Hepato-gastroenterology最新文献

Background/aims: Several adverse events have been reported in patients who are chronic users of proton pump inhibitors (PPIs); however, the association between PPI use and small-intestinal bacterial overgrowth (SIBO) is controversial. We examined the prevalence of SIBO, as assessed by the lactulose hydrogen breath test (LHBT), based on the use of gastric acid-suppressive drugs in Japanese patients. METH- ODOLOGY: Ninety-four patients who were examined by the LHBT were assessed retrospectively. We used several criteria to define a positive LHBT result. Nine patients received probiotics containing Lactobacillus casei.

Results: Fifty patients were PPI users, 14 were histamine-2 receptor antagonist (H2RA) users, and were 30 non-PPI and non-H2RA users (controls). There were no significant differences in prevalence of LHBT-positive cases among the three groups. Multiple-adjusted regression showed no significant association between PPI use and being LHBT-positive. Prevalence of postprandial fullness in PPI users was high (46%), but such symptoms were not related to LHBT results. Four (44%) of 9 cases became LHBT-negative and the maximal peak of H2 production decreased significantly after probiotic treatment.

Conclusions: PPI treatment is not associated with SIBO in Japanese patients. Mechanisms apart from SIBO could cause the high prevalence of postprandial fullness in PPI users.

Background/aims: Kupffer cells play critical roles in both progression and resolution of liver fibrosis. Interferon α2b is an important immunoregulator which has anti-fibrotic effect in addition to its antiviral effect. It remained unclear whether the anti-fibrotic effect of interferon α2b is mediated by regulating functions of Kupffer cells.

Methodology: Primary isolated Kupffer cells were cultured with interferon α2b and the expression of matrix metalloproteinase-13, interleukin-10, transforming growth factor -β1 and tumor necrosis factor-α were measured. To investigate the role of mitogen-activated protein kinase pathways in regulating cytokines production by interferon α2b-stimulated Kupffer cells, inhibitors were given before cells were treated with interferon a2b.

Results: Cell purity was more than 98%. Stimulating Kupffer cells with interferon α2b led to a dramatic increase in matrix metalloproteinase-13 and interleukin-10 expression. In contrast, the values of tumor necrosis factor-α and transforming growth factor -β1 remained unchanged throughout the 24-hour observation period. Inhibited ERK1/2 pathway prevented interferon α2b-triggered matrix metalloproteinase-13 production, while inhibited p38MAPK, ERK1/2 or JNK signaling pathways all blocked interleukin-10 expression.

Conclusions: Interferon α2b may exert anti-fibrotic effect by elevating the level of matrix metalloproteinase-13 and interleukin-10 in Kupffer cells, in a mitogen-activated protein kinase signaling pathways-dependent manner.

Background/aims: We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments.

Methodology: A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer.

Results: This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved.

Conclusion: This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

In recent years, more elderly patients with gastrointestinal cancers have been undergoing surgery. As one of main postoperative complications, postoperative delirium (POD) is harmful and difficult to prevent and treat. Prevention, diagnosis and treatment to POD properly and ptomptly can promote the patient's overall recovery. However, health care providers still have many problems for POD to face in elderly,with gastrointestinal cancers during the clinical care. In this paper, Etiology, damages, prevention, diagnosis and treatment of POD in elderly with gastrointestinal cancer were reviewed, and the prospect of POD was also discussed.

Background/aims: To observe the effects of Sargent gloryvine decoction (SGD) on severe acute pancreatitis (SAP) treatment and to evaluate its clinical value.

Methodology: 112 patients of SAP in our hospital from January, 2005 to December, 2012 were recruited for retrospective analysis. They were divided into two groups, SGD group (62 patients) and control group without treated with SGD (50 patients). Inflammation factor, CT grade and Ranson grade were used to estimate the severity of SAP, and were compared in these two groups. In addition, peripancreatic infection, incidence of pseudo pancreatic cyst, time of anal exsufflation and duration of fever were used to evaluate the effect of SGD treatment. After perfusion of SGD for different time, hospitalization days and cost were recorded to evaluate clinical value of SGD.

Results: After perfusion, many indexes in SGD were remarkably superior to those of control group, such as duration of fever, incidence of pseudo pancreatic cyst, peripancreatic infection and Ranson grade. Meanwhile, SGD can sharply down-regulate inflammation reaction levels of SAP patients, so that the hospitalization days and costs can be obviously saved.

Conclusion: According to comparison, perfusion of SGD is a potential candidate for SAP treatment and is valuable in clinical application.

Background/aims: We performed this retrospective cohort study to identify prognostic factors for unresectable pancreatic cancer treated with current standard therapy using gemcitabine (GEM) or S-1 and to stratify patients prior to treatment using a prognostic index (PI).

Methodology: We analyzed 182 patients with unresectable pancreatic cancer, who had received GEM or S-1 as first-line chemotherapy. Factors that contributed to the prognosis were identified by univariate and multivariate analysis using a Cox proportional hazards model. The PI was constructed using the factors identified in the multivariate analysis.

Results: By multivariate analysis, performance status (PS), stage, and absolute neutrophil count (ANC) were identified as factors that independently contributed to the prognosis of unresectable pancreatic cancer (P < 0.05). The hazard ratios were 1.69, 3.33, and 1.18, respectively. In addition, PI was calculated using these three factors. Patients were classified into three groups according to the PI values. A significant difference was observed among the survival curves of these three groups (P < 0.05).

Conclusions: We identified three prognostic factors in the population after the introduction of S-1, and have created a simple and useful PI. This index demonstrates the ability to accurately classify advanced pancreatic cancer patients before the start of treatment.

Background/aims: For hepatocellular carcinoma (HCC) within a single subsegment, the superiority of anatomical subsegmentectomy over non-anatomical partial resection is still controversial. In this study, we assessed the potential benefit of subsegmentectomy.

Methodology: We selected 44 patients with a single HCC lesion within one subsegment who had undergone anatomical subsegmentectomy or non-anatomical partial resection from among 173 patients who underwent hepatectomy in our hospital from August 2003 to May 2013. We compared the results following anatomical subsegmentectomy (Group A; n = 16) and non-anatomical partial resection (Group N; n = 28).

Results: One- and two-year survival rates were 92.5% and 89.3%, respectively; 1- and 2-year recurrence-free survival (RFS) rates were 88.9% and 69.1%, respectively. There was no significant difference in overall survival or RFS between the groups. However, among HBV-positive patients, RFS was significantly better for Group A than Group N (p = 0.008).

Conclusions: For HBV-positive HCC within a single subsegment, we recommend subsegmentectomy.

Background/aims: Advanced pancreatic body carcinoma frequently accompany extra-pancreatic nerve plexus (PL) invasion, one of the poor indicator of patient prognosis. The present study aimed to reveal the progress of the PL invasion from cancer of the pancreas body toward the root of the celiac artery (CA) and superior mesenteric artery (SMA) followed by investigation of the relevance of diagnostic accuracy.

Methodology: Resected specimens from 50 consecutive patients who underwent distal pancreatectomy with en bloc celiac axis resection (DP-CAR) were pathologically analyzed for the direction of PL invasion. Diagnostic accuracy on CT imaging were also investigated.

Results: Thirty seven of the 50 patients (74%) were positive for PL invasion around the CHA, SPA, CA and SMA. In terms of the diagnostic accuracy, positive predictive values for the PL invasion were 35%, 36%, 43% and 81% for the SPA, CHA, CA and SMA, respectively. Among 21 patients and 23 patients with PL invasion around CHA and SPA, 13 and 6 patients also accompanied PL invasion around CA, respectively.

Conclusions: Carcinoma of the pancreatic body is found to frequently accompany PL invasion around CA. Under the limitation of low diagnostic accuracy, DP-CAR might be feasible operation that increases the possibility of R0 resection.

Advanced stage ovarian cancer is a common situation at presentation and current medical practice lacks efficient methods of prevention and early diagnosis. Primary maximal cytoreductive surgery followed by adjuvant chemotherapy is currently a generally accepted principle; most patients however undergo recurrence and common therapeutical attitude is secondary cytoreduction based approximately on the same principles as the primary one. Due to the success of liver resections in colorectal metastases and the development of liver surgery in general, different centers worldwide analyzed in the last 20 years liver resections' utility for other primaries, including ovarian tumors.

Previous abdominal surgery (PAS) is an important factor for postoperative adhesion. It is considered to be the most common complication of gastrointestinal and pelvic surgery. Both an Internet based and a manual search were used to acquire relevant studies about this topic. Parameters have been compared such as, Operating time in PAS versus Non PAS, Blood loss, Perioperative blood transfusion, Conversion to open, Anastomotic leakage and overall complications. Results of this study suggest that laparoscopy is too safe and effective in the treatment of colorectal disease for patients with previous abdominal surgery as it is for those without surgical backgrounds. However sufficient large-volume study is necessary to validate the long-term outcomes in previous abdominal surgical patients.