Journal of clinical gastroenterology最新文献

Background and objectives: The negative pressure selectable for the wet-suction technique remains uncertain. The aim was to investigate the quality of sampling and diagnostic accuracy with solid lesions by 5 mL and 10 mL negative pressure with wet-suction techniques.

Methods: This is a single-center, crossover, randomized controlled trial conducted with a random sampling technique. In all, 160 patients consecutively undergoing EUS-FNA for solid lesions were randomized in a ratio of 1:1 into 2 groups, the 5 mL and 10 mL negative pressure wet-suction group. The main outcome was to compare the sample quality between the 2 groups. The secondary outcome was to compare the histologic and cytologic diagnostic accuracy of solid lesions.

Results: Pancreatic (n=129) and nonpancreatic (n=27) lesions from 156 lesions were examined. The sample quality concluding cellularity, adequacy, integrity, and blood contamination were comparable between the 2 groups. However, in subgroup analysis, we found 19G FNA provided more integrity of specimen in 5 mL than in 10 mL group (100% vs. 82.9%, P =0.025). In contrast, this benefit was not noteworthy in the 22G FNA subgroup. And there was no statistically significant in histologic (87.82% vs. 87.18%, P =1.000) and cytologic (78.85% vs. 80.77%, P =0.778) accuracy between 5 mL and 10 mL groups.

Conclusion: When using the wet-suction technique, 5 mL and 10 mL negative pressure offer equivalent sample quality and diagnostic accuracy. However, the 19G FNA can obtain better sample quality with 5 mL negative pressure than 10 mL negative pressure.

Objective: Helicobacter pylori ( H. Pylori ) is considered a main causative organism of gastric ulcers, gastric cancer and duodenal ulcers. The current treatment relies on a combination of antimicrobial agents and acid suppressant agents, but the eradication effect is not satisfactory. To clarify the concentration of antibiotics at the lesion site, we investigate the clinical efficacy and drug tissue distribution of the combination therapy of furazolidone and tetracycline in eradicating H. Pylori.

Materials and methods: Patients with H. pylori infection (n = 60) were randomized to either group A or B. Bismuth potassium citrate capsules 220 mg, omeprazole enteric-coated capsules 20 mg, amoxicillin capsules 1000 mg, each twice per day, and furazolidone tablets 500 mg were administered to group A. Group B was treated with bismuth potassium citrate capsules 220 mg, omeprazole enteric-coated capsules 20 mg, amoxicillin capsules 1000 mg, and tetracycline tablets 500 mg each twice per day for 2 weeks. The serum and gastric juice, gastric antrum, gastric horn, and gastric body samples were taken under a gastroscope on the 14th day. The antimicrobial concentrations in serum and tissue samples were determined by high-performance liquid chromatography.

Results: In the negative group of furazolidone, the concentrations of gastric antrum, gastric body, and gastric angle were significantly higher than those in the positive group ( P = 0.017, 0.015, and 0.028). The concentrations of furazolidone in gastric fluid, gastric antrum, gastric angle, and gastric body were ∼421 times, 82 times, 17 times, and 51 times higher than those in serum, respectively. The concentrations of tetracycline in the serum and gastric angle of the tetracycline negative group were significantly higher than those in the positive group ( P = 0.036 and 0.042), and the tetracycline concentrations in the gastric horn and gastric body were about 4 and 6 times higher than those in the serum, respectively. The concentration of amoxicillin in group B was higher than that in group A, especially in serum, gastric juice, gastric angle, and gastric body ( P < 0.05).

Conclusion: Furazolidone is mainly concentrated and sequentially distributed in gastric juice, gastric antrum, and gastric body tissue, and tetracycline is mainly distributed in serum, gastric angle, and gastric body, whereas amoxicillin is mainly distributed in serum, gastric juice, gastric angle, and gastric body. Improving the concentration and tissue distribution of antibacterial drugs in the human gastric mucosa is the key to ensuring the ideal eradication rate of quadruple therapy.

Background: Per-oral endoscopic myotomy (POEM) is an effective option for treating achalasia. Despite its high efficacy, a fraction of patients remain symptomatic after POEM, and the data on the optimal management of these patients is limited. Few studies have evaluated the effectiveness of repeat POEM after a failed POEM.

Aim: To evaluate the efficacy and safety of repeat POEM for persistent symptoms after the initial POEM.

Methods: We searched major databases from inception to April 2024 to identify studies evaluating the efficacy and safety of repeat POEM after failed POEM in patients with achalasia. Our outcomes of interest were clinical success (a reduction in the Eckardt score to ≤3 after the procedure), adverse events, and differences in pre-procedure and post-procedure Eckardt scores. Using the random effects model, we calculated pooled rates with 95% CI for categorical variables and mean difference (MD) with 95% CI for continuous variables.

Results: We included 6 observational studies with 123 patients. The mean time between myotomies ranged from 12.2 to 13.5 months. The pooled rate (95% CI) of clinical success was 82.69% (95% CI; 69.65%-93.06%). The pooled rate (95% CI) of adverse events was 17.97% (95% CI: 5.08%-35.15%). The pooled mean±SD post-procedure Eckardt score was 1.63±1.93. The mean post-procedure Eckardt score was significantly lower than the re-procedure Eckardt score, MD (95% CI): 3.68 (2.58, 4.78).

Conclusion: Repeated POEM is an effective option for persistent symptoms of achalasia after initial POEM; however, it is associated with nontrivial adverse events.

Background and aim: The laryngeal cognitive-affective tool (LCAT) was recently validated in the US to assess laryngeal-specific hypervigilance and anxiety. The aim of this study was to examine LCAT validity in the Taiwanese population.

Methods: This prospective single-center study enrolled adults from Hualien Tzu Chi Hospital with laryngeal symptoms for >6 months.

Results: One hundred four patients included: mean age 49.5 years (SD 13.3), 69% female, mean BMI 25.3 kg/m2 (5.8), and mean LCAT 25.9 (15.2). The LCAT had excellent internal consistency (α=0.969) and split-half reliability (Guttman=0.925).

Conclusions: The LCAT is newly validated in the Taiwanese population and assesses laryngeal-specific cognitive-affective processes in patients with chronic laryngeal symptoms.

Goals: To identify the association between infliximab trough levels (ITL) and treatment outcomes in small bowel Crohn's disease (SB-CD).

Background: Higher ITL are associated with favorable treatment outcomes in CD. However, the association between ITL and SB-CD treatment outcomes are rarely studied.

Study: This was a retrospective cross-sectional study. Patients with SB-CD who received maintenance infliximab therapy were recruited, and treatment efficacy was evaluated through double balloon endoscopy. Serum samples were collected to test ITL. The primary outcome was endoscopic remission (ER), which is defined as a Simple Endoscopic Score of Crohn's disease (SES-CD) of <3. The secondary outcome was mucosal healing (MH) (SES-CD: 0) and endoscopic response (SES-CD decreased by 50% from baseline). The factors associated with ER were also explored through logistic regression analysis.

Results: In total, 111 patients with SB-CD were enrolled. Forty-seven patients (42.3%) achieved ER. Median ITL was significantly higher in patients with ER than patients without ER (2.74 vs. 1.12 µg/mL, P<0.01). In a multivariate model, an elevated ITL was the only independent factor associated with an increased probability of ER [odds ratio (OR): 1.24, 95% CI: 1.08-1.43, P=0.003]. The cutoff level of ITL used to predict ER with a specificity of >80% was 3.45 µg/mL, and the area under the curve (AUC) was 0.790. Meanwhile, the AUC cutoff to predict MH and endoscopic responses was 0.767 and 0.759, respectively.

Conclusions: There was a significant association between higher ITL and favorable SB-CD treatment outcomes.

Background: Eosinophilic esophagitis (EoE) and celiac disease are both chronic T helper cell-mediated inflammatory conditions of the digestive tract. Although an association between these two conditions has been suggested, it has not been well characterized in a real-world setting.

Goals: Our objective was to better examine the association between celiac disease and EoE using a real-world population database.

Study: This was a retrospective cohort study of data using TriNetX, a global population database, to identify patient records using International Classification of Disease 10 (ICD-10) codes. We organized participants into six distinct cohorts predicated on age and diagnoses of celiac disease and EoE between April 28, 2003, and April 28, 2023. Patient demographics, prevalence, incidence, and medical characteristics of each cohort were extracted.

Results: Among 46,398 patients with EoE and 84,383 patients with celiac disease, individuals with EoE demonstrated a higher prevalence (2.76%) and incidence (329/100,000 persons/year) of celiac disease compared with those without EoE (0.21% prevalence and 146/100,000 incidence, between 2021 and 2023). A concurrent diagnosis of both conditions increased the risk of asthma (RR: 2.00 pediatric, 1.82 adult), allergic rhinitis (RR: 2.35 pediatric, 1.81 adult), atopic dermatitis (RR: 3.28 pediatric, 2.07 adult), and rheumatoid arthritis (RR: 3.53 pediatric, 1.41 adult). In addition, patients with celiac disease with EoE exhibited a heightened risk for iron deficiency anemia (aHR 1.789; 95% CI: 1.166 to 2.745).

Conclusions: Both the incidence and prevalence of EoE are elevated in patients with celiac disease and vice versa. These concurrent diagnoses affect disease characteristics and heighten the risk of complications in celiac disease.

Goals: Evaluate the benefit of adding bezlotoxumab to repeat fecal microbiota transplantation (FMT) in patients with recurrent Clostridioides difficile infections after the failure of FMT alone.

Background: The initial failure of FMT in breaking the cycle of recurrent Clostridium difficile(C. difficile) infections is associated with a greater risk of subsequent failure. Our previous analysis showed that FMT failure is associated with delayed repair of fecal microbiota at 1 week after administration. We hypothesized that increasing the symptom-free interval by adding bezlotoxumab would improve the outcomes of a second FMT.

Study: A new rescue protocol that combines FMT with bezlotoxumab for patients who previously failed FMT alone was implemented in 2 academic medical centers. The clinical outcomes of a new protocol were captured in a prospective registry. The results were compared in a retrospective analysis of clinical outcomes of prior experience with repeat FMT by itself. All FMT preparations were standardized for dose. Bezlotoxumab administration was synchronized temporally with the second FMT to maximize its duration of action.

Results: Our historical cure rate of second FMT in treatment of recurrent C. difficile infection was 48% (15/31 patients). Addition of bezlotoxumab to the second FMT resulted in a cure rate of 89% (24/27 patients).

Conclusions: Addition of bezlotoxumab markedly improved the cure rate of the second FMT following initial FMT failure. The rationale for the protocol design highlights the importance of understanding the pharmacokinetics of both bezlotoxumab and FMT. Similar principles may apply to other live biotherapeutic products that are becoming available for prevention of C. difficile infection recurrence.

Introduction and objectives: The portal vein pressure higher than 10 mm Hg in patients with hepatic cirrhosis is more likely to have serious complications and poor prognosis. Nonselective receptor blockers (NSBBs) can reduce the portal vein pressure; however, the efficacy and safety of different NSBBs in reducing portal vein pressure were unconsistent. A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of carvedilol versus propranolol in reducing portal vein pressure in this study.

Materials and methods: We assessed Randomized controlled trials (RCTs) through PubMed, Web of science, Embase, and Cochrane library up to January 2024. Data from eligible studies were pooled in fixed-effect or random-effect meta-analysis models, using RevMan software. Two researchers screened articles, extracted data, and assessed the study quality independently according to the PRISMA guidelines. The primary outcomes were the reduction of hepatic venous pressure gradient (HVPG), the hemodynamic response rate, and the incidence of adverse events. Secondary outcomes were mean artery pressure (MAP) and heart rate (HR).

Results: A total of 7 RCTs, including 351 patients, were included in our meta-analysis. The results indicated that the magnitude of reduction in HVPG was greater in carvedilol compared with propranolol (MD: 1.08; 95% CI: 0.61 to 1.54; I2=0%, P<0.00001) in short-term follow-up. Carvedilol's hemodynamic response rate was higher than that of propranolol (OR: 0.44; 95% CI: 0.27 to 0.72; I2=0%, P = 0.001).

Conclusions: Our meta-analysis indicated that compared with propranolol, carvedilol was better in lowering portal hypertensive and had higher response rate in patients with hepatic cirrhosis. There was no obvious difference in safety between the 2 medications.