Indian Journal of Gastroenterology最新文献

Non-steroidal anti-inflammatory drugs (NSAIDs) are essential for their analgesic, anti-inflammatory and anti-pyretic properties. However, their extended use can lead to NSAID enteropathy, a frequently underdiagnosed condition of the small intestine. This pathology manifests as mucosal damage, ulcerations, strictures and increased intestinal permeability, potentially resulting in complications such as bleeding, protein loss and nutrient malabsorption. Modern diagnostic technologies, particularly capsule endoscopy, have revealed that small-bowel injury affects up to 70% of chronic NSAID users, although many patients remain asymptomatic. This comprehensive review explores the epidemiology, underlying mechanisms, clinical manifestations, diagnostic approaches and treatment strategies for NSAID enteropathy, while emphasizing the growing importance of increased clinical awareness and continued research into preventive and therapeutic interventions, especially as long-term NSAID use becomes more prevalent in our aging global population.

Background: Due to the declining efficacy of the earlier regimens for Helicobacter pylori eradication because of anti-microbial resistance, non-bismuth quadruple (concomitant) and reverse-hybrid regimens are emerging as a new regimen. We compared eradication efficacy, compliance and adverse effects of concomitant therapy (CT) vs. reverse-hybrid therapy (RHT).

Methods: This was a prospective, single-centre, parallel-arm, open-label, non-inferiority randomized controlled study. Clinical Trials Registry-India: CTRI/2021/10/047865. Patients with peptic ulcer disease and gastritis found to be H. pylori positive were randomized 1:1 to concomitant therapy: omeprazole 20 mg twice daily (BD), amoxicillin 1 gm BD, clarithromycin 500 mg BD, metronidazole 400 mg thrice daily (TDS) for 14 days and reverse hybrid therapy groups omeprazole 20 mg BD and amoxicillin 1 g BD for 14 days plus clarithromycin 500 mg BD and metronidazole 400 mg TDS for the first seven days. Eradication was assessed six weeks post-therapy and compliance and adverse effects were noted.

Results: Total 148 patients were randomized to 74 in CT and RHT groups. Baseline features were comparable; mean age 44.5 ± 13.9 vs. 43.7 ± 13.5 years; males 56.8% vs. 58.1%. Eradication (CT vs. RHT) was 59 (79.7%) vs. 62 (83.7%) (intention-to-treat [ITT], p = 0.52), 59 (86.7%) vs. 62 (88.5%) (modified ITT, p = 0.74) and 59 (92.2%) vs. 62 (92.5%) (per-protocol, p = 0.94) analysis. Compliance was good and similar in both groups by per-protocol 64/70 (91.4%) vs. 67/71 (94.4%) (p = 0.497) and ITT 64/74 (86.5%) vs. 67/74 (90.5%) (p = 0.439) analysis. Adverse effects occurred at similar frequencies; the most common was altered taste 33/68 (48.5%) vs. 30/70 (42.9%) (p = 0.50). Overall, 98 adverse events were recorded in CT and 75 in RHT (1.44 vs. 1.07 events/patient; rate ratio 1.35, 95% CI 1.00-1.82; p = 0.053).

Conclusion: Fourteen-day concomitant and reverse-hybrid regimens achieved comparable eradication, with similar compliance and no difference in overall adverse events.

Background and aims: Irritable bowel syndrome (IBS), a prevalent functional gastrointestinal disorder, poses significant challenges for both patients and medical practitioners. Recent investigations have indicated the gut microbiome as a potential therapeutic target for IBS. Nevertheless, the exact association between these microorganisms and IBS symptoms remains incompletely elucidated. This updated systematic analysis aims to assess the extant research correlating the gut microbial community with IBS.

Methods: A systematic search was performed in major electronic databases including PubMed, EMBASE and Web of Science, spanning from their inception to December 2024. The objective was to identify case-control studies that examined and compared the composition of the fecal or colonic microbiota in individuals diagnosed with IBS against healthy controls.

Results: Our systematic search included 44 articles, which collectively revealed that IBS patients exhibit lower intestinal microbiome diversity compared to healthy controls. Fecal microbiome analysis demonstrated an imbalance in the phyla Firmicutes and Bacteroidetes among IBS patients. Specifically, IBS with diarrhea (IBS-D) patients showed reduced levels of Butyricimonas and Proteobacteria, while IBS with constipation (IBS-C) patients exhibited decreased Firmicutes and Actinobacteria, along with increased Verrucomicrobiota and Proteobacteria. Additionally, disruptions in the gut microbiome were noted, particularly in the duodenum and jejunum, as well as changes in key bacterial populations within the colon and rectum.

Conclusion: Our review confirms significant gut microbiota dysbiosis in IBS patients, characterized by reduced microbial diversity and altered abundances of Firmicutes and Bacteroidetes. These findings support the potential for microbiota-targeted therapies in IBS management, though further research is needed to establish causal mechanisms and clinical applications.