Digestive Diseases and Sciences最新文献

Background: Ulcerative colitis patients who undergo ileal pouch-anal anastomosis (IPAA) without mucosectomy may develop inflammation of the rectal cuff (cuffitis). Treatment of cuffitis typically includes mesalamine suppositories or corticosteroids, but refractory cuffitis may necessitate advanced therapies or procedural interventions. This review aims to summarize the existing literature regarding treatments options for cuffitis.

Methods: A broad search strategy was created by a medical librarian to capture cuffitis in IPAA patients. A total of 1877 citations were identified, and 957 studies remained after removal of 920 duplicates. Two reviewers screened all 957 abstracts and 294 full-text articles to determine if they were eligible for inclusion in this review.

Results: Twenty-three studies met the inclusion criteria. Medical interventions were investigated in 16 studies with mesalamine and corticosteroid regimens being the most common, followed by ustekinumab, vedolizumab, hyperbaric oxygen, tofacitinib, risankizumab, and infliximab. Studies investigating mesalamine and corticosteroid use generally had larger samples (ranging 4-120 patients) and showed symptomatic improvement in 52-100% of patients and decreases of 1.14-1.8 points in endoscopic disease activity indices. In contrast, advanced therapy studies had small samples (ranging 1-21 patients) and variable responses. Seven studies explored endoscopic and surgical approaches including secondary mucosectomy, cuff resection, needle-knife therapy, and balloon dilation for concomitant outlet strictures. These techniques generally resulted in symptomatic resolution but were limited by small samples (ranging 3-40 patients).

Conclusion: Studies evaluating therapies used to treat cuffitis suggest benefit from conventional mesalamine or corticosteroid-based therapies, whereas data regarding advanced therapies and interventional procedures are inconsistent given small sample sizes.

Objectives: As one of the most common complications of laryngopharyngeal reflux or gastroesophageal reflux disease, dental erosion presents a significant association with laryngopharyngeal reflux. This study aimed to elucidate the role of laryngopharyngeal reflux and gastroesophageal reflux disease on the severity and occurrence of dental erosion in adult populations.

Methods: A comprehensive search was performed in the databases of PubMed/MEDLINE, Web of Science, Cochrane Library, and Scopus for English literature published from July 1999 to June 2024. Peer-reviewed publications evaluating the relationship between gastroesophageal reflux disease, laryngopharyngeal reflux, and dental erosion in adult populations were retrieved. Opensigle and the International Clinical Trials Registry Platform database were used to search the potential gray literature. A manual search was also performed to uncover further relevant studies from the reference lists.

Results: The electronic literature search yielded 1382 studies, with 22 researches in line with the inclusion criteria. Results of included publications indicated a significantly higher prevalence of dental erosion in adult populations with gastroesophageal reflux disease or laryngopharyngeal reflux compared to healthy populations. Subjects with dental erosion demonstrate a greater prevalence of laryngopharyngeal reflux or gastroesophageal reflux disease as well. The heterogeneity of the evaluation of clinical outcomes, diagnostic methods, and the definition of diseases need to be considered. Future studies should define reflux disease according to a universal guideline to better enhance treatment in adult populations.

Conclusion: Gastroesophageal reflux disease or laryngopharyngeal reflux presents a significant association with dental erosion in adult populations. Clinicians should emphasize timely detection and management of the underlying factors of dental erosion in patients with laryngopharyngeal reflux or gastroesophageal reflux disease.

The Janus kinase/signal transducer and activator of transfection (JAK/STAT) system is comprised of multiple cell surface receptors, receptor tyrosine kinases, and signal transducers that are key components of numerous systems involved in malignancy, inflammation, immune surveillance and development, cellular proliferation, metabolism, differentiation, apoptosis, and hematologic disorders, all of which when disrupted can produce severe disease. Nevertheless, small molecule inhibitors of the four known JAKs, termed JAKinibs, have found therapeutic indications for a broad category of diseases. In this perspective, I will summarize the development of JAK inhibitors, whose origins were in antiquity, with particular attention to their use in treating patients with inflammatory bowel disease (IBD). This perspective is accompanied by a companion publication addressing how JAKinibs have forever altered the landscape of IBD therapy.

Background: Alcohol use disorder and alcohol-associated liver disease is increasing in the US, with subsequent and expected increases in morbidity and mortality due to these conditions.

Aims: To determine the impact of an educational intervention regarding alcohol use disorder on gastroenterology fellows.

Methods: A before-after survey study was carried out. Subjects were gastroenterology fellows at an urban tertiary care facility, who completed a pre-questionnaire and then attended a one-hour educational lecture on alcohol use disorder, alcohol-related liver disease, and treatment/resources available for patients. Immediately after the 1-h lecture, fellows were asked to complete a post-questionnaire and then a delayed questionnaire three months later. Pre- and post-answers were averaged out of a scale of 5 and analyzed using t-tests.

Results: The study included eight fellows. Post-intervention, 12% of fellows felt more confident in having adequate training to provide alcohol use disorder counseling to their patients, 25% felt more confident in who they should refer their patients to for alcohol use disorder, and 16% felt more comfortable in being able to speak with their patients regarding alcohol use disorder and help effectively reduce their patients' consumption of alcohol (p value < 0.05).

Conclusion: A 1-h presentation discussing the complexities associated with diagnosing and treating alcohol use disorder, and the methods of helping destigmatize the disease in the medical community, can increase trainees' confidence and knowledge base to help treat patients with alcohol use disorder in the clinic setting and reducing liver morbidity.

Aim: Sarcopenic obesity (SO) is associated with adverse outcomes in diseased patients. This study aimed to examine the prevalence and risks associated with SO, with a focus on the impact of SO on cardiovascular risk in patients with MASLD.

Materials and methods: In this cross-sectional study, patients with MASLD were prospectively enrolled. Through dual-energy X-ray absorptiometry (DXA) scans, their body compositions were analyzed to identify who had SO and osteopenia/osteoporosis. The primary aim is to investigate risks associated with SO, followed by analyzing the association between SO and cardiovascular disease (CVD).

Results: Two hundred and twenty-three patients with MASLD were enrolled. The prevalence of SO was 47.1%, respectively. Patients coexisted with MASLD and SO had increased visceral adipose tissue (VAT), higher fatty liver index (FLI) and fibrosis 4 (FIB-4) score. Regression analysis revealed higher FLI and FIB-4 score, as well as history of hypertension, were risks associated with SO. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score was higher in patients coexisted with MASLD and SO compared to those without (10.1% vs. 7.3%, p = 0.006). Regression analysis showed that increased VAT and FIB-4 score were associated with raised risk of ASCVD.

Conclusion: Prevalence of SO in MASLD patients is considerable. The presence of SO also linked to higher risk of ASCVD. Therefore, the recognition of SO in patients with MASLD is important in clinical care.

Background: Chronic constipation, diarrhea, and fecal incontinence (FI) are prevalent with significant impact on quality of life and healthcare utilization. Thyroid dysfunction was recognized as a potential contributor to bowel disturbances in selected populations, but the strength/consistency of this association remain unclear.

Aims: To investigate the relationship between thyroid function and bowel health measures (constipation, diarrhea, and FI) in a nationally representative sample of the U.S.

Population:

Methods: We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) in 2005-2008. Adults aged ≥ 20 with TSH, free T4 (fT4), and bowel health data were included. Multivariable logistic regression models were constructed to examine associations between thyroid function and bowel health measures, adjusting for potential confounders.

Results: Among 6,552 participants, 93.6%, 4.3%, 1.7%, and 0.4% had TSH levels of 0.24-5.4, 5.4-10, < 0.24, and ≥ 10 mIU/L, respectively. There were no significant differences in prevalence of thyroid dysfunction between individuals with constipation or diarrhea and those without. In fully adjusted models, TSH was not a significant predictor of constipation, diarrhea, or FI, but higher fT4 was protective against constipation as a continuous variable (OR 0.47, CI: 0.26-0.85, p = 0.014)). Neither hypothyroid nor hyperthyroid status significantly correlated with constipation or diarrhea, although hyperthyroidism was associated with FI (OR 3.58, CI:1.51-8.49, p = 0.005).

Conclusion: While bowel disturbances were common in this nationally representative sample, the yield of thyroid function testing was low. Overt hypo- and hyperthyroidism were not significantly associated with constipation or diarrhea. Clinical utility of routine thyroid testing for bowel symptoms may be low in patients without systemic manifestations of severe thyroid disease.