Digestive Diseases and Sciences最新文献

Introduction: Vitamin D deficiency is common in Paediatric Inflammatory Bowel Disease (PIBD) and has been implicated in disease pathogenesis and disease exacerbation. Current guidelines recommend oral vitamin D supplementation when 25OHD levels are below 50 nmol/L. Supplementation comes in two forms: either a daily supplement of a low dose of vitamin D3 (2000 IU) for several months or a single high dose of oral vitamin D3-termed 'stoss' therapy, with no consensus regarding optimum treatment.

Methods: A randomised controlled trial was conducted in children with a prior diagnosis of PIBD with 25OHD deficiency (< 50 nmol/L), comparing 2000 IU oral D3 daily to a stoss protocol (oral D3 dosage 400,000 IU for 3-12 years of age or 800,000 IU for > 12 years). Children were followed for 12 months, with biochemistry (25OHD, calcium, magnesium, phosphate, parathyroid hormone, haemoglobin, haematocrit, platelets, albumin), stool markers (calprotectin, S100A12), anthropometrics (weight, height, body mass index) as well as clinical disease indices (Paediatric Crohn's Disease Activity Index, Paediatric Ulcerative Colitis Activity Index) and medication use collected at 3, 6, 9 and 12 months.

Results: 74 children aged 5-18 years completed the study. Both 2000 IU daily and stoss protocol significantly increased 25OHD from baseline values at 3, 6, 9 and 12 months. One patient randomised to stoss protocol had a 25OHD level of 263 nmol/L with normal serum calcium. There was no difference in biochemical, stool or clinical markers between groups at any time point, nor was there any correlation between 25OHD level and calprotectin or 25OHD level and clinical disease activity scores.

Conclusion: Stoss protocol was non-inferior to 2000 IU daily vitamin D3 in raising 25OHD levels at 12 months. There was also no difference between 25OHD levels at 3, 6 and 9 months between groups.

Background: Severe Acute Pancreatitis (SAP) is associated with significant intestinal injury and inflammation. Hypoxia-Inducible Factor-1α (HIF-1α) and NLRP3 inflammasome have been implicated in this process, but their specific roles remain unclear.

Objective: This study aims to elucidate the roles of HIF-1α and NLRP3 in the pathogenesis of SAP and their effects on intestinal injury, barrier function, and inflammatory responses.

Methods: A SAP rat model was established, and histological changes were assessed via HE staining. Western blot was used to analyze HIF-1α and NLRP3 expression in intestinal mucosa. The effects of HIF-1α modulation were examined using the activator DMOG and inhibitor BAY87-2243. Immunohistochemistry, ELISA, and TUNEL staining were used to evaluate intestinal barrier function, permeability markers, and apoptosis.

Results: HIF-1α and NLRP3 expression significantly increased in SAP rats, peaking at 72 h. HIF-1α activation aggravated intestinal injury and barrier dysfunction, decreasing tight junction protein levels and increasing epithelial apoptosis. Enhanced intestinal permeability and elevated pro-inflammatory cytokines were also observed. Furthermore, HIF-1α activation promoted NLRP3 inflammasome assembly, resulting in increased caspase-1 and IL-1β expression.

Conclusion: HIF-1α exacerbates intestinal injury and inflammation in SAP, likely through NLRP3 inflammasome activation. Targeting HIF-1α may offer a potential therapeutic approach for SAP-induced damage and inflammation.

Background: The adenoma detection rate is a key colonoscopy quality indicator, but the adenoma miss rate (AMR) is more strongly linked to post-colonoscopy colorectal cancer risk. While studies examined high-definition colonoscopy and AMR, no studies have assessed its impact on consecutive polypectomy.

Aim: This study aimed to identify adenomas missed in screening or surveillance colonoscopy and determine if the endoscopic system affects the miss rate.

Methods: This retrospective study analyzed patients referred to Dong-A University Hospital for polypectomy after polyps were detected during screening or surveillance colonoscopy at 24 healthcare institutions. Endoscopic systems used in these colonoscopies were classified as FHD (FHD) or non-FHD. Consecutive polypectomies were performed by a single expert between March 2020 and February 2022 using the FHD system. The AMR was compared and analyzed for screening or surveillance colonoscopies performed using FHD endoscopic systems and those using non-FHD endoscopic systems.

Results: Of 542 polyps, 186 were missed (miss rate: 25.22%). Miss rates for adenoma and advanced neoplasia were 27.34% and 14.69%. Univariate analysis identified age, adenoma count, and endoscopic system as significant factors. However, only the endoscopic system remained significant in the multivariate analysis. In screening or surveillance colonoscopy, the use of FHD endoscopic systems demonstrated a lower AMR compared to non-FHD systems (21.86% vs. 31.41%, P = 0.014).

Conclusion: The use of FHD endoscopic systems reduced AMR compared to non-FHD systems.

Background: Theoretical infection concerns prompted national Department of Veterans Affairs guidance prohibiting simethicone use in colonoscope reservoirs on January 1, 2024.

Aims: We sought to determine if reservoir simethicone is associated with post-procedure infection and impact on procedure time, sedation usage, and adenoma detection rate.

Methods: We conducted a retrospective cohort study of all-comers undergoing colonoscopy at Houston's Veterans Affairs hospital during September 1-30, 2023 (reservoir simethicone) and April 1-30, 2024 (aliquots administered on request [channel simethicone]). Primary outcomes were mean withdrawal and cecal intubation times. Secondary outcomes were adenoma detection rate, post-procedure 30-day infection rate, and sedation usage. We adjusted for covariates and used linear regression to determine significant predictors for mean withdrawal and intubation times.

Results: Of 446 total colonoscopies, 211 used reservoir simethicone (47.3%) and 235 (52.7%) used channel simethicone. Mean intubation time was 8.3 min [SD ± 6.5] in the reservoir group and 9.9 min [SD ± 8.4] in the channel group (p = 0.03). Mean withdrawal time was 17.4 min [SD ± 10.2] in the reservoir group and 20.9 min [SD ± 11.9] in the channel group (p = < 0.01). Reservoir group procedures required less midazolam (p = 0.01) and fentanyl (p = 0.02). Post-operative infection (n = 1 vs n = 0; p = 0.47) and adenoma detection rate (p = 0.92) differences were not significant.

Conclusions: Reservoir simethicone was significantly associated with shorter intubation and withdrawal times and lower sedation usage, even after adjusting for covariates, suggesting increased efficiency with comparable infection risk.

Objective: Chronic non-specific stenosing ulcers (CNSU) of the small intestine is an under-recognized syndrome characterized by iron-deficiency anemia, superficial ulcerations, and stenoses of the small intestine. Despite the recent identification of a gene mutation SLCO2A1 in some Japanese patients that plays an etiological role, much remains uncertain about the etiology and pathogenesis of CNSU in the Western Hemisphere. We report a similar pattern of non-specific ulceration that is nontransmural and often associated with small intestinal stenosis and iron deficiency but not hypoalbuminemia, and that appears to be distinct from Crohn's disease, and compare the demographic, clinic, and histopathologic features.

Methods: This was a retrospective, single-center study performed at a tertiary care hospital between 2007 and 2019. Forty patients were included, of whom 20 were diagnosed with CNSU and 20 with small intestinal CD. Demographic, clinical, and histopathologic data were collected and compared.

Results: Patients with CNSU were significantly older than patients with CD (56.9-years vs. 33.6-years, p < 0.0001), and had significantly lower rates of diarrhea (10% vs 90%; p < 0.01) and weight loss (5% vs 40%; p = 0.005) and greater rates of blood transfusions (50% vs 10%, p = 0.005) and iron infusions (35% vs. 0%, p = 0.001). In addition, qualitative descriptions of endoscopic findings and histopathologic features differed between the two groups.

Conclusion: CNSU is an uncommon small intestinal disease with clinical and pathologic features that distinguish it from CD. However, the immunology of both conditions is similar, suggesting a generic immune response. Further research is needed to better define the pathogenesis and prognosis of the disease.

Background: Individuals with an increased risk of colorectal cancer (CRC) are advised to have surveillance colonoscopies at guideline-recommended intervals to prevent cancer development. As more recent clinical guideline updates have extended colonoscopy intervals for those with lower risk findings, effective communication of these surveillance changes is essential for ensuring patient acceptance.

Aims: To evaluate patient preferences for surveillance colonoscopy frequency, and responses to an extended colonoscopy interval.

Methods: The study population included individuals at increased risk for CRC who were enrolled in a South Australian surveillance program. Preferences for surveillance frequency were collected via survey, and responses to a letter implementing a guideline-recommended colonoscopy interval change from 3 to 5 years were obtained from clinical data.

Results: While 46.6% (n = 186/399) of survey respondents preferred a more frequent colonoscopy interval than their current clinical recommendation, 80.4% indicated that they would be comfortable following whatever their specialist recommends. In practice, only 2.9% (n = 11/380) of patients queried the extended surveillance colonoscopy interval with the clinical team.

Conclusions: Specialist involvement can increase the acceptance of extended colonoscopy intervals, despite patient preferences for more frequent procedures. Therefore, the implementation of updated surveillance guidelines should be communicated to patients with specialist endorsement.