GastroHep最新文献_第5页

Helicobacter pylori eradication by low-dose rifabutin triple therapy (RHB-105) is unaffected by high body mass index 低剂量利福布丁三联疗法（RHB-105）根除幽门螺杆菌不受高体重指数影响

GastroHep

Pub Date : 2021-09-28 DOI: 10.1002/ygh2.494

John Y. Kao, June S. Almenoff, Dana D. Portenier, Kely L. Sheldon

Background

Helicobacter pylori infection affects ~35% of Americans and may lead to serious sequelae if left untreated, including gastric cancer. Obesity is a significant risk factor for antibiotic treatment failure; however, little work has been done to understand the influence of high body mass index (BMI) on the success rates of H pylori eradication regimens in treatment-naïve and refractory adult patients.

Aim

This analysis evaluated the association of subject obesity on overall H pylori eradication rates for RHB-105 (rifabutin, amoxicillin, and omeprazole magnesium; Talicia^®) and its comparators using data from two Phase 3 clinical trials.

Methods

A post hoc analysis of the eradication rates of RHB-105 vs comparators in a total of 269 subjects who tested positive for H pylori was conducted. Comparators in the two studies included placebo (placebo comparator) and amoxicillin and omeprazole (active comparator). Subjects were treated for 14 days and returned for follow-up test-of-cure at 28-59 days post-therapy using urea breath testing.

Results

Subjects receiving RHB-105 with 30 ≤ BMI < 40 or BMI ≥ 40 had pooled modified intent to treat (mITT) eradication rates of 88.1% (95% CI: 81.1-92.8) and 90.9% (95% CI: 72.2-97.5) [P = .707], respectively, compared to active comparator rates of 62.9% (95% CI: 52.5-72.2) and 31.8% (95% CI: 16.4-52.7) [P = .008].

Conclusions

Obese patients treated with RHB-105 were associated with efficacy rates comparable to the overall study population. This supports further evaluation of the efficacy of RHB-105 in obese populations, where H pylori is prevalent. ClinTrials.gov # NCT01980095 & NCT031985070.

背景幽门螺杆菌感染影响约35%的美国人，如果不治疗可能会导致严重的后遗症，包括癌症。肥胖是抗生素治疗失败的重要危险因素；然而，很少有研究了解高体重指数（BMI）对治疗幼稚和难治性成年患者的幽门螺杆菌根除方案成功率的影响。目的本分析使用两项3期临床试验的数据评估了受试者肥胖与RHB-105（利福布汀、阿莫西林和奥美拉唑镁；Talicia®）及其对照品的幽门螺杆菌总根除率的关系。方法对269名幽门螺杆菌检测呈阳性的受试者中RHB-105与对照组的根除率进行事后分析。两项研究中的对照品包括安慰剂（安慰剂对照品）和阿莫西林和奥美拉唑（活性对照品）。受试者接受了14天的治疗，并在治疗后28-59天通过尿素呼气测试返回进行治愈随访测试。结果接受RHB-105治疗的受试者BMI＜30；40或BMI≥40的患者的改良意向治疗（mITT）根除率分别为88.1%（95%CI:81-19.2.8）和90.9%（95%CI:72-2-97.5）[P=.707]，与62.9%（95%CI:52.5-72.2）和31.8%（95%CI:16.4-52.7）的活性对照率相比[P=.008]。结论接受RHB-105治疗的肥胖患者的有效率与整个研究人群相当。这支持进一步评估RHB-105在幽门螺杆菌流行的肥胖人群中的疗效。ClinTrials.gov#NCT01980095&；NCT031985070。

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引用次数: 0

An updated incidence of paediatric achalasia and number of myotomies performed in the United Kingdom 英国儿童贲门失弛缓症的最新发病率和截肌次数

GastroHep

Pub Date : 2021-09-18 DOI: 10.1002/ygh2.493

Kitt Dokal, Mohamed Mutalib

Background

Achalasia is a rare condition characterised by an absent oesophageal peristalsis and a non-relaxing lower oesophageal sphincter. The incidence of paediatric achalasia is poorly studied and inconsistently reported. We aimed to provide an up to date incidence of paediatric achalasia in the UK.

Methods

All United Kingdom hospitals with paediatric gastroenterology and/or paediatric surgery were contacted to provide data on achalasia diagnosis and myotomies performed (2008-2020). Hospital Episode Statistics includes diagnostic and procedural data for all hospitals in England that were searched for achalasia and myotomy in children (1998-2020). Proxy data (epilepsy diagnosis) were used to compare diagnosis.

Results

The incidence of paediatric achalasia in the UK was 0.38 (England 0.43, Wales 0.09, Scotland 0.15 and Northern Ireland 0.17) per 100 000 population per year. The number of myotomies performed remained stable with an average of (±SD) 11.6 (±5) from 2000 to 2020, however, there was a gradual increase in achalasia admissions 58.4 (±19) in the same time period. Using epilepsy as proxy condition, hospitals appear to diagnose achalasia predominantly from their geographic catchment population raising concerns about underdiagnosing achalasia in children.

Conclusion

The incidence of paediatric achalasia in the UK is significantly higher than previously reported. Although this is still lower than the incidence in adults, the gap is narrowing. There is evidence to suggest an ongoing underdiagnosis of achalasia in childhood contributing to the wide variation in care across the UK.

背景贲门失弛缓症是一种罕见的疾病，其特征是食道蠕动缺失和食道下括约肌不松弛。儿童贲门失弛缓症的发病率研究较少，报道不一致。我们旨在提供英国儿童贲门失弛缓症的最新发病率。医院事件统计包括英格兰所有医院的诊断和手术数据，这些医院在儿童中搜索了贲门失弛缓症和肌切开术（1998-2020）。代理数据（癫痫诊断）用于比较诊断。结果英国儿童贲门失弛缓症的发病率为每年每10万人口0.38例（英格兰0.43例，威尔士0.09例，苏格兰0.15例，北爱尔兰0.17例）。从2000年到2020年，截肌次数保持稳定，平均为（±SD）11.6（±5），但同期贲门失弛缓症入院人数逐渐增加，为58.4（±19）。使用癫痫作为替代条件，医院似乎主要从其地理分布人群中诊断出贲门失弛缓症，这引发了人们对儿童贲门失弛弛缓症诊断不足的担忧。结论英国儿童贲门失弛缓症的发病率明显高于以往报道。尽管这仍然低于成年人的发病率，但差距正在缩小。有证据表明，儿童期贲门失弛缓症的诊断不足导致了英国各地护理的广泛差异。

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引用次数: 0

Post-cholecystectomy diarrhoea: New light on old problem 胆囊切除术后腹泻：对老问题的新认识

GastroHep

Pub Date : 2021-09-16 DOI: 10.1002/ygh2.492

Her Hsin Tsai

Up to 10% of patients who have had cholecystectomies suffer from symptomatic diarrhoea. The mechanism of this diarrhoea is not fully understood. It is often assumed that the diarrhoea is caused by increased bile acid. The evidence for this is based on studies which show that twothirds of patients who experience diarrhoea after the operation have excess bile acid and respond to cholestyramine, a bile acid sequestrant.1 Other poorly understood neuroendocrine effects of cholecystectomy may also be contributory factor and may account for the remaining third of patients. The mechanism by which there is increased bile acid in the lower gut after cholecystectomy is unclear. There are several proposals: a faster enterohepatic recycling of bile acids with increased bile acid synthesis or a change in the composition of the bile acid pool could play a role. The bile synthesis rate may be assessed with plasma 7αhydroxy4cholesten3one (C4), whereas ileal reabsorption of bile acids may be assessed with plasma fibroblast growth factor 19 (FGF19).2 In patients with bile acid diarrhoea, lower fasting FGF19 and higher fasting C4 have been previously demonstrated. In this paper, Borup et al tries to shed more light into this intriguing condition.3 They measured FGF19 and C4 levels in 18 individuals before and after cholecystectomy. FGF19 is stimulated in the ileum in response to bile acid and is thus a useful biomarker for ileal bile acid load. They assessed their symptoms and looked at fasting and postprandial levels of FGF19 in these individuals before and after cholecystectomy. They demonstrated that fasting levels of FGF19 are unchanged but postprandial levels are significantly increased after cholecystectomy. They also found that fasting C4 levels to be unchanged after cholecystectomy in their cohort. These results are puzzling and could lead to a rethink as to the mechanism of postcholecystectomy diarrhoea. Unfortunately, none of the patients they studied had symptomatic diarrhoea. This is likely to be a statistical fluke and rather unfortunate as these results suggest that both bile acid production and recycling is increased after cholecystectomy. Perhaps if they could continue their studies and recruit a larger cohort they may start to further elucidate the pathophysiology of postcholecystectomy diarrhoea.

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引用次数: 0

Mortality pattern in cirrhosis: A reflection of liver disease burden in India 肝硬化的死亡率模式:印度肝病负担的反映

GastroHep

Pub Date : 2021-09-09 DOI: 10.1002/ygh2.497

D. Misra, K. Das, Saswata Chatterjee, Parthasarathi Mukherjee, A. Chowdhury

Mortality data from high‐income group countries are frequently used in developing countries for healthcare planning. This study was planned to explore the mortality pattern of cirrhosis in India in terms of survival after diagnosis of cirrhosis, predictors of death and aetiology specific effect on mortality.

高收入国家的死亡率数据经常用于发展中国家的医疗保健规划。本研究旨在探讨印度肝硬化的死亡率模式，包括肝硬化诊断后的生存率、死亡预测因素和病因学对死亡率的特定影响。

引用次数: 2

Post‐cholecystectomy diarrhoea: New light on old problem 胆囊切除术后腹泻:对老问题的新认识

GastroHep

Pub Date : 2021-09-01 DOI: 10.1002/ygh2.492

H. Tsai

Up to 10% of patients who have had cholecystectomies suffer from symptomatic diarrhoea. The mechanism of this diarrhoea is not fully understood. It is often assumed that the diarrhoea is caused by increased bile acid. The evidence for this is based on studies which show that twothirds of patients who experience diarrhoea after the operation have excess bile acid and respond to cholestyramine, a bile acid sequestrant.1 Other poorly understood neuroendocrine effects of cholecystectomy may also be contributory factor and may account for the remaining third of patients. The mechanism by which there is increased bile acid in the lower gut after cholecystectomy is unclear. There are several proposals: a faster enterohepatic recycling of bile acids with increased bile acid synthesis or a change in the composition of the bile acid pool could play a role. The bile synthesis rate may be assessed with plasma 7αhydroxy4cholesten3one (C4), whereas ileal reabsorption of bile acids may be assessed with plasma fibroblast growth factor 19 (FGF19).2 In patients with bile acid diarrhoea, lower fasting FGF19 and higher fasting C4 have been previously demonstrated. In this paper, Borup et al tries to shed more light into this intriguing condition.3 They measured FGF19 and C4 levels in 18 individuals before and after cholecystectomy. FGF19 is stimulated in the ileum in response to bile acid and is thus a useful biomarker for ileal bile acid load. They assessed their symptoms and looked at fasting and postprandial levels of FGF19 in these individuals before and after cholecystectomy. They demonstrated that fasting levels of FGF19 are unchanged but postprandial levels are significantly increased after cholecystectomy. They also found that fasting C4 levels to be unchanged after cholecystectomy in their cohort. These results are puzzling and could lead to a rethink as to the mechanism of postcholecystectomy diarrhoea. Unfortunately, none of the patients they studied had symptomatic diarrhoea. This is likely to be a statistical fluke and rather unfortunate as these results suggest that both bile acid production and recycling is increased after cholecystectomy. Perhaps if they could continue their studies and recruit a larger cohort they may start to further elucidate the pathophysiology of postcholecystectomy diarrhoea.

高达10%的胆囊切除术患者出现症状性腹泻。这种腹泻的机制尚不完全清楚。通常认为腹泻是由胆汁酸增加引起的。有研究表明，手术后出现腹泻的患者中，有三分之二的患者胆汁酸过多，并对胆甾胺(一种胆汁酸隔离剂)有反应其他对胆囊切除术的神经内分泌影响知之甚少，也可能是一个促成因素，可能占其余三分之一的患者。胆囊切除术后下肠胆汁酸增加的机制尚不清楚。有几种建议:随着胆汁酸合成的增加，胆汁酸的肠肝循环更快或胆汁酸池组成的改变可能起作用。胆汁合成速率可用血浆7α -羟基胆甾醇31酮(C4)评估，胆汁酸的回肠重吸收可用血浆成纤维细胞生长因子19 (FGF19)评估在胆汁酸腹泻患者中，先前已证实空腹FGF19较低和空腹C4较高。在这篇论文中，Borup等人试图阐明这个有趣的情况他们测量了18个人胆囊切除术前后的FGF19和C4水平。FGF19在回肠中响应胆汁酸而受到刺激，因此是回肠胆汁酸负荷的有用生物标志物。他们评估了他们的症状，并观察了这些人在胆囊切除术前后的空腹和餐后FGF19水平。他们证明空腹FGF19水平不变，但胆囊切除术后餐后水平显著升高。他们还发现，在他们的队列中，胆囊切除术后空腹C4水平没有变化。这些结果令人困惑，并可能导致对胆囊切除术后腹泻机制的重新思考。不幸的是，他们研究的病人都没有出现症状性腹泻。这很可能是统计上的侥幸，而且相当不幸，因为这些结果表明胆囊切除术后胆汁酸的产生和循环都增加了。也许如果他们能够继续他们的研究并招募更大的队列，他们可能会开始进一步阐明胆囊切除术后腹泻的病理生理学。

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引用次数: 0

Telotristat in the management of Carcinoid diarrhoea – A real world experience of patients from ENETs centre of excellence in Neuroendocrine tumours Telotristat治疗类癌性腹泻——来自ENETs神经内分泌肿瘤卓越中心的患者的真实世界经验

GastroHep

Pub Date : 2021-09-01 DOI: 10.1002/ygh2.491

A. Khanna, N. Cianci, Husnain Abbas Shah, A. Goel, A. Jebril, J. Chauhan, M. Pipe, S. Shetty, C. Weston, H. Venkataraman, Stacey Smith, S. Vickrage, J. Kemp-Blake, T. Shah

Diarrhoea is a common and debilitating symptom of Carcinoid syndrome. Effective control of symptoms is achieved with somatostatin analogues (SSAs) and additional loperamide and/or codeine phosphate. Symptom control is lost with time and disease progression. There is, therefore, a strong need for additional and more effective therapies. Telotristat‐ethyl is a peripheral tryptophan‐hydroxylase inhibitor approved for treatment of diarrhoea. Here, we present our experience of Telotristat for treating carcinoid diarrhoea in a large cohort of patients outside of clinical trials. The primary outcome was reduction in stool frequency of >30%, as defined in most studies.

腹泻是类癌综合征常见的衰弱症状。生长抑素类似物(SSAs)和额外的洛哌丁胺和/或磷酸可待因可有效控制症状。症状控制随着时间和疾病进展而丧失。因此，迫切需要更多和更有效的治疗方法。Telotristat‐ethyl是一种外周色氨酸‐羟化酶抑制剂，被批准用于治疗腹泻。在这里，我们介绍了我们在临床试验之外的一大群患者中使用Telotristat治疗类癌性腹泻的经验。根据大多数研究的定义，主要结局是大便频率减少>30%。

引用次数: 0

Effect of cholecystectomy on bile acid diarrhoea biomarkers: A prospective clinical study 胆囊切除术对胆汁酸腹泻生物标志物的影响:一项前瞻性临床研究

GastroHep

Pub Date : 2021-09-01 DOI: 10.1002/ygh2.489

C. Borup, Nora Hedbäck, S. Wildt, J. Rumessen, P. Bouchelouche, Emilie Gauliard, D. Rainteau, L. Munck

The pathophysiological mechanisms of bile acid diarrhoea after cholecystectomy are unknown. Therefore, we aimed to explore the effects of cholecystectomy on the plasma biomarkers of bile acid diarrhoea: fibroblast growth factor 19 and 7α‐hydroxy‐4‐cholesten‐3‐one.

胆囊切除术后胆汁酸腹泻的病理生理机制尚不清楚。因此，我们旨在探讨胆囊切除术对胆汁酸腹泻血浆生物标志物:成纤维细胞生长因子19和7α -羟基- 4 -胆甾醇- 3 - 1的影响。

引用次数: 2

Telotristat in the management of Carcinoid diarrhoea – A real world experience of patients from ENETs centre of excellence in Neuroendocrine tumours Telotristat治疗类癌性腹泻——ENETs神经内分泌肿瘤卓越中心患者的真实体验

GastroHep

Pub Date : 2021-08-30 DOI: 10.1002/ygh2.491

Amardeep Khanna, Nicole Cianci, Husnain Abbas Shah, Ashish Goel, Asma Jebril, Jessica Chauhan, Michelle Pipe, Shishir Shetty, Christopher Weston, Hema Venkataraman, Stacey Smith, Suzanne Vickrage, Joanne Kemp-Blake, Tahir Shah

Background and Aims

Diarrhoea is a common and debilitating symptom of Carcinoid syndrome. Effective control of symptoms is achieved with somatostatin analogues (SSAs) and additional loperamide and/or codeine phosphate. Symptom control is lost with time and disease progression. There is, therefore, a strong need for additional and more effective therapies. Telotristat-ethyl is a peripheral tryptophan-hydroxylase inhibitor approved for treatment of diarrhoea. Here, we present our experience of Telotristat for treating carcinoid diarrhoea in a large cohort of patients outside of clinical trials. The primary outcome was reduction in stool frequency of >30%, as defined in most studies.

Methods

Patients were identified from a prospective database and information collected retrospectively from the hospital's electronic patient records. We included 31 patients (25 males, 6 females; Median age 69 years) on Telotristat and 10 patients on fortnightly high-dose SSA (6 males, 4 females; Median age 67 years).

Results

The mean (range) duration of treatment in telotristat and 2 weekly SSA groups was 258 (15-479) and 689 (219-1446) days respectively. Primary endpoint was achieved in 82% (23/28) patients on Telotristat with median percentage reduction in stool frequency of 60% (IQR 50-69), compared to 28% (2/7) (22 (−30 to 55) %) in the control group. Odds ratio for reduction in stool frequency >30% was −11, (95% CI 1.71-77.1).

Conclusion

This real world experience supports the effectiveness and safety of Telotristat to treat carcinoid diarrhoea not adequately controlled by standard treatment with SSA.

背景和目的腹泻是类癌综合征中常见的使人衰弱的症状。生长抑素类似物（SSAs）和额外的洛哌丁胺和/或磷酸可待因可有效控制症状。症状控制随着时间和疾病进展而丧失。因此，迫切需要更多更有效的治疗方法。Telotristat ethyl是一种外周色氨酸羟化酶抑制剂，被批准用于治疗腹泻。在这里，我们在临床试验之外的一大群患者中介绍了Telotristat治疗类癌腹泻的经验。主要结果是粪便频率降低>；30%，正如大多数研究中所定义的那样。方法从前瞻性数据库中识别患者，并从医院的电子患者记录中回顾性收集信息。我们纳入了31名接受Telotristat治疗的患者（25名男性，6名女性；中位年龄69岁）和10名每两周接受一次高剂量SSA的患者（6名男性，4名女性；年龄67岁）。结果telotristat组和2周SSA组的平均（范围）治疗时间分别为258（15-479）和689（219-1446）天。82%（23/28）的Telotristat患者达到了主要终点，排便频率的中位百分比降低了60%（IQR 50-69），而对照组为28%（2/7）（22（-30至55）%）。大便次数减少的比值比>；30%为−11，（95%可信区间1.71-77.1）。结论这一真实世界的经验支持Telotristat治疗类癌性腹泻的有效性和安全性，而SSA的标准治疗不能充分控制此类腹泻。

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引用次数: 0

An updated incidence of paediatric achalasia and number of myotomies performed in the United Kingdom 在英国进行的儿科贲门失弛缓症的最新发病率和肌切开术的数量

GastroHep

Pub Date : 2021-08-25 DOI: 10.1002/ygh2.493

K. Dokal, M. Mutalib

Achalasia is a rare condition characterised by an absent oesophageal peristalsis and a non‐relaxing lower oesophageal sphincter. The incidence of paediatric achalasia is poorly studied and inconsistently reported. We aimed to provide an up to date incidence of paediatric achalasia in the UK.

贲门失弛缓症是一种罕见的疾病，其特征是食管蠕动缺失和食管下括约肌不松弛。儿童贲门失弛缓症的发病率研究很少，报道也不一致。我们的目的是提供一个最新的发病率的儿科贲门失弛缓症在英国。

引用次数: 0

Patient perceptions of successful hepatitis C virus treatment adherence in Veterans 退伍军人对丙型肝炎病毒治疗依从性的看法

GastroHep

Pub Date : 2021-08-24 DOI: 10.1002/ygh2.474

Grace Y. Zhang, Krupa Patel, Olufunso Agbalajobi, Wheytnie Alexandre, A. Reid, M. Serper, Linda Calgaro, S. Zickmund, Tami Coppler, Margaret Mizah, O. Shaikh, Shari S. Rogal

Treatment adherence remains a potential barrier to achieving population‐level hepatitis C virus (HCV) elimination by 2030. We aimed to understand barriers to and facilitators of HCV treatment adherence pre‐ and post‐direct‐acting antiviral (DAA) treatment.

治疗依从性仍然是实现到2030年消除人群水平丙型肝炎病毒(HCV)的潜在障碍。我们的目的是了解直接作用抗病毒(DAA)治疗前后HCV治疗依从性的障碍和促进因素。

引用次数: 0