Indian Journal of Gastroenterology最新文献

Selective biliary cannulation is the prerequisite for successful biliary interventions. In the setting of cannulation failure, various rescue cannulation techniques are used for achieving selective biliary access. The various rescue cannulation techniques are (1) free-hand techniques (precut papillotomy and fistulotomy); (2) wire-guided techniques (transpancreatic sphincterotomy [TPS] and double guidewire [DGW]) and (3) endoscopic ultrasound (EUS)-guided technique (EUS-guided rendezvous for biliary access). The morphology of the papilla is the best guide to select the rescue technique. For classic and pendulous down facing papilla, pre-cut fistulotomy is preferable while for irregular ridged type, pre-cut papillotomy is suitable, while for small flat type, a very cautious pre-cut papillotomy may be utilized only by experts in pre-cut techniques. When an inadvertent pancreatic duct cannulation occurs, TPS is the preferred technique for all except small flat type of papilla where DGW is preferable to avoid perforation. We review the literature comparing these techniques to assess their efficacy and safety. Finally, we provide an algorithm that can be used to select the best rescue technique.

Background and objectives: Psychological stress is widely recognized as a key factor that can initiate or aggravate symptoms in patients with inflammatory bowel disease (IBD). This research was aimed at examining the influence of stressors, coping mechanisms and psychological symptoms on disease activity in patients with Crohn's disease (CD) and ulcerative colitis (UC).

Methods: A retrospective case-control research was performed with 138 patients diagnosed with IBD (76 with CD and 62 with UC). The participants were categorized into case groups (active disease: 31 CD, 38 UC) and control groups (inactive disease: 31 CD, 38 UC), with matching on demographic and clinical characteristics. Each participant completed several assessments such as the Simple Clinical Colitis Activity Index (SCCAI), the Harvey-Bradshaw index (HBI), the Life Distress Inventory (LDI), the Symptom Checklist (SCL-25) and the Coping Inventory for Stressful Situations (CISS-21).

Results: Participants experiencing active disease reported higher levels of life stress, with mean scores of 65.42 ± 8.88 in CD and 65.42 ± 8.88 in UC, in comparison with 45.97 ± 13.23 and 41.79 ± 13.49, respectively, in those with inactive disease. Additionally, psychological symptoms were more prevalent in both CD group (57.00 ± 12.71 vs. 47.39 ± 14.65) and the UC group (57.80 ± 9.82 vs. 40.05 ± 11.23) with active disease. Patients with active disease were more likely to employ coping strategies centered on avoidance, emotional responses and tasks than those without disease activity. Logistic regression analysis identified life stress (p < 0.001, 95% CI = [1.06-1.18], B = 1.24) and emotion-focused coping strategies (p < 0.001, 95% CI = [1.26-1.88], B = 1.54) as notable predictors of disease activity, whereas task-focused coping emerged as a protective factor (p < 0.029, 95% CI = [1.68-1.98], B = 1.81).

Conclusion: This research underscores the critical role of managing stress and adopting effective coping mechanisms in reducing the likelihood of disease flare-ups in IBD subjects. Healthcare providers should prioritize integrating these approaches into treatment protocols for IBD management.

Background: Anti-human epidermal growth factor receptor-2 (Her-2/neu) target therapy has substantially improved the disease outcome of patients with breast and gastric/gastroesophageal cancers characterized by Her-2/neu overexpression and/or amplification. Consequently, evaluating Her-2/neu expression in other cancers to predict response to Her-2/neu targeting agents emerges as a crucial approach. We aimed at investigating the positivity rate of this receptor in gallbladder cancer (GBC) and assess the relationship between Her-2/neu status, clinicopathological parameters and survival to identify patients who would benefit most from anti-Her-2/neu-targeted therapy. The Her-2/neu expression was correlated with clinicopathological parameters and survival of GBC cases.

Methods: Total 235 surgically resected and histopathologically proven primary GBC cases were collected over a five-year period from January 1, 2017, and December 31, 2020. Her-2/neu expression in these cases was analyzed using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH).

Results: Employing testing algorithms (IHC scoring based on gastric cancer criteria, followed by FISH in equivocal cases), Her-2/neu positivity was identified in 43 (18.29%) GBC cases and was significantly associated with grade I tumors, tumor stage > T2, perineural invasion, surgical margin positivity and advanced TNM stage. The mean survival time for Her-2/neu-positive cases was 14 months (SE, 1.1; 95%CI, 11.7-16.06), while it was 20 months (SE, 0.69; 95%CI, 18.1-20.9) for Her-2-negative cases (p < 0.001).

Conclusions: Her-2/neu is expressed in about one-fifth of GBC patients and is significantly associated with tumor behavior and patient survival. Utilizing novel targeted agents may hold the key to improving the prognosis of these patients.

Background: Groove pancreatitis (GP) is a form of pancreatitis that affects the pancreaticoduodenal groove area, which lies between the head of the pancreas, the second part of the duodenum and the distal bile duct, presenting as abdominal pain and gastric outlet obstruction. In this study, we present the clinical and radiological characteristics of individuals diagnosed with groove pancreatitis at our center and discuss the use of a conservative treatment approach in managing GP.

Methods: The data of patients with groove pancreatitis treated at our center between January 2012 and December 2021 was analyzed. The clinical, laboratory and radiological features were recorded and patients were followed up for at least six months in the pancreatic clinic by a specialist doctor.

Results: Fifty patients were included in the study. Most patients were males (98%) in the middle age group (35 to 55 years) (70%) with chronic alcohol use and/or smoking noted in 48 (96%) of them. Ninety-six per cent presented with recurrent abdominal pain. The most common imaging features were the thickening of the medial duodenal wall (100%) followed by enhancement of the scar tissue in the groove (98%). All patients were initially treated conservatively with advice to abstain from addictions, of whom 35 patients were followed up. Twenty per cent of the patients (seven out of 35) did not respond and required a step-up approach with endoscopic retrograde cholangiopancreatography (for biliary obstruction), celiac block (for ongoing abdominal pain) and surgery (gastrojejunostomy for gastric outlet obstruction, Frey's procedure for abdominal pain). Most patients were asymptomatic at follow-up (mean follow-up of 30 months).

Conclusion: The diagnosis of GP continues to be a challenge. A step-up approach appears to be a reasonable strategy in managing GP as most of them can be managed conservatively.

Clostridioides difficile (C. difficile) infection (CDI) is common after antibiotic exposure and presents significant morbidity, mortality and healthcare costs worldwide. The rising incidence of recurrent CDI, driven by hypervirulent strains, widespread antibiotic use and increased community transmission, has led to an urgent need for novel therapeutic strategies. Conventional antibiotic treatments, although effective, face limitations due to rising antibiotic resistance and high recurrence rates, which can reach up to 60% after multiple infections. This has prompted exploration of alternative therapies such as fecal microbiota-based therapies, including fecal microbiota transplantation (FMT) and live biotherapeutics (LBPs), which demonstrate superior efficacy in preventing recurrence. They are aimed at restoring the gut microbiota. Fecal microbiota, live-jslm and fecal microbiota spores, live-brpk have been approved by the U.S. Food and Drug Administration in individuals aged 18 years or older for recurrent CDI after standard antimicrobial treatment. They have demonstrated high efficacy and a favorable safety profile in clinical trials. Another LBP under study includes VE-303, which is not derived from human donor stool. This review provides a comprehensive overview of the current therapeutic landscape for CDI, including its epidemiology, pathophysiology, risk factors, diagnostic modalities and treatment strategies. The review delves into the emerging role of live biotherapeutics, with a particular focus on fecal microbiota-based therapies. We explore their development, mechanisms of action, clinical applications and potential to revolutionize CDI management.