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The elderly population are more vulnerable for the management of colorectal cancer during the COVID-19 pandemic: a nationwide, population-based study. 新冠肺炎大流行期间,老年人更容易患结直肠癌癌症:一项全国性的基于人群的研究。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-08-29 DOI: 10.5217/ir.2023.00004
Hong Sun Kang, Seung Hoon Jeon, Su Bee Park, Jin Young Youn, Min Seob Kwak, Jae Myung Cha

Background/aims: The impact of coronavirus disease 2019 (COVID-19) on the management of colorectal cancer (CRC) may worse in elderly population, as almost all COVID-19 deaths occurred in the elderly patients. This study aimed to evaluate the impact of COVID-19 on CRC management in the elderly population.

Methods: The numbers of patients who underwent colonoscopy, who visited hospitals or operated for CRC in 2020 and 2021 (COVID-19 era) were compared with those in 2019, according to 3 age groups (≥70 years, 50-69 years, and ≤49 years), based on the nationwide, population-based database (2019-2021) in South Korea.

Results: The annual volumes of colonoscopy and hospital visits for CRC in 2020 were more significantly declined in the old age group than in the young age group (both P<0.001). In addition, the annual volume of patients operated for CRC numerically more declined in old age group than in young age group. During the first surge of COVID-19 (March and April 2020), old age patients showed statistically significant declines for the monthly number of colonoscopies (-46.5% vs. -39.3%, P<0.001), hospital visits (-15.4% vs. -7.9%, P<0.001), CRC operations (-33.8% vs. -0.7%, P<0.05), and colonoscopic polypectomies (-41.8% vs. -38.0%, P<0.001) than young age patients, compared with those of same months in 2019.

Conclusions: Elderly population are more vulnerable for the management of CRC during the COVID-19 pandemic. Therefore, the elderly population are more carefully cared for in the management of CRC during the next pandemic.

背景/目的:2019冠状病毒病(新冠肺炎)对癌症(CRC)治疗的影响可能在老年人群中更严重,因为几乎所有新冠肺炎死亡都发生在老年患者身上。本研究旨在评估新冠肺炎对老年人群CRC管理的影响。方法:根据3个年龄组(≥70岁、50-69岁和≤49岁),在全国范围内,将2020年和2021年(新冠肺炎时代)接受结肠镜检查、去医院或做CRC手术的患者人数与2019年进行比较,韩国基于人群的数据库(2019-2021)。结果:2020年结直肠癌的结肠镜检查和医院就诊量在老年组比年轻组下降更显著(两项结论:在新冠肺炎大流行期间,老年人更容易受到CRC的管理。因此,在下一次大流行期间,在CRC的管理中,老年人受到更仔细的照顾。
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引用次数: 1
Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease. 原发性硬化性胆管炎合并炎症性肠病的治疗。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-09-01 DOI: 10.5217/ir.2023.00039
You Sun Kim, Edward H Hurley, Yoojeong Park, Sungjin Ko

Primary sclerosing cholangitis (PSC) is a progressive cholestatic, inflammatory, and fibrotic disease that is strongly associated with inflammatory bowel disease (IBD). PSC-IBD represents a unique disease entity and patients with this disease have an increased risk of malignancy development, such as colorectal cancer and cholangiocarcinoma. The pathogenesis of PSC-IBD involves genetic and environmental factors such as gut dysbiosis and bile acids alteration. However, despite the advancement of disease characteristics, no effective medical therapy has proven to have a significant impact on the prognosis of PSC. The treatment options for patients with PSC-IBD do not differ from those for patients with PSC alone. Potential candidate drugs have been developed based on the pathogenesis of PSC-IBD, such as those that target modulation of bile acids, inflammation, fibrosis, and gut dysbiosis. In this review, we summarize the current medical treatments for PSC-IBD and the status of new emerging therapeutic agents.

原发性硬化性胆管炎(PSC)是一种进行性胆汁淤积、炎症和纤维化疾病,与炎症性肠病(IBD)密切相关。PSC-IBD代表一种独特的疾病实体,患有这种疾病的患者发生恶性肿瘤的风险增加,如结直肠癌癌症和胆管癌。PSC-IBD的发病机制涉及遗传和环境因素,如肠道微生态失调和胆汁酸改变。然而,尽管疾病特征有所改善,但没有任何有效的药物治疗被证明对PSC的预后有显著影响。PSC-IBD患者的治疗选择与单独患有PSC的患者没有区别。基于PSC-IBD的发病机制,已经开发出潜在的候选药物,例如那些靶向胆汁酸、炎症、纤维化和肠道微生态失调的药物。在这篇综述中,我们总结了目前PSC-IBD的医学治疗方法和新兴治疗剂的现状。
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引用次数: 0
How the COVID-19 pandemic affected the severity and clinical presentation of diverticulitis. 新冠肺炎大流行如何影响膀胱炎的严重程度和临床表现。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-10-26 DOI: 10.5217/ir.2022.00042
Sara S Soliman, Rolando H Rolandelli, Grace C Chang, Amanda K Nemecz, Zoltan H Nemeth

Background/aims: Single-institution studies showed that patients presented with more severe diverticulitis and underwent more emergency operations during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we studied this trend using nationwide data from the American College of Surgeons National Surgical Quality Improvement Program database.

Methods: Patients (n = 23,383) who underwent a colectomy for diverticulitis in 2018 (control year) and 2020 (pandemic year) were selected. We compared these groups for differences in disease severity, comorbidities, perioperative factors, and complications.

Results: During the pandemic, colonic operations for diverticulitis decreased by 13.14%, but the rates of emergency operations (17.31% vs. 20.04%, P< 0.001) and cases with a known abscess/perforation (50.11% vs. 54.55%, P< 0.001) increased. Likewise, the prevalence of comorbidities, such as congestive heart failure, acute renal failure, systemic inflammatory response syndrome, and septic shock, were higher during the pandemic (P< 0.05). During this same period, significantly more patients were classified under American Society of Anesthesiologists classes 3, 4, and 5, suggesting their preoperative health states were more severe and life-threatening. Correspondingly, the average operation time was longer (P< 0.001) and complications, such as organ space surgical site infection, wound disruption, pneumonia, acute renal failure, septic shock, and myocardial infarction, increased (P< 0.05) during the pandemic.

Conclusions: During the pandemic, surgical volume decreased, but the clinical presentation of diverticulitis became more severe. Due to resource reallocation and possibly patient fear of seeking medical attention, diverticulitis was likely underdiagnosed, and cases that would have been elective became emergent. This underscores the importance of monitoring patients at risk for diverticulitis and intervening when criteria for surgery are met.

背景/目的:单机构研究表明,在2019冠状病毒病(新冠肺炎)大流行期间,患者出现了更严重的膀胱炎,并接受了更多的紧急手术。因此,我们使用美国外科医生学会国家外科质量改进计划数据库中的全国数据研究了这一趋势。方法:选择2018年(对照年)和2020年(疫情年)因憩室炎接受结肠切除术的患者(n=23383)。我们比较了这些组在疾病严重程度、合并症、围手术期因素和并发症方面的差异。结果:在疫情期间,憩室炎的结肠手术减少了13.14%,但急诊手术率(17.31%对20.04%,P<0.001)和已知脓肿/穿孔病例(50.11%对54.55%,P<001)增加。同样,在疫情期间,充血性心力衰竭、急性肾功能衰竭、全身炎症反应综合征和感染性休克等合并症的患病率更高(P<0.05)。在同一时期,美国麻醉师学会将更多的患者分为3、4和5级,表明他们术前的健康状况更加严重,危及生命。相应地,在疫情期间,平均手术时间更长(P<0.001),器官间隙手术部位感染、伤口破裂、肺炎、急性肾功能衰竭、感染性休克和心肌梗死等并发症增加(P<0.05)。结论:在疫情期间,手术量减少,但憩室炎的临床表现变得更加严重。由于资源的重新分配,以及患者可能害怕寻求医疗救助,憩室炎可能诊断不足,本应是选择性的病例变得紧急。这强调了监测有憩室炎风险的患者并在符合手术标准时进行干预的重要性。
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引用次数: 0
Malnutrition and inflammation status in nonobese patients with inflammatory bowel disease are associated with nonalcoholic fatty liver disease: a retrospective study. 非肥胖炎症性肠病患者营养不良和炎症状态与非酒精性脂肪肝相关:一项回顾性研究。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-08-11 DOI: 10.5217/ir.2023.00035
Takahiro Nagata, Sadahiro Funakoshi, Daisuke Morihara, Satoshi Shakado, Keiji Yokoyama, Kazuhide Takata, Takashi Tanaka, Atsushi Fukunaga, Ryo Yamauchi, Hiromi Fukuda, Hiroki Matsuoka, So Imakiire, Hideto Sakisaka, Satoshi Matsuoka, Nobuaki Kuno, Koichi Abe, Hideki Ishibashi, Shinya Ashizuka, Fumihito Hirai

Background/aims: The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD.

Methods: We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters.

Results: Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m2), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment.

Conclusions: Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.

背景/目的:炎症性肠病(IBD)患者出现非酒精性脂肪肝(NAFLD)并发症的频率和细节尚不清楚。本研究旨在阐明IBD患者NAFLD的特点。方法:我们回顾性地确定并登记了2005年至2020年间在我们机构接受腹部计算机断层扫描(CT)诊断为NAFLD或非NAFLD的IBD患者。主要终点是IBD患者的NAFLD并发症发生率。次要终点是非肥胖IBD和合并NAFLD患者的临床特征及其与营养和炎症参数的关系。结果:96例符合条件的IBD患者中有21例(21.9%)也患有NAFLD。非肥胖患者(定义为具有体重指数的患者)结论:IBD患者营养和炎症状态恶化与NAFLD并发症有关。使用CT成像诊断IBD患者的NAFLD不仅有助于早期发现NAFLD,而且有助于评估IBD治疗干预的必要性。
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引用次数: 0
Summary and comparison of recently updated post-polypectomy surveillance guidelines. 最近更新的息肉切除术后监测指南的总结和比较。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-10-26 DOI: 10.5217/ir.2023.00107
Yoon Suk Jung

Recently, updated guidelines for post-polypectomy surveillance have been published by the U.S. Multi-Society Task Force (USMSTF), the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE), the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), and the Korean Multi-Society Taskforce Committee. This review summarizes and compares the updated recommendations of these 5 guidelines. There are some differences between the guidelines for the recommended post-polypectomy surveillance intervals. In particular, there are prominent differences between the guidelines for 1-4 tubular adenomas < 10 mm with low-grade dysplasia (nonadvanced adenomas [NAAs]) and tubulovillous or villous adenomas. The USMSTF, JGES, and Korean guidelines recommend colonoscopic surveillance for patients with 1-4 NAAs and those with tubulovillous or villous adenomas, whereas the BSG/ACPGBI/PHE and ESGE guidelines do not recommend endoscopic surveillance for such patients. Surveillance recommendations for patients with serrated polyps (SPs) are limited. Although the USMSTF guidelines provide specific recommendations for patients who have undergone SPs removal, these are weak and based on very lowquality evidence. Future studies should examine this topic to better guide the surveillance recommendations for patients with SPs. For countries that do not have separate guidelines, we hope that this review article will help select the most appropriate guidelines as per each country's healthcare environment.

最近,美国多社会工作组(USMSTF)、英国胃肠病学会/大不列颠及爱尔兰结肠直肠学协会/英格兰公共卫生局(BSG/ACPGBI/PHE)、欧洲胃肠内窥镜学会(ESGE)、日本胃肠内窥镜中学会(JGES)发布了息肉切除术后监测的最新指南,以及韩国多社会工作组委员会。本次审查总结并比较了这5项准则的最新建议。建议的息肉切除术后监测间隔的指南之间存在一些差异。特别是,1-4个<10mm的管状腺瘤伴低度发育不良(非晚期腺瘤[NAAs])与管状或绒毛状腺瘤的指南之间存在显著差异。USMSTF、JGES和韩国指南建议对1-4例NAA患者和管状或绒毛腺瘤患者进行结肠镜监测,而BSG/ACPGBI/PHE和ESGE指南不建议对此类患者进行内镜监测。对锯齿状息肉(SP)患者的监测建议有限。尽管USMSTF指南为接受SP切除的患者提供了具体的建议,但这些建议很薄弱,而且基于非常低质量的证据。未来的研究应研究这一主题,以更好地指导SP患者的监测建议。对于没有单独指南的国家,我们希望这篇综述文章将有助于根据每个国家的医疗环境选择最合适的指南。
{"title":"Summary and comparison of recently updated post-polypectomy surveillance guidelines.","authors":"Yoon Suk Jung","doi":"10.5217/ir.2023.00107","DOIUrl":"10.5217/ir.2023.00107","url":null,"abstract":"<p><p>Recently, updated guidelines for post-polypectomy surveillance have been published by the U.S. Multi-Society Task Force (USMSTF), the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE), the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), and the Korean Multi-Society Taskforce Committee. This review summarizes and compares the updated recommendations of these 5 guidelines. There are some differences between the guidelines for the recommended post-polypectomy surveillance intervals. In particular, there are prominent differences between the guidelines for 1-4 tubular adenomas < 10 mm with low-grade dysplasia (nonadvanced adenomas [NAAs]) and tubulovillous or villous adenomas. The USMSTF, JGES, and Korean guidelines recommend colonoscopic surveillance for patients with 1-4 NAAs and those with tubulovillous or villous adenomas, whereas the BSG/ACPGBI/PHE and ESGE guidelines do not recommend endoscopic surveillance for such patients. Surveillance recommendations for patients with serrated polyps (SPs) are limited. Although the USMSTF guidelines provide specific recommendations for patients who have undergone SPs removal, these are weak and based on very lowquality evidence. Future studies should examine this topic to better guide the surveillance recommendations for patients with SPs. For countries that do not have separate guidelines, we hope that this review article will help select the most appropriate guidelines as per each country's healthcare environment.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":"21 4","pages":"443-451"},"PeriodicalIF":4.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71423574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Regional variations in the prevalence of primary sclerosing cholangitis associated with inflammatory bowel disease. 原发性硬化性胆管炎与炎症性肠病发病率的区域差异。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-10-26 DOI: 10.5217/ir.2023.00133
Kwang Woo Kim, Hyoun Woo Kang
Ulcerative colitis (UC) and Crohn’s disease (CD) are types of inflammatory bowel disease (IBD), characterized as chronic, relapsing bowel disorder causing a significant impact on the personal health. 1,2 Many studies have reported various mechanisms in genetic, immunologic, microbial, environmental fields and experimental models for IBD have suggested essential components in the pathogenesis. 3 One of the pathologic characteristics of IBD is presenting various extraintestinal manifestations. 4
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引用次数: 0
Gut microbiome on immune checkpoint inhibitor therapy and consequent immune-related colitis: a review. 肠道微生物组在免疫检查点抑制剂治疗和随后的免疫相关结肠炎中的作用:综述。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-08-29 DOI: 10.5217/ir.2023.00019
Sung Wook Hwang, Min Kyu Kim, Mi-Na Kweon

Immune checkpoint inhibitors have dramatically revolutionized the therapeutic landscape for patients with advanced malignancies. Recently, convincing evidence has shown meaningful influence of gut microbiome on human immune system. With the complex link between gut microbiome, host immunity and cancer, the variations in the gut microbiota may influence the efficacy of immune checkpoint inhibitors. Indeed, some bacterial species have been reported to be predictive for cancer outcome in patients treated with immune checkpoint inhibitors. Although immune checkpoint inhibitors are currently proven to be an effective anti-tumor treatment, they can induce a distinct form of toxicity, termed immune-related adverse events. Immune-related colitis is one of the common toxicities from immune checkpoint inhibitors, and it might preclude the cancer therapy in severe or refractory cases. The manipulation of gut microbiome by fecal microbiota transplantation or probiotics administration has been suggested as one of the methods to enhance anti-tumor effects and decrease the risk of immune-related colitis. Here we review the role of gut microbiome on immune checkpoint inhibitor therapy and consequent immune-related colitis to provide a new insight for better anti-cancer therapy.

免疫检查点抑制剂极大地改变了晚期恶性肿瘤患者的治疗格局。最近,令人信服的证据表明,肠道微生物组对人类免疫系统有着重要影响。由于肠道微生物组、宿主免疫和癌症之间的复杂联系,肠道微生物组的变化可能会影响免疫检查点抑制剂的疗效。事实上,据报道,一些细菌种类可以预测接受免疫检查点抑制剂治疗的患者的癌症结果。尽管免疫检查点抑制剂目前被证明是一种有效的抗肿瘤治疗方法,但它们可以诱导一种不同形式的毒性,称为免疫相关不良事件。免疫相关性结肠炎是免疫检查点抑制剂的常见毒性之一,在严重或难治的病例中,它可能会排除癌症治疗。通过粪便微生物群移植或益生菌管理肠道微生物组已被认为是增强抗肿瘤效果和降低免疫相关结肠炎风险的方法之一。在此,我们回顾了肠道微生物组在免疫检查点抑制剂治疗和随后的免疫相关结肠炎中的作用,为更好的抗癌治疗提供了新的见解。
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引用次数: 0
Clinical characteristics and risk factors related to polyposis recurrence and advanced neoplasm development among patients with non-hereditary colorectal polyposis. 非遗传性结直肠息肉病患者的临床特征和与息肉病复发和晚期肿瘤发展相关的危险因素。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-05-31 DOI: 10.5217/ir.2022.00139
Jihun Jang, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim

Background/aims: Patients with more than 10 cumulative polyps might involve a greater genetic risk of colorectal neoplasia development. However, few studies have investigated the risk factors of polyposis recurrence and development of advanced neoplasms among patients with non-hereditary colorectal polyposis.

Methods: This study included patients (n=855) with 10 or more cumulative polyps diagnosed at Severance Hospital from January 2012 to September 2021. Patients with known genetic mutations related to polyposis, known hereditary polyposis syndromes, insufficient information, total colectomy, and less than 3 years of follow-up were excluded. Finally, 169 patients were included for analysis. We collected clinical data, including colonoscopy surveillance results, and performed Cox regression analyses of risk factors for polyposis recurrence and advanced neoplasm development.

Results: The 169 patients were predominantly male (84.02%), with a mean age of 64.19±9.92 years. The mean number of adenomas on index colonoscopy was 15.33±8.47. Multivariable analysis revealed history of cancer except colon cancer (hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.23-4.01), current smoking (HR, 2.39; 95% CI, 1.17-4.87), and detection of many polyps (≥15) on index colonoscopy (HR, 2.05; 95% CI, 1.21-3.50) were significant risk factors for recurrence of polyposis. We found no statistically significant risk factors for advanced neoplasm development during surveillance among our cohort.

Conclusions: The presence of many polyps (≥15) on index colonoscopy, history of cancer except colon cancer, and current smoking state were significant risk factors for polyposis recurrence among patients with non-hereditary colorectal polyposis.

背景/目的:累积息肉超过10个的患者可能有更大的结直肠肿瘤发生的遗传风险。然而,很少有研究调查非遗传性结直肠息肉病患者中息肉病复发和发展为晚期肿瘤的危险因素。方法:本研究包括2012年1月至2021年9月在Severance医院诊断的10个或10个以上累积息肉的患者(n=855)。排除与息肉病相关的已知基因突变、已知遗传性息肉病综合征、信息不足、全结肠切除术和随访时间不到3年的患者。最后,纳入169名患者进行分析。我们收集了临床数据,包括结肠镜检查监测结果,并对息肉病复发和晚期肿瘤发展的危险因素进行了Cox回归分析。结果:169例患者以男性为主(84.02%),平均年龄64.19±9.92岁。指数结肠镜检查的腺瘤平均数为15.33±8.47。多因素分析显示,除癌症外的癌症病史(危险比[HR],2.23;95%置信区间[CI],1.23-4.01)、目前吸烟(HR,2.39;95%置信度,1.17-4.87)和指数结肠镜检查发现许多息肉(≥15)(HR,2.05;95%置信指数,1.21-3.50)是息肉病复发的重要危险因素。在我们的队列监测中,我们没有发现晚期肿瘤发展的统计学显著风险因素。结论:在非遗传性结直肠息肉病患者中,指数结肠镜检查中存在许多息肉(≥15)、除癌症以外的癌症病史和吸烟状况是息肉病复发的重要危险因素。
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引用次数: 0
Comparative outcomes of acute colonic diverticulitis in immunocompromised versus immunocompetent patients: a systematic review and meta-analysis. 免疫功能低下和免疫功能正常患者急性结肠憩室炎的比较结果:一项系统综述和荟萃分析。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-05-31 DOI: 10.5217/ir.2023.00005
Jae Gon Lee, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Shin Hee Lee, Myung-Won You, Seong-Eun Kim

Background/aims: Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the comparative outcomes of immunocompromised and immunocompetent patients with diverticulitis is lacking. This systematic review and meta-analysis investigated the outcomes of medical treatment in immunocompromised and immunocompetent patients with diverticulitis.

Methods: A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included.

Results: A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31-2.38 and RR, 3.05; 95% CI, 1.70-5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95-1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73-7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease.

Conclusions: Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.

背景/目的:免疫受损的急性结肠憩室炎患者并发症和非手术治疗失败的风险很高。然而,缺乏关于免疫功能低下和免疫功能正常的憩室炎患者的比较结果的证据。这项系统综述和荟萃分析调查了免疫功能低下和免疫功能低下的憩室炎患者的药物治疗结果。方法:在PubMed、Embase和Cochrane图书馆进行综合文献检索。包括比较免疫功能低下和免疫功能正常的憩室炎患者的临床结果的研究。结果:共有10项研究,1946461名受试者被纳入定量综合。免疫功能受损患者的紧急手术风险和紧急手术后的术后死亡率显著高于免疫功能受损的憩室炎患者(风险比[RR],1.76;95%置信区间[CI],1.31-2.38和RR,3.05;95%置信度,1.70-5.45)。免疫功能受损患者与憩室炎相关并发症的总体风险并不显著高于免疫功能正常患者(RR,1.24;95%CI,0.95-1.63,选择性手术后的死亡率在免疫功能受损和免疫功能正常的憩室炎患者之间没有显著差异。在亚组分析中,免疫功能受损的并发憩室炎患者急诊手术和复发的风险显著较高,而轻度疾病患者则没有显著差异。结论:免疫功能受损的憩室炎患者应采用多学科方法进行最佳治疗,因为与免疫功能正常的患者相比,他们的手术风险、术后发病率和死亡率增加。
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引用次数: 0
Low prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease in India. 印度炎症性肠病患者原发性硬化性胆管炎患病率低。
IF 4.9 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2022-12-02 DOI: 10.5217/ir.2022.00087
Arshdeep Singh, Vandana Midha, Vikram Narang, Saurabh Kedia, Ramit Mahajan, Pavan Dhoble, Bhavjeet Kaur Kahlon, Ashvin Singh Dhaliwal, Ashish Tripathi, Shivam Kalra, Narender Pal Jain, Namita Bansal, Rupa Banerjee, Devendra Desai, Usha Dutta, Vineet Ahuja, Ajit Sood

Background/aims: Primary sclerosing cholangitis (PSC) represents the most common hepatobiliary extraintestinal manifestation of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). Limited data exist on PSC in patients with IBD from India. We aimed to assess the prevalence and disease spectrum of PSC in Indian patients with IBD.

Methods: Database of IBD patients at 5 tertiary care IBD centers in India were analyzed retrospectively. Data were extracted and the prevalence of PSC-IBD was calculated.

Results: Forty-eight patients out of 12,216 patients with IBD (9,231 UC, 2,939 CD, and 46 IBD unclassified) were identified to have PSC, resulting in a prevalence of 0.39%. The UC to CD ratio was 7:1. Male sex and pancolitis (UC) or colonic CD were more commonly associated with PSC-IBD. The diagnosis of IBD preceded the diagnosis of PSC in most of the patients. Majority of the patients were symptomatic for liver disease at diagnosis. Eight patients (16.66%) developed cirrhosis, 5 patients (10.41%), all UC, developed malignancies (3 colorectal cancer [6.25%] and 2 cholangiocarcinoma [4.16%]), and 3 patients died (2 decompensated liver disease [4.16%] and 1 cholangiocarcinoma [2.08%]) on follow-up. None of the patients mandated surgical therapy for IBD.

Conclusions: Concomitant PSC in patients with IBD is uncommon in India and is associated with lower rates of development of malignancies.

背景/目的:原发性硬化性胆管炎(PSC)是炎症性肠病(IBD)最常见的肝胆管外表现,包括溃疡性结肠炎(UC)和克罗恩病(CD)。关于印度IBD患者PSC的数据有限。我们旨在评估印度IBD患者PSC的患病率和疾病谱。方法:回顾性分析印度5个三级护理IBD中心的IBD患者数据库。提取数据并计算PSC-IBD的患病率。结果:12216例IBD患者中有48例(9231例UC、2939例CD和46例未分类IBD)被确定为PSC,患病率为0.39%。UC与CD的比率为7:1。男性和泛结肠炎(UC)或结肠CD更常见于PSC-IBD。在大多数患者中,IBD的诊断先于PSC的诊断。大多数患者在诊断时有肝病症状。8名患者(16.66%)发展为肝硬化,5名患者(10.41%),全部UC,发展为恶性肿瘤(3例癌症[6.25%]和2例胆管癌[4.16%]),3名患者在随访中死亡(2例失代偿性肝病[4.16%]和1例胆管癌[2.08%])。没有一名患者要求对IBD进行手术治疗。结论:IBD患者并发PSC在印度并不常见,并且与较低的恶性肿瘤发生率有关。
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引用次数: 3
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Intestinal Research
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