibited unfavorable prognostic features: mitotic index 18/50 high-power fields, large primary tumor size and male sex. Complete tumor resection with negative margins was achieved and metastases were not detected. The patient presented six months later with jaundice, asterixis and elevated liver enzymes. Computerized tomography showed multiple liver hypodense lesions representing metastases. Treatment with imatinib mesylate was of no avail and the patient died 3 days later as the result of hepatic failure. Massive liver metastases can, even though rarely, be responsible for fulminant hepatic failure. Clinical and radiological follow-up are crucial in patients with GIST even after surgical resection.

肝脏转移性肿瘤导致暴发性肝功能衰竭是一种罕见的现象，并且以前没有在胃肠道间质瘤(GIST)患者中描述过。一名70岁男子因餐后不适被转诊至医院。经检查诊断为19.5 cm大的胃上皮样间质瘤。肿块表现出预后不良的特点:有丝分裂指数18/50，高倍视野，原发肿瘤大，性别为男性。肿瘤完全切除，边缘呈阴性，未发现转移。患者6个月后出现黄疸、星形肿和肝酶升高。电脑断层显示肝脏多发低密度病灶，代表转移。甲磺酸伊马替尼治疗无效，患者3天后因肝功能衰竭死亡。大量的肝转移可以，即使很少，负责暴发性肝衰竭。临床和放射学随访是至关重要的胃肠道间质瘤患者，即使在手术切除。

引用次数: 0

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