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Endoscopic Kyoto and Kimura-Takemoto Classifications Are Comparable in Predicting High-Risk Gastric Precancerous Lesions. 在预测高风险胃癌前病变方面,内镜京都分级和木村泷本分级具有可比性。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-01-08 DOI: 10.1159/000536048
Doan Thi Nha Nguyen, Duc Trong Quach, Quang Dinh Le, Nhu Thi Hanh Vu, Ngoc Le Bich Dang, Huy Minh Le, Nhan Quang Le, Shiro Oka, Shinji Tanaka, Toru Hiyama

Introduction: Severe and extensive gastric atrophy, extensive or incomplete gastric intestinal metaplasia, and gastric dysplasia are considered high-risk gastric precancerous lesions (HGPLs). Endoscopic findings based on the endoscopic Kyoto classification (EKC) and the Kimura-Takemoto classification (KTC) have been reported to be significantly associated with HGPLs. This study aimed to compare these two classifications in predicting active Helicobacter pylori (H. pylori) infection and HGPLs.

Methods: This is a cross-sectional study conducted on naïve dyspeptic patients who underwent upper gastrointestinal endoscopy at a tertiary hospital. Endoscopic findings were scored according to the EKC and KTC. Mapping biopsies were taken, and H. pylori infection was determined using a locally validated rapid urease test and histology. The performance of EKC was compared with that of KTC using the area under the receiver operating characteristic curve (AUC) in predicting active H. pylori infection and HGPLs.

Results: There were 292 patients with a median age of 46 and a male-to-female ratio of 1:1. The rates of active H. pylori infection and HGPLs were 61.3% and 14.0%, respectively. The EKC was better than the KTC in predicting active H. pylori infection (AUC: 0.771 vs. 0.658, respectively; p < 0.001). However, these two classifications had comparable performance in predicting HGPLs (AUC: 0.792 vs. 0.791, respectively; p = 0.956).

Conclusion: Compared to EKC, KTC is inferior in predicting active H. pylori infection but has comparable performance in predicting HGPLs.

背景/目的:严重和广泛的胃萎缩、广泛或不完全的胃肠化生以及胃发育不良被认为是高风险胃癌前病变(HGPLs)。据报道,基于内镜京都分类法(EKC)和木村-竹本分类法(KTC)的内镜检查结果与 HGPLs 显著相关。本研究旨在比较这两种分类在预测活动性幽门螺杆菌(H. pylori)感染和 HGPLs 方面的作用:这是一项横断面研究,对象是在一家三甲医院接受上消化道内镜检查的天真消化不良患者。根据 EKC 和 KTC 分类对内镜检查结果进行评分。采集映射活组织切片,使用当地验证的快速尿素酶测试和组织学方法确定幽门螺杆菌感染情况。在预测活动性幽门螺杆菌感染和 HGPLs 方面,使用接收器操作特征曲线下面积(AUC)比较了 EKC 和 KTC 的性能:共有 292 名患者,中位年龄为 46 岁,男女比例为 1:1。活动性幽门螺杆菌感染率和 HGPLs 感染率分别为 61.3% 和 14.0%。在预测活动性幽门螺杆菌感染方面,EKC 优于 KTC(AUC:分别为 0.771 和 0.658;P< 0.001)。然而,这两种分类在预测 HGPLs 方面的表现相当(AUC:分别为 0.792 vs. 0.791;p = 0.956):结论:与 EKC 相比,KTC 在预测活动性幽门螺杆菌感染方面较差,但在预测 HGPL 方面性能相当。
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引用次数: 0
Impact of Functional Status on Development of Clostridioides difficile Infection and Increase in Inhospital Mortality among Antibiotic Users. 功能状态对抗生素使用者中艰难梭菌感染发展和住院死亡率增加的影响
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-23 DOI: 10.1159/000535306
Kenta Watanabe, Tsuyotoshi Tsuji, Yohei Saruta, Hisanori Matsuzawa, Yosuke Shimodaira, Katsunori Iijima

Introduction: Functional status is one of the surrogates of advanced age, an established risk factor for Clostridioides difficile infection (CDI). We aimed to investigate the usefulness of functional status in the clinical management of CDI.

Methods: We enrolled all hospitalized adult patients receiving antibiotics from a retrospective hospital-based cohort in Japan between 2016 and 2020. Using the Barthel index (BI), which is an objective scale of functional status, we investigated the association of BI with developing CDI and its impact on inhospital mortality in patients with CDI.

Results: We enrolled 17,131 patients with 100 cases of CDI. Multivariable analysis revealed that lower BI (≤25) was an independent risk factor for developing CDI (adjusted odds ratio, 4.11; 95% confidence interval, 2.62-6.46). Furthermore, a combination of BI and Charlson comorbidity index (CCI) showed an adjusted odds ratio of 36.40 (95% confidence interval, 17.30-76.60) in the highest risk group. A high-risk group according to the combination of BI and CCI was estimated to have significantly higher inhospital mortality in patients with CDI using the Kaplan-Meier method (p = 0.017). A combination of lower BI and higher CCI was an independent predictor of inhospital mortality even in the multivariable Cox regression model (adjusted hazard ratio, 3.00; 95% confidence interval, 1.01-8.88).

Conclusions: Assessment of functional status, especially combined with comorbidities, was significantly associated with developing CDI and may also be useful in predicting inhospital mortality.

功能状态是高龄的替代指标之一,是艰难梭菌感染(CDI)的确定危险因素。我们的目的是探讨功能状态在CDI临床管理中的作用。方法:我们纳入了2016年至2020年期间日本所有接受抗生素治疗的住院成人患者。使用Barthel指数(BI),这是一种客观的功能状态量表,我们研究了BI与CDI的关系及其对CDI患者住院死亡率的影响。结果:共纳入100例CDI患者17131例。多变量分析显示,较低的BI(≤25)是发生CDI的独立危险因素(调整优势比为4.11;95%置信区间,2.62-6.46)。此外,结合BI和Charlson合并症指数(CCI),最高危险组的校正优势比为36.40(95%可信区间为17.30-76.60)。使用Kaplan-Meier方法估计,根据BI和CCI合并的高危组CDI患者的住院死亡率显着更高(p = 0.017)。即使在多变量Cox回归模型中,较低BI和较高CCI的组合也是院内死亡率的独立预测因子(校正风险比,3.00;95%置信区间,1.01-8.88)。结论:功能状态的评估,特别是合并合并症的评估,与CDI的发生显著相关,也可用于预测住院死亡率。
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引用次数: 0
Antibodies Targeting the Tumor Necrosis Factor-Like Ligand 1A in Inflammatory Bowel Disease: A New Kid on the (Biologics) Block? 针对炎症性肠病中肿瘤坏死因子 (TNF) 样配体 1A (TL1A) 的抗体--(生物制剂)领域的新秀?
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-07-26 DOI: 10.1159/000540421
Daniel Schweckendiek, Gerhard Rogler

Background: The treatment options for inflammatory bowel disease (IBD) have grown over the last years. However, a significant fraction of patients either do not respond to their treatment or lose response over time.

Summary: Future treatment options could include antibodies that target the tumor necrosis factor-like ligand 1A (TL1A). TL1A is a key cytokine involved in the pathogenesis of a variety of autoimmune diseases including IBD. Studies have shown that IBD disease severity correlates well with serum levels of TL1A. Phase 2 data from two agents currently in clinical testing have been released. In line with requirements for modern therapeutics, companion diagnostic was part of these trials. This aims to identify those patients that are more likely to respond to the agents tested.

Key messages: With regard to the available data the risk/benefit profile of TL1A inhibitors seems to be promising. This article gives a short update and overview, where we are at this point in time with antibodies targeting the TL1A protein in IBD.

近年来,炎症性肠病(IBD)的治疗方案不断增加。然而,相当一部分患者要么对治疗没有反应,要么随着时间的推移失去反应。未来的治疗方案可能包括针对肿瘤坏死因子(TNF)配体 1A(TL1A)的抗体。TL1A 是一种关键的细胞因子,参与了包括 IBD 在内的多种自身免疫性疾病的发病机制。研究表明,IBD 疾病的严重程度与血清中的 TL1A 水平密切相关。目前正在进行临床试验的两种药物的第二阶段数据已经公布。根据现代疗法的要求,辅助诊断是这些试验的一部分。其目的是确定哪些患者更有可能对测试药物产生反应。从现有数据来看,风险/效益分析似乎很有前景。本文简要介绍了针对 TL1A 蛋白的抗体治疗 IBD 的最新进展。
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引用次数: 0
Randomized Controlled Trial of Remimazolam Compared with Placebo in Japanese Patients Undergoing Colonoscopy: A Phase III, Investigator-Initiated Trial. 在接受结肠镜检查的日本患者中进行雷马唑仑与安慰剂比较的随机对照试验:一项由研究者发起的 III 期试验。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-07-26 DOI: 10.1159/000540527
Ryoji Ichijima, Hisatomo Ikehara, Hiroyuki Ono, Kinichi Hotta, Daisuke Yamaguchi, Mitsuru Esaki, Yosuke Minoda, Yasuhiko Nagata, Kanako Ogura, Shinsuke Kiriyama, Tetsuya Sumiyoshi, Yuichi Kanmura

Introduction: We conducted an investigator-initiated clinical trial in which remimazolam was used to achieve sedation in patients undergoing colonoscopies.

Methods: This multicenter, double-blind, placebo-controlled, phase III investigator-initiated trial included patients who underwent colonoscopy under sedation with remimazolam (initial dose: 3 mg; additional dose: 1 mg) or normal saline (placebo). The primary endpoint of the study was the successful sedation rate during colonoscopy, defined as achieving a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of ≤4 before the procedure, maintaining this score throughout colonoscopy, and requiring no more than five additional drug doses per 15 min.

Results: The sedation success rate was 95.0% (38/40 patients) in the remimazolam group and 0.0% (0/11 patients) in the placebo group (p < 0.01). The time from the end of procedure to regaining consciousness was 0.0 (interquartile range: 0.0-0.0) min in both groups. The time from the end of the procedure to ambulation was 5.0 (interquartile range: 0.0-10.0) min in the remimazolam group and 0.0 (interquartile range: 0.0-0.0) min in the placebo group (p = 0.02). Serious adverse events were not observed.

Conclusion: The use of remimazolam to achieve sedation in Japanese patients undergoing colonoscopy was more effective than placebo.

简介我们开展了一项由研究者发起的临床试验,在该试验中使用了瑞马唑仑对接受结肠镜检查的患者进行镇静:这项由研究者发起的多中心、双盲、安慰剂对照的 III 期临床试验纳入了在使用雷马唑仑(初始剂量:3 毫克;追加剂量:1 毫克)或生理盐水(安慰剂)镇静的情况下接受结肠镜检查的患者。主要终点是结肠镜检查期间的镇静成功率,定义为成功镇静(结肠镜检查前改良观察者警觉/镇静[MOAA/S]评分≤4分)、结肠镜检查顺利完成,以及手术过程中每15分钟内瑞马唑仑追加剂量不超过5次:结果:瑞美唑仑组的镇静成功率为 95.0%(38/40 名患者),安慰剂组为 0.0%(0/11 名患者)(p<0.01)。两组患者从手术结束到苏醒的时间均为 0.0 分钟(四分位间范围:0.0-0.0)。从手术结束到下地行走的时间,雷马唑仑组是5.0分钟(四分位间范围:0.0-10.0分钟),安慰剂组是0.0分钟(四分位间范围:0.0-0.0分钟)(P=0.02)。无严重不良事件发生:结论:对接受结肠镜检查的日本患者使用雷马唑仑进行镇静比使用安慰剂更有效:本研究已在日本临床试验注册中心注册(注册号:jRCT2031200360)。
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引用次数: 0
Prevalence and Risk Factors of Constipation Symptoms among Patients Undergoing Colonoscopy: A Single-Center Cross-Sectional Study. 结肠镜检查患者便秘症状的发生率和风险因素:一项单中心横断面研究。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-05-16 DOI: 10.1159/000539366
Shiori Komori, Junichi Akiyama, Naoko Tatsuno, Erika Yamada, Atsuko Izumi, Mariko Hamada, Kana Seto, Yuriko Nishiie, Keigo Suzuki, Yuya Hisada, Yuki Otake, Yuka Yanai, Hidetaka Okubo, Kazuhiro Watanabe, Naoki Akazawa, Natsuyo Yamamoto, Yasuo Tanaka, Mikio Yanase, Akiko Saito, Kazuhiko Yamada, Chizu Yokoi, Akihito Nagahara

Introduction: Constipation is one of the most common gastrointestinal symptoms. It may compromise quality of life and social functioning and result in increased healthcare use and costs. We aimed to evaluate the prevalence and risk factors of constipation symptoms, as well as those of refractory constipation symptoms among patients who underwent colonoscopy.

Methods: Over 4.5 years, patients who underwent colonoscopy and completed questionnaires were analyzed. Patients' symptoms were evaluated using the Gastrointestinal Symptoms Rating Scale.

Results: Among 8,621 eligible patients, the prevalence of constipation symptoms was 33.3%. Multivariate analysis revealed female sex (odds ratio [OR] 1.7, p < 0.001), older age (OR 1.3, p < 0.001), cerebral stroke with paralysis (OR 1.7, p = 0.009), chronic renal failure (OR 2.6, p < 0.001), ischemic heart disease (OR 1.3, p = 0.008), diabetes (OR 1.4, p < 0.001), chronic obstructive pulmonary disease (OR 1.5, p = 0.002), benzodiazepine use (OR 1.7, p < 0.001), antiparkinsonian medications use (OR 1.9, p = 0.030), and opioid use (OR 2.1, p = 0.002) as independent risk factors for constipation symptoms. The number of patients taking any medication for constipation was 1,134 (13.2%); however, refractory symptoms of constipation were still present in 61.4% of these patients. Diabetes (OR 1.5, p = 0.028) and irritable bowel syndrome (OR 3.1, p < 0.001) were identified as predictors for refractory constipation symptoms.

Conclusions: Constipation occurred in one-third of patients, and more than half of patients still exhibited refractory symptoms of constipation despite taking laxatives. Multiple medications and concurrent diseases seem to be associated with constipation symptoms.

简介便秘是最常见的胃肠道症状之一。它可能会影响生活质量和社会功能,并导致医疗费用的增加。我们旨在评估接受结肠镜检查的患者中便秘症状的发生率和风险因素,以及难治性便秘症状的发生率和风险因素:我们对 4.5 年来接受结肠镜检查并填写问卷的患者进行了分析。结果:在 8621 名符合条件的患者中,有 1.7% 的人有便秘症状:在8621名符合条件的患者中,便秘症状的发生率为33.3%。多变量分析显示,女性(几率比 [OR] 1.7,P <0.001)、老年(OR 1.3,P <0.001)、脑中风伴瘫痪(OR 1.7,P = 0.009)、慢性肾功能衰竭(OR 2.6,P <0.001)、缺血性心脏病(OR 1.3,P = 0.008)、糖尿病(OR 1.4, P < 0.001)、慢性阻塞性肺病(OR 1.5, P = 0.002)、苯二氮卓类药物的使用(OR 1.7, P < 0.001)、抗帕金森病药物的使用(OR 1.9, P = 0.030)和阿片类药物的使用(OR 2.1, P = 0.002)为便秘症状的独立危险因素。服用任何药物治疗便秘的患者人数为 1,134 人(13.2%),但其中 61.4% 的患者仍存在难治性便秘症状。糖尿病(OR 1.5,P = 0.028)和肠易激综合征(OR 3.1,P < 0.001)被认为是预测难治性便秘症状的因素:结论:三分之一的患者出现便秘,超过一半的患者在服用泻药后仍表现出难治性便秘症状。多种药物和并发疾病似乎与便秘症状有关。
{"title":"Prevalence and Risk Factors of Constipation Symptoms among Patients Undergoing Colonoscopy: A Single-Center Cross-Sectional Study.","authors":"Shiori Komori, Junichi Akiyama, Naoko Tatsuno, Erika Yamada, Atsuko Izumi, Mariko Hamada, Kana Seto, Yuriko Nishiie, Keigo Suzuki, Yuya Hisada, Yuki Otake, Yuka Yanai, Hidetaka Okubo, Kazuhiro Watanabe, Naoki Akazawa, Natsuyo Yamamoto, Yasuo Tanaka, Mikio Yanase, Akiko Saito, Kazuhiko Yamada, Chizu Yokoi, Akihito Nagahara","doi":"10.1159/000539366","DOIUrl":"10.1159/000539366","url":null,"abstract":"<p><strong>Introduction: </strong>Constipation is one of the most common gastrointestinal symptoms. It may compromise quality of life and social functioning and result in increased healthcare use and costs. We aimed to evaluate the prevalence and risk factors of constipation symptoms, as well as those of refractory constipation symptoms among patients who underwent colonoscopy.</p><p><strong>Methods: </strong>Over 4.5 years, patients who underwent colonoscopy and completed questionnaires were analyzed. Patients' symptoms were evaluated using the Gastrointestinal Symptoms Rating Scale.</p><p><strong>Results: </strong>Among 8,621 eligible patients, the prevalence of constipation symptoms was 33.3%. Multivariate analysis revealed female sex (odds ratio [OR] 1.7, p &lt; 0.001), older age (OR 1.3, p &lt; 0.001), cerebral stroke with paralysis (OR 1.7, p = 0.009), chronic renal failure (OR 2.6, p &lt; 0.001), ischemic heart disease (OR 1.3, p = 0.008), diabetes (OR 1.4, p &lt; 0.001), chronic obstructive pulmonary disease (OR 1.5, p = 0.002), benzodiazepine use (OR 1.7, p &lt; 0.001), antiparkinsonian medications use (OR 1.9, p = 0.030), and opioid use (OR 2.1, p = 0.002) as independent risk factors for constipation symptoms. The number of patients taking any medication for constipation was 1,134 (13.2%); however, refractory symptoms of constipation were still present in 61.4% of these patients. Diabetes (OR 1.5, p = 0.028) and irritable bowel syndrome (OR 3.1, p &lt; 0.001) were identified as predictors for refractory constipation symptoms.</p><p><strong>Conclusions: </strong>Constipation occurred in one-third of patients, and more than half of patients still exhibited refractory symptoms of constipation despite taking laxatives. Multiple medications and concurrent diseases seem to be associated with constipation symptoms.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"299-309"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk Factors for Post-Colorectal Endoscopic Submucosal Dissection Bleeding and Efficacy of Carbazochrome Sodium Sulfonate: A Multicenter Retrospective Cohort Study. 结直肠内镜黏膜下剥离术后出血的风险因素和卡氮磺酸钠的疗效:一项多中心回顾性队列研究。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-05-22 DOI: 10.1159/000539367
Keitaro Takahashi, Takuya Iwama, Kazuyuki Tanaka, Yuki Miyazawa, Shohei Kuroda, Masashi Horiuchi, Seisuke Saito, Momotaro Muto, Aki Sakatani, Katsuyoshi Ando, Nobuhiro Ueno, Shin Kashima, Kentaro Moriichi, Hiroki Tanabe, Toshikatsu Okumura, Mikihiro Fujiya

Introduction: Carbazochrome sodium sulfonate (CSS) is a hemostatic agent that reduces capillary permeability and enhances capillary resistance. However, its specific effects on colorectal endoscopic submucosal dissection (ESD) outcomes remain uncertain. This study aimed to assess the risk factors for post-ESD bleeding and the effect of CSS on colorectal ESD outcomes.

Methods: First, we retrospectively analyzed the risk factors for post-ESD bleeding using data from 1,315 lesions in 1,223 patients who underwent ESD for superficial colorectal neoplasms at eight institutions. Second, patients were divided into CSS and non-CSS groups using propensity score matching, and their outcomes from colorectal ESD were analyzed.

Results: The risk factors for post-colorectal ESD bleeding were identified as age of ≥70 years, tumor located in the rectum, tumor size of ≥40 mm, and post-ESD defect unclosure in both univariate and multivariate analyses. The CSS and non-CSS groups each consisted of 423 lesions after propensity score matching. The post-colorectal ESD bleeding rate was 3.5% (15/423) and 3.3% (14/423) in the CSS and non-CSS groups, respectively, indicating no significant differences. Among patients with the high-risk factors for post-ESD bleeding, the administration of CSS also did not demonstrate a significant reduction in the post-ESD bleeding rate compared to the non-CSS group.

Conclusion: CSS administration is ineffective in preventing post-colorectal ESD bleeding in both the general population and individuals at a high risk for such bleeding. Our results indicate the necessity to reconsider the application of CSS for preventing post-colorectal ESD bleeding.

背景:卡络磺酸钠(CSS)是一种止血剂,可降低毛细血管通透性并增强毛细血管阻力。然而,它对结肠直肠内镜黏膜下剥离术(ESD)结果的具体影响仍不确定。本研究旨在评估ESD术后出血的风险因素以及CSS对结直肠ESD结果的影响:方法:首先,我们利用在八家医疗机构接受ESD治疗浅表结直肠肿瘤的1223名患者的1315个病灶的数据,对ESD术后出血的风险因素进行了回顾性分析。其次,采用倾向得分匹配法将患者分为CSS组和非CSS组,并分析他们的结直肠ESD结果:结果:在单变量和多变量分析中,结直肠ESD术后出血的风险因素被确定为年龄≥70岁、肿瘤位于直肠、肿瘤大小≥40毫米以及ESD术后缺损未闭合。经过倾向评分匹配后,CSS组和非CSS组各有423个病灶。CSS组和非CSS组的结肠直肠ESD术后出血率分别为3.5%(15/423)和3.3%(14/423),无明显差异。在具有ESD术后出血高危因素的患者中,与未使用CSS组相比,使用CSS也未能显著降低ESD术后出血率:结论:在普通人群和ESD出血高危人群中,使用CSS无法有效预防结肠直肠ESD后出血。我们的研究结果表明,有必要重新考虑使用 CSS 预防结肠直肠ESD后出血。
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引用次数: 0
Efficacy and Safety of STW 5-II for Functional Dyspepsia Treatment: A Patient Data-Based Meta-Analysis. STW 5-II 治疗功能性消化不良的有效性和安全性:基于患者数据的荟萃分析。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-01-19 DOI: 10.1159/000535672
Viola Andresen, Ayesha Shah, Careen Fink, Sabine Rabini, Manfred Wargenau, Gerald Holtmann

Introduction: Functional dyspepsia (FD) is a chronic relapsing gastroduodenal disorder with limited treatment options. Herbal products, like the six-herb combination STW 5-II, can target multiple FD gastrointestinal symptoms. In this meta-analysis, we evaluated the efficacy and safety of STW 5-II for overall FD, and key symptoms, based on Rome IV criteria.

Methods: We systematically screened the literature for randomized controlled clinical studies testing STW 5-II in FD. Meta-analysis was performed using data from individual patients with at least one key FD symptom (fullness, early satiety, or epigastric pain) of at least moderate severity at baseline. ANCOVA-based meta-analyses were performed on improvements in the total symptom sum score, and single symptoms, after 4 and 8 weeks. Safety data were analyzed by calculating odds ratios for all adverse events.

Results: Four randomized controlled trials, including 613 patients, were identified, and two were eligible for efficacy analysis. STW 5-II significantly improved the FD symptom sum score (mean difference of 1.74 after 4 weeks and 2.07 after 8 weeks) and key FD symptoms of fullness (0.28 and 0.29), early satiety (0.25 and 0.26), and epigastric/upper abdominal pain (0.26 and 0.3). Treatment-related or severe adverse events did not differ between STW 5-II and placebo.

Conclusion: The results support that STW 5-II significantly improves FD symptoms after 4 and 8 weeks of treatment with no difference in relation to safety signals compared to placebo. Thus, STW 5-II can be considered an effective and safe treatment option for FD.

背景:功能性消化不良(FD)是一种慢性复发性胃十二指肠疾病,治疗方法有限。草药产品,如六味草药组合 STW5-II,可针对功能性消化不良的多种胃肠道症状。在这项荟萃分析中,我们根据罗马IV标准评估了STW 5-II对FD整体症状和主要症状的疗效和安全性。摘要:我们系统地筛选了文献中测试STW 5-II治疗FD的随机对照临床研究。我们使用基线时至少有一种关键 FD 症状(饱胀、早饱或上腹痛)达到中度严重程度的患者数据进行了荟萃分析。4 周和 8 周后,对症状总分和单一症状的改善情况进行了基于方差分析的荟萃分析。通过计算所有不良事件的几率比(ORs)分析了安全性数据。共确定了四项随机对照试验,包括 613 名患者,其中两项符合疗效分析条件。STW 5-II 可明显改善 FD 症状总分(4 周后的平均差异为 1.74,8 周后为 2.07)以及饱腹感(0.28 和 0.29)、早饱(0.25 和 0.26)和上腹/上腹部疼痛(0.26 和 0.3)等主要 FD 症状。STW5-II与安慰剂的治疗相关不良反应或严重不良反应没有差异:现有数据表明,对于符合罗马IV标准的FD患者,STW 5-II可在治疗4周和8周后显著改善FD的总体情况和主要症状,与安慰剂相比无安全性差异。因此,STW 5-II 可被视为一种有效、安全的 FD 治疗方案。
{"title":"Efficacy and Safety of STW 5-II for Functional Dyspepsia Treatment: A Patient Data-Based Meta-Analysis.","authors":"Viola Andresen, Ayesha Shah, Careen Fink, Sabine Rabini, Manfred Wargenau, Gerald Holtmann","doi":"10.1159/000535672","DOIUrl":"10.1159/000535672","url":null,"abstract":"<p><strong>Introduction: </strong>Functional dyspepsia (FD) is a chronic relapsing gastroduodenal disorder with limited treatment options. Herbal products, like the six-herb combination STW 5-II, can target multiple FD gastrointestinal symptoms. In this meta-analysis, we evaluated the efficacy and safety of STW 5-II for overall FD, and key symptoms, based on Rome IV criteria.</p><p><strong>Methods: </strong>We systematically screened the literature for randomized controlled clinical studies testing STW 5-II in FD. Meta-analysis was performed using data from individual patients with at least one key FD symptom (fullness, early satiety, or epigastric pain) of at least moderate severity at baseline. ANCOVA-based meta-analyses were performed on improvements in the total symptom sum score, and single symptoms, after 4 and 8 weeks. Safety data were analyzed by calculating odds ratios for all adverse events.</p><p><strong>Results: </strong>Four randomized controlled trials, including 613 patients, were identified, and two were eligible for efficacy analysis. STW 5-II significantly improved the FD symptom sum score (mean difference of 1.74 after 4 weeks and 2.07 after 8 weeks) and key FD symptoms of fullness (0.28 and 0.29), early satiety (0.25 and 0.26), and epigastric/upper abdominal pain (0.26 and 0.3). Treatment-related or severe adverse events did not differ between STW 5-II and placebo.</p><p><strong>Conclusion: </strong>The results support that STW 5-II significantly improves FD symptoms after 4 and 8 weeks of treatment with no difference in relation to safety signals compared to placebo. Thus, STW 5-II can be considered an effective and safe treatment option for FD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"166-174"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Functional Dyspepsia: Current Understanding and Future Perspective. 功能性消化不良:当前认识与未来展望。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-08-18 DOI: 10.1159/000532082
Tadayuki Oshima

Background: Functional dyspepsia (FD) is a common disorder characterized by chronic or recurrent upper abdominal pain or discomfort without any structural abnormalities in the gastrointestinal tract. FD is categorized into two subgroups based on symptoms: postprandial distress syndrome (PDS) and epigastric pain syndrome.

Summary: The pathophysiology of FD involves several mechanisms. Delayed gastric emptying is observed in approximately 30% of FD patients but does not correlate with symptom patterns or severity. Impaired gastric accommodation is important in the pathophysiology, particularly for PDS. Visceral hypersensitivity, characterized by heightened sensitivity to normal activities, contributes to the perception of discomfort or pain in FD. Alterations to the duodenal mucosa, including impaired mucosal barrier function and low-grade inflammation, are also implicated in the pathogenesis of FD. Microbial dysbiosis and psychological factors such as stress can further exacerbate symptoms. Treatment options include dietary modifications, establishing a physician-patient relationship, acid suppressants, prokinetics, neuromodulators, and behavioral therapies. Dietary recommendations include eating smaller, more frequent meals, and avoiding trigger foods. Acid suppressants are used as the first-line treatment. Prokinetics and neuromodulators aim to improve gastric motility and central pain processing, respectively. Behavioral therapies, including cognitive behavioral therapy and hypnotherapy, have shown benefits for refractory FD. Severe and refractory cases may require combination therapies or experimental treatments.

Key messages: FD is a disorder of gut-brain interaction involving diverse pathophysiological mechanisms. Individualized treatment based on symptoms and responses to interventions is crucial. Further research is needed to improve the understanding of FD and advance the development of effective therapies.

背景:功能性消化不良(FD)是一种常见疾病,以慢性或反复发作的上腹部疼痛或不适为特征,胃肠道无任何结构异常。根据症状,功能性消化不良可分为两个亚组:餐后不适综合征(PDS)和上腹痛综合征。大约 30% 的 FD 患者会出现胃排空延迟,但这与症状模式或严重程度无关。胃容纳功能受损是病理生理学中的重要因素,尤其是对 PDS 而言。内脏过敏症的特点是对正常活动的敏感性增高,这也是 FD 患者感到不适或疼痛的原因之一。十二指肠粘膜的改变,包括粘膜屏障功能受损和低度炎症,也与 FD 的发病机制有关。微生物菌群失调和压力等心理因素会进一步加重症状。治疗方案包括调整饮食、建立医患关系、抑酸剂、促动力药、神经调节剂和行为疗法。饮食建议包括少食多餐,避免食用诱发食物。抑酸剂是一线治疗方法。促动力药和神经调节剂分别旨在改善胃肠蠕动和中枢疼痛处理。行为疗法,包括认知行为疗法和催眠疗法,对难治性 FD 有一定疗效。严重和难治性病例可能需要综合疗法或实验性疗法:FD是一种涉及多种病理生理机制的肠脑相互作用紊乱。根据症状和对干预措施的反应进行个体化治疗至关重要。需要进一步开展研究,以加深对 FD 的了解,推动有效疗法的开发。
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引用次数: 0
Esophageal Motility Disorders: Diagnosis and Treatment Strategies. 食管运动障碍:诊断与治疗策略。
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-08-25 DOI: 10.1159/000533347
Yoshimasa Hoshikawa, Katsuhiko Iwakiri

Background: Esophageal motility disorders (EMDs) are caused by the impaired relaxation of the upper/lower esophageal sphincter and/or defective esophageal peristaltic contractions, resulting in dysphagia and noncardiac chest pain. High-resolution manometry (HRM) is essential for the diagnosis of primary EMD; however, the recognition of EMD and HRM by general practitioners in Japan is limited. This review summarizes the diagnosis of and treatment strategies for EMD.

Summary: HRM is a specific test for the diagnosis of EMD, whereas endoscopy and barium swallow as screening tests provide characteristic findings (i.e., esophageal rosette and bird's beak sign) in some cases. It is important to note that manometric diagnoses apart from achalasia are often clinically irrelevant; therefore, the recently updated guidelines suggest additional manometric maneuvers, such as the rapid drink challenge, and further testing, including functional lumen imaging, for a more accurate diagnosis before invasive treatment. Endoscopic/surgical myotomy, pneumatic dilation, and botulinum toxin injections need to be considered for patients with achalasia and clinically relevant esophagogastric junction outflow obstruction.

Key message: Since the detailed pathophysiology of EMD remains unclear, their diagnosis needs to be cautiously established prior to the initiation of invasive treatment.

背景:食管运动障碍(EMDs)是由食管上/下括约肌松弛功能受损和/或食管蠕动收缩功能缺陷引起的,会导致吞咽困难和非心源性胸痛。高分辨率测压法(HRM)是诊断原发性食管内膜异位症的关键;然而,日本全科医生对食管内膜异位症和高分辨率测压法的认识有限。本综述总结了 EMD 的诊断和治疗策略。摘要:HRM 是诊断 EMD 的特异性检查,而作为筛查检查的内窥镜检查和吞钡检查可在某些病例中提供特征性结果(即食管玫瑰征和鸟嘴征)。值得注意的是,除贲门失弛缓症外,其他测压诊断往往与临床无关;因此,最近更新的指南建议在侵入性治疗前进行额外的测压操作(如快速饮水挑战)和进一步检查(包括功能性管腔成像),以获得更准确的诊断。对于有贲门失弛缓症和临床相关食管胃交界处流出道梗阻的患者,需要考虑内镜/外科肌切开术、气压扩张术和肉毒杆菌毒素注射:关键信息:由于EMD的详细病理生理学仍不清楚,因此在开始侵入性治疗之前需要谨慎确定其诊断。
{"title":"Esophageal Motility Disorders: Diagnosis and Treatment Strategies.","authors":"Yoshimasa Hoshikawa, Katsuhiko Iwakiri","doi":"10.1159/000533347","DOIUrl":"10.1159/000533347","url":null,"abstract":"<p><strong>Background: </strong>Esophageal motility disorders (EMDs) are caused by the impaired relaxation of the upper/lower esophageal sphincter and/or defective esophageal peristaltic contractions, resulting in dysphagia and noncardiac chest pain. High-resolution manometry (HRM) is essential for the diagnosis of primary EMD; however, the recognition of EMD and HRM by general practitioners in Japan is limited. This review summarizes the diagnosis of and treatment strategies for EMD.</p><p><strong>Summary: </strong>HRM is a specific test for the diagnosis of EMD, whereas endoscopy and barium swallow as screening tests provide characteristic findings (i.e., esophageal rosette and bird's beak sign) in some cases. It is important to note that manometric diagnoses apart from achalasia are often clinically irrelevant; therefore, the recently updated guidelines suggest additional manometric maneuvers, such as the rapid drink challenge, and further testing, including functional lumen imaging, for a more accurate diagnosis before invasive treatment. Endoscopic/surgical myotomy, pneumatic dilation, and botulinum toxin injections need to be considered for patients with achalasia and clinically relevant esophagogastric junction outflow obstruction.</p><p><strong>Key message: </strong>Since the detailed pathophysiology of EMD remains unclear, their diagnosis needs to be cautiously established prior to the initiation of invasive treatment.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"11-17"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10458701","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
Analysis of the Medication Persistence Rate for and Adherence to Oral 5-Aminosalicylic Acid Preparations in Japanese Patients with Ulcerative Colitis: Study Using a Nationwide Claims Database. 日本溃疡性结肠炎患者口服 5-氨基水杨酸制剂的用药持续率和依从性分析:使用全国索赔数据库进行的研究。
IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2024-03-25 DOI: 10.1159/000538319
Takumi Ota, Takahiro Takebe, Yutaka Shimizu, Takashi Orido, Hiroyuki Tanaka, Shiro Nakamura

Introduction: 5-aminosalicylic acid (5-ASA) is the first-line drug for the treatment of mild-to-moderate ulcerative colitis (UC). Three oral sustained-release formulations are often used. However, no unified view of their actual use in routine medical practice has been presented to date.

Methods: Using a health insurance claims database, we extracted patients with an initial diagnosis of mild-to-moderate UC during the period from December 1, 2017, to March 31, 2022. For the three types of oral 5-ASA formulation, we calculated and compared descriptive statistics of medication persistence rates (MPR), proportions of days covered (PDC), and adherence proportion (PDC ≥80%) in the extracted population.

Results: An oral 5-ASA formulation was used in combination with a topical preparation (cohort 1) in 899 patients, and oral 5-ASA was used alone (cohort 2) in 1,829 patients. In cohort 1, MPR at days 151-180 with concomitant use of topical formulation was significantly higher for the Multi Matrix System™ (MMX) formulation (65.2%) compared with that for pH-dependent formulation (51.7%, p < 0.025), while MPR tended to be higher for MMX than for the time-dependent formulation (56.4%, not significant). During days 151-180 after starting the oral formulation, MPR for MMX (66.7% and 65.8%) was higher than for pH-dependent (55.9% and 55.3%) and time-dependent (57.6% and 55.9%) formulations in cohorts 1 + 2 and 2, respectively. In cohort 1, there was a significant difference between MMX (68.3%) and pH-dependent (57.1%) formulations, but no significant difference was seen with time-dependent formulations (61.8%). In terms of the proportion of adherence until day 180, MMX was significantly better than the other formulations.

Conclusion: The analyses of the three oral 5-ASA formulations suggested that both MPR and medication adherence were better for the MMX formulation than for time-dependent or pH-dependent formulations.

导言 5-氨基水杨酸(5-ASA)是治疗轻度至中度溃疡性结肠炎(UC)的一线药物。目前常用的有三种口服缓释制剂。然而,迄今为止还没有关于它们在常规医疗实践中实际使用情况的统一观点。方法 我们利用医疗保险理赔数据库,提取了 2017 年 12 月 1 日至 2022 年 3 月 31 日期间初步诊断为轻度至中度 UC 的患者。针对三种口服 5-ASA 制剂,我们计算并比较了提取人群中的用药持续率 (MPR)、覆盖天数比例 (PDC) 和依从性比例(PDC ≥ 80%)的描述性统计。结果 899 名患者口服 5-ASA 制剂与外用制剂联合使用(队列 1),1829 名患者单独口服 5-ASA 制剂(队列 2)。在队列 1 中,在同时使用外用制剂的第 151-180 天,Multi Matrix SystemTM (MMX) 制剂的 MPR(65.2%)显著高于 pH 依赖性制剂(51.7%,p < 0.025),而 MMX 的 MPR 往往高于时间依赖性制剂(56.4%,无显著性)。在开始口服制剂后的第 151-180 天,组群 1+2 和组群 2 中,MMX(66.7% 和 65.8%)的 MPR 分别高于 pH 依赖性制剂(55.9% 和 55.3%)和时间依赖性制剂(57.6% 和 55.9%)。在组群 1 中,MMX(68.3%)与 pH 依赖性制剂(57.1%)之间存在显著差异,但与时间依赖性制剂(61.8%)之间没有显著差异。在坚持服用至第 180 天的比例方面,MMX 明显优于其他制剂。结论 对三种口服 5-ASA 制剂的分析表明,MMX 制剂的 MPR 和服药依从性均优于时间依赖性制剂或 pH 依赖性制剂。
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引用次数: 0
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