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A Novel Method to Localize Patency Capsule by Ileocolonoscopy Facilitates Endoscopic Assessment of the Small and Large Intestine in Patients with Crohn's Disease. 通过回肠结肠镜定位通畅囊的新方法有助于对克罗恩病患者的小肠和大肠进行内镜评估。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-06-10 DOI: 10.1159/000539682
Akira Sonoda, Kazuhiro Mizukami, Soh Okano, Takanori Nishiguchi, Dai Yamazaki, Yoshimasa Horie, Tsubasa Tateishi, Yuichi Saito, Yuki Hirose, Hirohito Sano, Satoshi Saito, Masakazu Takazoe, Shiho Iwamoto, Minako Sako, Masayuki Fukata

Introduction: Patients with Crohn's disease (CD) require an assessment of small bowel lesions, while difficulties exist in performing small intestinal examinations, especially in small-sized medical offices. Small bowel capsule endoscopy (SBCE) is handy and can be performed in most clinical settings. The only drawback of SBCE is a requirement of patency testing prior to the exam because it sometimes requires CT scanning to localize the ingested patency capsule (PC), which may be a substantial burden for the patient. We have developed a novel PC detection system named PICS (patency capsule, ileocolonoscopy, and small bowel capsule endoscopy) method by which we can avoid CT scanning. In the PICS method, ileocolonoscopy (ICS) is performed after 30-33 h of PC ingestion and the PC can be localized by ICS in patients who have not excreted the PC, and the entire intestine can be examined in combination with subsequent SBCE without additional bowel preparation. The aim of this study was to assess the usefulness and safety of the PICS method for CD patients.

Methods: CD patients who underwent PICS method from April 2021 to March 2023 were reviewed for clinical data, outcome of PICS method including the rates of PC detection by ICS, the number of patients underwent SBCE, and adverse events. Lewis score was used to assess SBCE results.

Results: The PICS method was performed in 54 patients. The median age of patients was 28.5 years old, and 64.8% of them were ileocolic type. The median disease duration was 10.5 months and 24.1% had history of small bowel resection. Five cases (9.3%) confirmed gastrointestinal patency by ICS, and none of the cases required CT scanning. One patient who could not be confirmed patency by ICS, and the other patient who excreted PC but was found ileal stenosis by ICS did not undergo SBCE. Remaining 52 patients received SBCE, and the median Lewis score of them was 0 (IQR 0, 450). There were no adverse events including small bowel obstruction by PC and SBCE retention in this series.

Conclusion: The PICS method is not only feasible and safe but also convenient to assess disease extent in patients with CD. By localizing PC with ICS, additional CT scanning could be unnecessary for SBCE, which benefits both physicians and CD patients.

简介克罗恩病(CD)患者需要对小肠病变进行评估,但进行小肠检查存在困难,尤其是在小型医疗诊所。小肠胶囊内窥镜检查(SBCE)非常方便,可在大多数临床环境中进行。小肠胶囊内镜检查的唯一缺点是需要在检查前进行通畅性检测,因为有时需要通过 CT 扫描来确定摄入的通畅胶囊(PC)的位置,这可能会给患者造成很大的负担。我们开发了一种新型 PC 检测系统,命名为 PICS(通畅胶囊、回肠结肠镜和小肠胶囊内镜检查)方法,通过这种方法我们可以避免 CT 扫描。在 PICS 方法中,在摄入 PC 30 至 33 小时后进行回肠-结肠镜检查(ICS),通过 ICS 可以对未排出 PC 的患者进行 PC 定位,并结合随后的 SBCE 检查整个肠道,而无需额外的肠道准备。本研究旨在评估 PICS 方法对 CD 患者的实用性和安全性:方法:回顾 2021 年 4 月至 2023 年 3 月期间接受 PICS 方法的 CD 患者的临床数据、PICS 方法的结果(包括 ICS PC 检测率)、接受 SBCE 的患者人数以及不良事件。Lewis 评分用于评估 SBCE 结果:54名患者接受了PICS方法。中位年龄为 28.5 岁,64.8% 的患者为回肠结肠型。中位病程为 10.5 个月,24.1% 的患者有小肠切除史。5例患者(9.3%)通过ICS确认胃肠道通畅,无一例需要进行CT扫描。一名患者无法通过 ICS 证实胃肠通畅,另一名患者排出 PC,但通过 ICS 发现回肠狭窄,因此没有接受 SBCE。其余 52 名患者接受了 SBCE,他们的 Lewis 评分中位数为 0(IQR 0,450)。这一系列患者均未发生 PC 小肠梗阻和 SBCE 滞留等不良事件:结论:PICS 方法不仅可行、安全,而且便于评估 CD 患者的疾病程度。结论:PICS 方法不仅可行、安全,而且能方便地评估 CD 患者的疾病范围。通过 ICS 定位 PC,SBCE 无需进行额外的 CT 扫描,这对医生和 CD 患者都有好处。
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引用次数: 0
Nutritional Status Indicators Predict Tolerability to Adjuvant Chemotherapy in Patients with Stage II/III Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy. 营养状况指标可预测接受新辅助化放疗的II/III期直肠癌患者对辅助化疗的耐受性。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-05-29 DOI: 10.1159/000539211
Shinya Abe, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Yuichiro Yokoyama, Hiroyuki Matsuzaki, Yuzo Nagai, Takahide Shinagawa, Hirofumi Sonoda, Soichiro Ishihara

Introduction: Adjuvant chemotherapy (AC) after radical surgery following preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) is now the standard of care. The identification of risk factors for the discontinuation of AC is important for further improvements in survival. We herein examined the prognostic impact of chemotherapy compliance and its relationship with the prognostic nutritional index (PNI) before surgery.

Methods: A total of 335 stage II-III LARC patients who underwent preoperative CRT between 2003 and 2022 at the University of Tokyo Hospital were retrospectively reviewed. We excluded patients with recurrence during AC and those who had not received AC. The relationship between AC and long-term outcomes and that between PNI values and the duration of AC were examined.

Results: Thirty-one patients discontinued AC and 62 continued AC. Recurrence-free survival (RFS) was significantly shorter in patients who discontinued AC (p = 0.0056). The discontinuation of AC was identified as an independent risk factor for RFS (hazard ratio [HR]: 2.24, p = 0.0233). Twenty-one patients were classified as having low PNI (less than 40), which correlated with an older age, low body mass index, and incomplete AC. Low PNI was an independent risk factor for a shorter duration of AC (HR: 2.53, p = 0.0123).

Conclusion: The discontinuation of AC was related to poor RFS in patients with LARC undergoing preoperative CRT. Furthermore, a low PNI value was identified as a risk factor for a shorter duration of AC.

简介:局部晚期直肠癌(LARC)术前化放疗(CRT)后根治术后辅助化疗(AC)是目前的治疗标准。确定停用辅助化疗的风险因素对于进一步提高生存率非常重要。我们在此研究了化疗依从性对预后的影响及其与术前预后营养指数(PNI)的关系:我们对 2003 年至 2022 年期间在东京大学医院接受术前 CRT 的 335 例 II-III 期 LARC 患者进行了回顾性研究。我们排除了在 AC 期间复发的患者和未接受 AC 的患者。研究了 AC 与长期预后之间的关系,以及 PNI 值与 AC 持续时间之间的关系:结果:31 名患者中断了 AC,62 名患者继续 AC。停用 AC 的患者无复发生存期(RFS)明显较短(P = 0.0056)。停用 AC 被认为是影响 RFS 的一个独立风险因素(HR 2.24,p = 0.0233)。21 名患者被归类为低 PNI(低于 40),这与年龄较大、低体重指数和 AC 不完全相关。低 PNI 是缩短 AC 持续时间的独立风险因素(HR 2.53,P = 0.0123):结论:术前接受 CRT 的 LARC 患者停止 AC 与 RFS 差有关。此外,低 PNI 值也是缩短 AC 持续时间的一个风险因素。
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引用次数: 0
Current Treatment Practices for Adult Patients with Constipation in Japan. 日本成人便秘患者的当前治疗方法。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-09-11 DOI: 10.1159/000533548
Takaomi Kessoku, Noboru Misawa, Hidenori Ohkubo, Atsushi Nakajima

Background: The prevalence of constipation in Japan is estimated to be 2-5%. Constipation is a disease found in older adults. In particular, Japan is an aging society, with 65% of men and 80.5% of women aged 65 years or older accounting for the majority of its population. Chronic constipation may be associated with survival, cardiovascular events, decreased quality of life, and death. This study summarizes the recent findings regarding constipation treatment practice in Japan.

Summary: Until recently, the diagnosis of constipation was mainly based on medical interviews; however, with the recent development of handheld ultrasound devices, both physicians and nurses can easily and objectively diagnose fecal retention. Magnesium oxide and stimulant laxatives have been the mainstay treatments; however, since 2012, more than five new drugs for treating constipation have become available in Japan.

Key messages: Magnesium oxide is less effective in patients who use acid-secretion inhibitors and patients who have undergone total gastrectomy and should be cared for hypermagnesemia. In addition, regular use of stimulant laxatives may lead to colonic inertia and decreased bowel movements; therefore, they should be used only occasionally. The following is an overview of the different uses of conventional and newer laxatives for treating constipation.

背景:据估计,日本的便秘发病率为 2-5%。便秘是一种常见于老年人的疾病。特别是,日本是一个老龄化社会,65 岁或以上的男性和女性分别占总人口的 65% 和 80.5%。慢性便秘可能与生存、心血管事件、生活质量下降和死亡有关。本研究总结了日本便秘治疗实践的最新发现。摘要:直到最近,便秘的诊断仍主要基于医学访谈;然而,随着手持超声波设备的最新发展,医生和护士都可以轻松、客观地诊断粪便潴留。氧化镁和刺激性泻药一直是主要的治疗方法,但自2012年以来,日本已有超过五种治疗便秘的新药上市:关键信息:氧化镁对使用胃酸分泌抑制剂的患者和接受过全胃切除术的患者效果较差,应注意高镁血症。此外,经常使用刺激性泻药可能会导致结肠惰性和肠蠕动减少,因此只能偶尔使用。下面概述了治疗便秘的传统和新型泻药的不同用途。
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引用次数: 0
Long-Term Monitoring and Clinical Implications of Small Bowel Capsule Endoscopy in Patients with Crohn's Disease with Small Bowel Lesions: A Retrospective Analysis. 小肠胶囊内镜对克罗恩病患者小肠病变的长期监测和临床意义:回顾性分析
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-06-10 DOI: 10.1159/000539745
Masanao Nakamura, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Kentaro Murate, Kazuhiro Furukawa, Takashi Hirose, Kota Uetsuki, Tadashi Iida, Yasuyuki Mizutani, Kentaro Yamao, Yoji Ishizu, Takuya Ishikawa, Takashi Honda, Hiroki Kawashima

Introduction: Crohn's disease (CD) induces persistent inflammation throughout the gastrointestinal (GI) tract, potentially resulting in complications such as intestinal stenosis and fistulas, particularly in the small bowel. Small bowel capsule endoscopy (SBCE) is recommended for monitoring CD, especially when GI tract patency is maintained. This study aimed to retrospectively assess patients with CD who underwent SBCE to determine the timing of clinical changes and address the current lack of evidence regarding GI tract patency loss during CD treatment.

Methods: Of the 166 consecutive patients who underwent SBCE at our institution, 120 were followed up and included in this study. Forty-six patients were excluded due to colitis type or immediate treatment changes post-SBCE. This study focused on the primary and secondary endpoints, including the cumulative stricture-free rate of the GI tract, emergency hospitalization post-SBCE, and post-SBCE treatment strategies, at the discretion of the attending physicians.

Results: Demographic data revealed that the mean age of the study population was 43 years and that there was a male predominance (75%). The median disease duration was 12 years and the mean Crohn's Disease Activity Index was 98. During a 1,486-day observation period, 37% of patients experienced treatment changes. A Lewis score of >264 and perianal lesions were identified as independent risk factors for additional treatment needs. Emergency hospitalization occurred in 6% of patients and GI patency failure in 11%. Female sex and Lewis score>264 were associated with higher risks. GI patency rate declined 2 years after SBCE.

Conclusions: For patients who experienced no treatment changes based on SBCE results, it is recommended to undergo SBCE monitoring at intervals of no longer than 2 years.

导言:克罗恩病(CD)诱发整个胃肠道(GI)的持续炎症,可能导致肠狭窄和瘘管等并发症,尤其是在小肠。建议使用小肠胶囊内镜(SBCE)监测 CD,尤其是在消化道保持通畅的情况下。本研究旨在对接受 SBCE 检查的 CD 患者进行回顾性评估,以确定临床变化的时间,并解决目前缺乏有关 CD 治疗期间消化道通畅性丧失的证据的问题:在我院连续接受 SBCE 治疗的 166 例患者中,有 120 例接受了随访并纳入本研究。有 46 例患者因结肠炎类型或 SBCE 后的直接治疗变化而被排除在外。本研究主要关注主要和次要终点,包括消化道累积无狭窄率、SBCE 后急诊住院情况以及主治医生决定的 SBCE 后治疗策略:人口统计学数据显示,研究对象的平均年龄为 43 岁,男性占多数(75%)。病程中位数为 12 年,克罗恩病活动指数平均值为 98。在 1486 天的观察期内,37% 的患者更换了治疗方案。刘易斯评分为264分和肛周病变被确定为需要额外治疗的独立风险因素。6%的患者出现急诊住院,11%的患者出现消化道通畅失败。女性和Lewis评分>264与更高的风险相关。SBCE治疗两年后,消化道通畅率有所下降:结论:对于没有根据 SBCE 结果改变治疗方案的患者,建议每隔不超过两年进行一次 SBCE 监测。
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引用次数: 0
Efficacy of Donor-Recipient-Matched Faecal Microbiota Transplantation in Patients with IBS-D: A Single-Centre, Randomized, Double-Blind Placebo-Controlled Study. 供体与受体匹配的粪便微生物群移植对肠易激综合征(IBS-D)患者的疗效:一项单中心、随机、双盲安慰剂对照研究。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-07-31 DOI: 10.1159/000540420
Yanli Zhang, Shuai Wang, Huifen Wang, Man Cao, Miao Wang, Bangzhou Zhang, Chuanxing Xiao, Huiting Zhu, Shiyu Du

Introduction: The imbalance in gut microbiota is contributing to the development and progression of IBS. FMT can improve the gut microbiota, and donor-recipient-matched FMT can help develop individualized treatment plans according to different enterotypes. This study aimed to explore the efficacy of donor-recipient-matched FMT in IBS with predominant diarrhoea (IBS-D) and evaluate its effects on gut microbiota.

Methods: Twenty-seven patients with IBS-D were randomly divided into donor-recipient-matched FMT group (group P), random-donor FMT group (group R), and placebo group (group B). All participants received corresponding FMT treatment after filling in IBS-S, IBS-QoL, GSRS, and HADS questionnaires and having their stool samples collected at 4, 8, and 12 weeks after treatment. The improvement in the symptoms and the changes in the bacterial flora were analysed for three groups.

Results: The IBS-SSS, IBS-QoL, GSRS, and anxiety scores of group P were significantly lower after treatment (p < 0.05). The IBS-QoL scores of group R were significantly lower after treatment (p < 0.05). Beta diversity analysis showed that the gut microbiota of group P had an obvious trend of classification after treatment. Seven bacterial genera were related to the differences in the IBS-SSS scores before and after treatment.

Conclusion: Donor-recipient-matched FMT significantly improved the clinical symptoms, quality of life, and anxiety scores of the patients with IBS-D than random-donor FMT.

简介肠道微生物群失衡是肠易激综合征发病和恶化的原因之一。FMT可改善肠道微生物群,而供体-受体匹配的FMT有助于根据不同肠型制定个体化治疗方案。本研究旨在探讨供体-受体匹配FMT对IBS-D的疗效,并评估其对肠道微生物群的影响:方法:27 名 IBS-D 患者被随机分为供受匹配 FMT 组(P 组)、随机供体 FMT 组(R 组)和安慰剂组(B 组)。所有参与者在治疗后 4 周、8 周和 12 周填写 IBS-S、IBS-QoL、GSRS 和 HADS 问卷并采集粪便样本,然后接受相应的 FMT 治疗。分析了三组患者症状的改善情况和细菌菌群的变化:1.P 组的 IBS-SSS、IBS-Qol、GSRS 和焦虑评分在治疗后明显降低(P<0.05)。R 组治疗后 IBS-Qol 评分明显降低(P<0.05)。2.2. Beta 多样性分析显示,P 组治疗后肠道微生物群有明显的分类趋势。3.3.7个细菌属与治疗前后IBS-SSS评分的差异有关:结论:与随机供体FMT相比,供体-受体匹配FMT能明显改善IBS-D患者的临床症状、生活质量和焦虑评分。
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引用次数: 0
Prelims 预赛
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1159/000535126
Its Concept, Pathogenesis Naito, Y. Kyoto
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引用次数: 0
Subject Index Vol. 105, No. 1, 2024 主题索引》第 105 卷第 1 期,2024 年
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1159/000535125
{"title":"Subject Index Vol. 105, No. 1, 2024","authors":"","doi":"10.1159/000535125","DOIUrl":"https://doi.org/10.1159/000535125","url":null,"abstract":"","PeriodicalId":11315,"journal":{"name":"Digestion","volume":"15 8","pages":"70 - 70"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of Antibiotics for Uncomplicated Diverticulitis: A Retrospective Investigation Using a Nationwide Database in Japan. 抗生素治疗非复杂性滑膜炎的疗效:日本全国数据库的回顾性调查。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-10-19 DOI: 10.1159/000534167
Rintaro Moroi, Kunio Tarasawa, Hiroshi Nagai, Yusukue Shimoyama, Takeo Naito, Hisashi Shiga, Shin Hamada, Yoichi Kakuta, Kiyohide Fushimi, Kenji Fujimori, Yoshitaka Kinouchi, Atsushi Masamune

Introduction: The efficacy of antibiotics for diverticulitis without abscess or peritonitis (uncomplicated diverticulitis) is controversial. We aimed to investigate the effectiveness of antibiotics for uncomplicated diverticulitis.

Methods: We collected admission data for patients with acute uncomplicated diverticulitis using a nationwide database. We divided eligible admissions into two groups according to antibiotic initiation within 2 days after admission (antibiotic group vs. nonantibiotic group). We conducted propensity score matching and compared the rates of surgery (intestinal resection and stoma creation), in-hospital death, and medical costs between the groups. We also performed multivariate analysis to identify the clinical factors that affect surgery.

Results: We enrolled 131,936 admissions; among these, we obtained 6,061 pairs after propensity score matching. Rates of both intestinal resection and stoma creation in the antibiotic group were lower than those in the nonantibiotic group (0.61 vs. 3.09%, p < 0.0001, and 0.08 vs. 0.26%, p = 0.027, respectively). Median costs in the antibiotic group were higher than those in the nonantibiotic group (315,820 JPY vs. 300,175 JPY, p < 0.0001, respectively). Multivariate analysis showed that non-initiation of antibiotics within 2 days after admission was a clinical factor that increased the risk of intestinal resection (odds ratio [OR] = 5.19, 95% confidence interval [CI]: 4.38-6.16, p < 0.0001) and stoma creation (OR = 2.68, 95% CI: 1.53-4.70, p = 0.0006).

Conclusion: Our results indicated that antibiotics for uncomplicated diverticulitis expected to have moderate to severe disease activity may reduce the risk of intestinal resection and stoma creation. Further investigations are warranted.

引言:抗生素治疗无脓肿或腹膜炎的憩室炎(无复杂性憩室炎)的疗效存在争议。我们旨在研究抗生素治疗无并发症憩室炎的有效性。方法:我们使用全国数据库收集了急性无并发症憩室炎患者的入院数据。根据入院后2天内开始使用抗生素的情况,我们将符合条件的入院分为两组(抗生素组与非抗生素组)。我们进行了倾向评分匹配,并比较了两组之间的手术率(肠切除和造瘘)、住院死亡率和医疗费用。我们还进行了多变量分析,以确定影响手术的临床因素。结果:我们录取了131936名学生;其中,我们在倾向得分匹配后获得了6061对。抗生素组的肠切除率和造瘘率均低于非抗生素组(分别为0.61对3.09%,p<0.0001和0.08对0.26%,p=0.027)。抗生素组的中位成本高于非抗生素组(分别为315820日元对300175日元,p<0.0001)。多因素分析显示,入院后2天内未开始使用抗生素是增加肠切除(比值比[OR]=5.19,95%置信区间[CI]:4.38-6.16,p<;0.0001)和造瘘(OR=2.68,95%CI:1.53-4.70,p=0.0006)风险的一个临床因素进行中度至重度疾病活动可以降低肠切除和造瘘的风险。需要进一步调查。
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引用次数: 0
Frontiers in Endoscopic Treatment for Gastroesophageal Reflux Disease. 内镜治疗胃食管反流病的前沿。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-08-17 DOI: 10.1159/000533200
Kazuhiro Ota, Toshihisa Takeuchi, Kazuhide Higuchi, Shun Sasaki, Yosuke Mori, Hironori Tanaka, Akitoshi Hakoda, Noriaki Sugawara, Taro Iwatsubo, Hiroki Nishikawa

Background: The 3rd edition of the evidence-based clinical practice guidelines for gastroesophageal reflux disease (GERD) 2021 from the Japanese Society of Gastroenterology states that the treatment strategy for potassium-competitive acid blocker (PCAB)-refractory GERD remains unclear. Furthermore, even if GERD improves with the administration of an acid secretion inhibitor, it is feared that GERD may flare up after discontinuation of the drug, resulting in some cases in which patients are forced to take vonoprazan semipermanently (the so-called PCAB-dependent cases). From a global perspective, PCAB is not yet used in all countries and regions, and measures that can be taken now for cases in which a conventional proton pump inhibitor (PPI) is inadequately effective need to be devised.

Summary: Endoscopic treatment for GERD may be effective in cases where conventional proton pump inhibitors are ineffective; however, there are insufficient long-term studies to corroborate this, and its cost effectiveness is unknown. Other treatment options for PCAB or PPI-refractory GERD include surgical procedures (Nissen and Toupet operations), which have a longer history than endoscopic treatment for GERD. However, their long-term results are not as good as those of acid secretion inhibitors, and they are not cost effective. Endoscopic treatment for GERD may fill gaps in inadequate surgical treatment. In April 2022, endoscopic anti-reflux mucosal resections (ARMS [anti-reflux mucosectomy] and ESD-G [endoscopic submucosal dissection for GERD]) were approved for reimbursement, making endoscopic treatment of GERD possible throughout Japan.

Key messages: It is important to identify the background factors in cases in which endoscopic treatments are effective.

背景:日本胃肠病学会 2021 年第三版胃食管反流病(GERD)循证临床实践指南指出,钾竞争性酸阻滞剂(PCAB)难治性胃食管反流病的治疗策略仍不明确。此外,即使胃食管反流病在服用胃酸分泌抑制剂后有所改善,人们也担心停药后胃食管反流病可能会复发,从而导致一些患者不得不半永久性地服用凡诺普生(即所谓的 PCAB 依赖性病例)。小结:内镜治疗胃食管反流病可能对传统质子泵抑制剂无效的病例有效,但目前还没有足够的长期研究证实这一点,其成本效益也不得而知。PCAB 或 PPI 难治性胃食管反流病的其他治疗方法包括外科手术(Nissen 和 Toupet 手术),其历史比胃食管反流病的内窥镜治疗更悠久。但其长期疗效不如酸分泌抑制剂,而且成本效益不高。内镜治疗胃食管反流病可以弥补手术治疗的不足。2022 年 4 月,内镜下抗反流粘膜切除术(ARMS[抗反流粘膜切除术]和 ESD-G[内镜下胃食管反流病粘膜下剥离术])获准报销,使胃食管反流病的内镜治疗在日本全国成为可能:关键信息:确定内镜治疗有效病例的背景因素非常重要。
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引用次数: 0
Esophageal Dilation in Patients with Achalasia Is a Predictive Factor for the Inability to Traverse the Esophagogastric Junction with a Manometric Catheter. 贲门失弛缓症患者的食管扩张是无法使用测压导管穿过食管-胃交界处的一个预测因素。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-10-27 DOI: 10.1159/000534448
Yoshimasa Hoshikawa, Eri Momma, Noriyuki Kawami, Katsuhiko Iwakiri

Introduction: The insertion of a high-resolution manometry (HRM) catheter into the stomach is essential for accurate manometric diagnoses; however, it is impossible in some cases due to the inability to traverse the esophagogastric junction (EGJ). Predictive factors for these patients have not been investigated in detail, necessitating time-consuming and burdensome procedures for investigators and patients. Therefore, the present study investigated the percentage of and risk factors for failed intubation at the EGJ.

Methods: We initially reviewed the medical charts of consecutive HRM procedures performed at our hospital between September 2018 and January 2023. Patient characteristics and the findings of endoscopy and esophagography (where available) were compared between successful and failed procedures. A multivariate logistic regression analysis was conducted to identify predictive factors for the inability to traverse the EGJ. We then validated the predictive factors identified by reviewing consecutive procedures performed between February 2023 and August 2023.

Results: Among the 781 procedures performed, 55 (7.0%) failed due to the inability to traverse the EGJ. Achalasia was the most common disorder in these procedures. An older age and dilated esophagus of >34 mm were independent predictive factors for the inability to traverse the EGJ in patients with treatment-naïve achalasia. In the validation study, 7 out of 68 procedures (10.3%) failed due to the inability to traverse the EGJ. A flowchart using the findings of endoscopy and an esophageal diameter of >34 mm predicted the inability to traverse the EGJ with a sensitivity of 71.4% and specificity of 86.9%.

Conclusion: Based on an esophageal diameter >34 mm and endoscopic findings, we predicted the inability to traverse the EGJ in more than 70% of patients. A multi-center prospective study is warranted in the future.

引言:将高分辨率测压导管插入胃部对于准确的测压诊断至关重要;然而,在某些情况下,由于无法穿过食管胃交界处(EGJ),这是不可能的。这些患者的预测因素尚未得到详细调查,这使得研究人员和患者必须进行耗时且繁重的程序。因此,本研究调查了EGJ插管失败的百分比和风险因素。方法:我们初步回顾了2018年9月至2023年1月期间在我院进行的连续HRM手术的病历。比较成功和失败手术的患者特征以及内窥镜检查和食管造影检查结果(如有)。进行了多变量逻辑回归分析,以确定无法穿越EGJ的预测因素。然后,我们通过回顾2023年2月至2023年8月期间进行的连续手术,验证了确定的预测因素。结果:在进行的781次手术中,有55次(7.0%)因无法穿过EGJ而失败。失弛缓症是这些手术中最常见的病症。年龄较大且>;34mm是治疗早期贲门失弛缓症患者无法通过EGJ的独立预测因素。在验证研究中,68例手术中有7例(10.3%)因无法穿过EGJ而失败。使用内窥镜检查结果和>;34mm预测不能通过EGJ的敏感性为71.4%,特异性为86.9%;34mm和内窥镜检查结果,我们预测超过70%的患者无法穿过EGJ。未来有必要进行多中心前瞻性研究。
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引用次数: 0
期刊
Digestion
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