Journal of Digestive Diseases最新文献_第6页

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis 评估重叠的上消化道症状对功能性便秘患者临床特征的影响以及风险因素分析

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-05-02 DOI: 10.1111/1751-2980.13268

Feng Zhu, Fei Li, Mei Hui Lyu, Ben Chang Feng, Lin Lin, Yu Rong Tang, Dong Qian, Ting Yu

Objectives

Functional constipation (FC), a common functional gastrointestinal disorder, is usually overlapping with upper gastrointestinal symptoms (UGS). We aimed to explore the clinical characteristics of patients with FC overlapping UGS along with the related risk factors.

Methods

The differences in the severity of constipation symptoms, psychological state, quality of life (QoL), anorectal motility and perception function, autonomic function, and the effect of biofeedback therapy (BFT) among patients with FC in different groups were analyzed, along with the risk factors of overlapping UGS.

Results

Compared with patients with FC alone, those with FC overlapping UGS had higher scores in the Patient Assessment of Constipation Symptoms and Self-Rating Anxiety Scale and lower scores in the Short Form-36 health survey (P < 0.05). Patients with FC overlapping UGS also had lower rectal propulsion, more negative autonomic nervous function, and worse BFT efficacy (P < 0.05). Overlapping UGS, especially overlapping functional dyspepsia, considerably affected the severity of FC. Logistic regression model showed that age, body mass index (BMI), anxiety, exercise, and sleep quality were independent factors influencing overlapping UGS in patients with FC.

Conclusions

Overlapping UGS reduces the physical and mental health and the QoL of patients with FC. It also increases the difficulty in the treatment of FC. Patient's age, BMI, anxiety, physical exercise, and sleep quality might be predictors for FC overlapping UGS.

目的功能性便秘（FC）是一种常见的功能性胃肠道疾病，通常与上消化道症状（UGS）重叠。我们旨在探讨功能性便秘与上消化道症状重叠患者的临床特征及相关风险因素。方法分析不同组别 FC 患者的便秘症状严重程度、心理状态、生活质量（QoL）、肛门直肠运动和感知功能、自主神经功能以及生物反馈疗法（BFT）效果的差异，并分析重叠 UGS 的风险因素。结果与单纯 FC 患者相比，FC 重叠 UGS 患者的便秘症状患者评估和焦虑自评量表得分更高，而简表-36 健康调查得分更低（P < 0.05）。FC重叠UGS患者的直肠推进力也较低，自主神经功能更消极，BFT疗效更差（P < 0.05）。重叠的 UGS，尤其是重叠的功能性消化不良，对 FC 的严重程度有很大影响。逻辑回归模型显示，年龄、体重指数（BMI）、焦虑、运动和睡眠质量是影响 FC 患者重叠 UGS 的独立因素。结论 UGS 重叠会降低 FC 患者的身心健康和生活质量。它还增加了 FC 治疗的难度。患者的年龄、体重指数、焦虑、体育锻炼和睡眠质量可能是预测 FC 重叠 UGS 的因素。

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引用次数: 0

Endoscopic papillectomy for synchronous adenoma of the major and minor duodenal papilla 十二指肠大乳头和小乳头同步腺瘤的内窥镜乳头切除术

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-26 DOI: 10.1111/1751-2980.13269

Jin Pei Dong, Ji Xin Zhang, Gui Gen Teng, Hai Xia Niu, Da Peng Bian, Qiu Shi Feng

Objectives

Synchronous adenomas of the major and minor duodenal papilla are seldom reported. The aim of this study was to describe the characteristics of synchronous major and minor papilla adenomas and to evaluate the safety and efficacy of endoscopic papillectomy (EP) for the management of the disease.

Methods

Consecutive patients who underwent endoscopy for synchronous major and minor papilla adenomas from January 1, 2013 to August 31, 2023 were analyzed retrospectively. Patients’ characteristics, clinical manifestations, laboratory, imaging and endoscopic findings were collected.

Results

The nine patients with synchronous major and minor papilla adenomas had an average age of 50.78 ± 10.70 years. The diameter of major and minor papilla adenomas was 12.11 ± 3.41 mm and 6.11 ± 1.05 mm, respectively. Most major papilla adenomas had R0 horizontal margins (n = 8), while R0 vertical margins were achieved in all patients. While minor papilla adenomas were resected with both R0 horizontal and vertical margins in all patients. Post-EP bleeding was observed in one patient, which was classified as mild. Post-EP hyperamylasemia and pancreatitis was observed in two and four patients, respectively; the latter consisted of three with mild pancreatitis and one with severe pancreatitis. No perforation was observed. The mean follow-up duration was 9.22 ± 5.99 months. Histologically confirmed recurrence at the resection site was detected in one patient at 3 months after the procedure.

Conclusions

Synchronous major and minor papilla adenomas may not be as rare as previously speculated. EP may be an effective and safe alternative modality for their management.

目的十二指肠大乳头和小乳头同步腺瘤鲜有报道。本研究旨在描述同步性大、小乳头腺瘤的特征，并评估内镜下乳头切除术（EP）治疗该病的安全性和有效性。方法回顾性分析2013年1月1日至2023年8月31日期间因同步性大、小乳头腺瘤接受内镜检查的连续患者。结果9例同步大小乳头状腺瘤患者的平均年龄为（50.78±10.70）岁。大乳头腺瘤和小乳头腺瘤的直径分别为（12.11±3.41）毫米和（6.11±1.05）毫米。大多数大乳头状腺瘤的水平边缘为R0（8人），所有患者的垂直边缘均为R0。所有患者切除的小乳头状腺瘤的水平边缘和垂直边缘均为R0。一名患者出现了胃切除术后出血，被归类为轻度出血。分别有两名和四名患者在手术后出现高淀粉血症和胰腺炎；后者包括三名轻度胰腺炎患者和一名重度胰腺炎患者。未观察到穿孔。平均随访时间为（9.22 ± 5.99）个月。一名患者在术后 3 个月发现切除部位经组织学证实复发。EP可能是一种有效、安全的替代治疗方法。

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引用次数: 0

Endoscopic ultrasound for the diagnosis and treatment of primary hepatocellular carcinoma 内窥镜超声诊断和治疗原发性肝细胞癌

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-17 DOI: 10.1111/1751-2980.13266

Jian Xiang Wang, Lun Gen Lu, Xiao Bo Cai

Chronic liver disease has emerged as a significant global concern, with primary hepatocellular carcinoma (HCC) representing a critical consequence of this disease. However, early detection of HCC remains challenging in clinical practice. Recently, there has been a growing interest in applying endoscopic ultrasound (EUS) as a diagnostic tool for gastrointestinal diseases. Nevertheless, using EUS to diagnose and treat HCC is uncommon. In this review we described the diagnostic and therapeutic applications of EUS in primary HCC and evaluated its clinical significance. The diagnostic procedures primarily involve EUS-guided fine-needle biopsy or aspiration, assessment of metastatic lymph nodes and portal vein thrombosis, portal pressure monitoring, and portal vein blood collection. Treatment mainly includes EUS-guided tumor ablation, brachytherapy, injectable chemotherapy, and managing variceal hemorrhage related to portal hypertension.

慢性肝病已成为全球关注的重大问题，而原发性肝细胞癌（HCC）则是这一疾病的重要后果。然而，在临床实践中，HCC 的早期检测仍然具有挑战性。最近，人们对应用内窥镜超声（EUS）作为胃肠道疾病的诊断工具越来越感兴趣。然而，使用 EUS 诊断和治疗 HCC 的情况并不多见。在这篇综述中，我们介绍了 EUS 在原发性 HCC 中的诊断和治疗应用，并评估了其临床意义。诊断程序主要包括 EUS 引导下的细针活检或抽吸、转移淋巴结和门静脉血栓评估、门静脉压力监测和门静脉采血。治疗主要包括 EUS 引导下的肿瘤消融、近距离放射治疗、注射化疗，以及处理与门静脉高压有关的静脉曲张出血。

引用次数: 0

Application of furazolidone in Helicobacter pylori infection eradication 呋喃唑酮在根除幽门螺旋杆菌感染中的应用

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-16 DOI: 10.1111/1751-2980.13265

Ying Ying Han, Ji Yan Li, Jia Lun Guan, Mei Liu, Pei Yuan Li

Increasing antibiotic resistance is the primary reason for treatment failure of Helicobacter pylori (H. pylori) infection. To enhance the eradication rate, minimize the development of secondary resistance, and alleviate the socioeconomic burden, it is crucial to select H. pylori-sensitive antibiotics carefully. Furazolidone has been used for H. pylori eradication in developing countries for decades due to its affordability and low resistance rate. Numerous studies have demonstrated that furazolidone-containing regimens are more efficacious than those containing other antibiotics, as both first- and second-line therapies, and are also well tolerated. However, utility of furazolidone is restricted or not optimal in certain countries due to its infrequent but potentially severe adverse effects. The decision to discontinue usage of furazolidone because of concerns regarding adverse effects may be misguided. Here we comprehensively reviewed the studies on furazolidone at different dosages and treatment durations for H. pylori eradication. Further research on the mechanisms of action and clinical trials of furazolidone are of great practical importance.

抗生素耐药性的增加是幽门螺旋杆菌（H. pylori）感染治疗失败的主要原因。为了提高根除率，减少二次耐药性的产生，减轻社会经济负担，谨慎选择对幽门螺杆菌敏感的抗生素至关重要。几十年来，呋喃唑酮因其价格低廉、耐药率低，一直被发展中国家用于根除幽门螺杆菌。大量研究表明，含有呋喃唑酮的治疗方案比含有其他抗生素的治疗方案更有效，无论是作为一线还是二线疗法，耐受性都很好。然而，在某些国家，呋喃唑酮的使用受到了限制，或者由于其不常见但潜在的严重不良反应而无法达到最佳效果。因担心不良反应而决定停用呋喃唑酮可能是错误的。在此，我们全面回顾了不同剂量和疗程的呋喃唑酮根除幽门螺杆菌的研究。对呋喃唑酮作用机制的进一步研究和临床试验具有重要的现实意义。

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引用次数: 0

Therapeutic drug monitoring in inflammatory bowel disease patients on vedolizumab 使用维多珠单抗的炎症性肠病患者的治疗药物监测

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-10 DOI: 10.1111/1751-2980.13261

Mohammed Ansari, Kerri Glassner, Malcolm Irani, Adam Saleh, Lin Wang, Chika Ezeana, Stephen Wong, Caroline Perry, Bincy Abraham

Objective

We aimed to investigate whether vedolizumab (VDZ) levels were associated with inflammatory markers or clinical or endoscopic scoring in inflammatory bowel disease (IBD).

Methods

Besides demographic data, clinical scoring, endoscopic data, and laboratory markers of IBD patients treated with VDZ from 2015 to 2020 who had trough levels drawn on maintenance therapy were collected at baseline and at follow-up (after at least 8 weeks on VDZ therapy or after change in dose frequency). Low drug levels were defined as VDZ trough <20 μg/mL.

Results

We identified 89 patients with a mean age of 42.9 years. Of the 90 total trough levels drawn, 61.1% were low. Among patients on every 8 week (Q8 week) VDZ dosing, 81.5% had low troughs. After increasing dosing frequency to Q4 weeks, all patients showed improvement in VDZ levels, but 30.6% remained <20 μg/mL. Higher VDZ levels on Q8 week dosing were associated with higher albumin levels (P = 0.01). While higher VDZ levels on Q4 week dosing were associated with higher albumin (P = 0.02), lower erythrocyte sedimentation rate (P = 0.04) and higher likelihood of having mild disease or endoscopic remission (P = 0.01). No significant association was found between VDZ levels and clinical scoring, body mass index, hemoglobin, vitamin D or platelet levels on either Q8 or Q4 week dosing.

Conclusions

Higher VDZ troughs were associated with higher albumin, mild endoscopic disease or endoscopic remission. Patients who continue to have low VDZ troughs despite Q4 week dosing may require a change in therapy.

目的我们旨在研究韦多珠单抗（VDZ）水平是否与炎症性肠病（IBD）的炎症指标或临床或内窥镜评分相关。方法在基线和随访时（接受 VDZ 治疗至少 8 周后或改变剂量频率后）收集 2015 年至 2020 年接受 VDZ 治疗的 IBD 患者的人口统计学数据、临床评分、内窥镜数据和实验室标记物，并在维持治疗时提取谷值。低药物水平定义为 VDZ 谷值为 20 μg/mL。结果我们共发现 89 名患者，平均年龄为 42.9 岁。在抽取的 90 个谷值中，61.1% 为低剂量。在每 8 周（Q8 周）服用一次 VDZ 的患者中，81.5% 出现低谷。将给药频率增加到第 4 周后，所有患者的 VDZ 水平都有所改善，但仍有 30.6% 的患者的 VDZ 水平为 20 μg/mL。第 8 周用药时 VDZ 水平较高与白蛋白水平较高有关（P = 0.01）。而在第4周用药时，较高的VDZ水平与较高的白蛋白（P = 0.02）、较低的红细胞沉降率（P = 0.04）和较高的轻度疾病或内镜缓解可能性（P = 0.01）相关。无论是第8周还是第4周用药，VDZ水平与临床评分、体重指数、血红蛋白、维生素D或血小板水平之间均无明显关联。结论较高的 VDZ 谷值与较高的白蛋白、轻度内镜疾病或内镜缓解有关。在第 4 周用药后 VDZ 谷值仍然较低的患者可能需要改变疗法。

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引用次数: 0

Inadequate pregnancy-specific knowledge among patients with inflammatory bowel disease: A multicenter survey in China 炎症性肠病患者对妊娠相关知识了解不足：中国多中心调查

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-10 DOI: 10.1111/1751-2980.13258

Rui Xia Li, Tong Wu, Xiao Fei Li, He Zhou, Yan Ting Shi, Fang Wang, Jie Liang

Objectives

The perceptions and attitudes of inflammatory bowel disease (IBD) patients towards pregnancy may affect their fertility plan and disease progression. We performed a nationwide multicenter survey of pregnancy-related knowledge among gastroenterologists and IBD patients in China to investigate whether specific educational interventions could improve their understanding and broadly influence fertility plan.

Methods

A cross-sectional questionnaire regarding pregnancy-specific knowledge was carried out among 63 IBD centers in China. Questionnaires were collected from 185 physicians and 609 patients. The patients then received education regarding pregnancy during IBD and filled in the same questionnaire again. Their knowledge regarding pregnancy during IBD was compared before and after education.

Results

Compared to physicians, patients' knowledge regarding fertility (39.1% vs 70.8%), imaging examinations (22.8% vs 72.4%), endoscopy performed during pregnancy (19.9% vs 71.4%), and vaccination for infants (16.6% vs 46.5%) was significantly more limited (all P < 0.001). There was a lack of knowledge among gastroenterologists regarding the delivery mode (36.8%), medications (36.8%), and emergency surgery (26.5%) during pregnancy in patients with IBD. After education, the patients showed significant improvement in knowledge regarding medications (26.7% vs 51.7%), fertility (45.0% vs 63.3%), heritability (40.0% vs 58.3%), indications for emergency surgery (15.0% vs 53.3%), imaging examinations during pregnancy (20.0% vs 40.0%), and vaccinations for infants (26.7% vs 45.0%) (all P < 0.05).

Conclusions

Pregnancy-specific IBD knowledge needs to be improved among certain gastroenterologists and patients in China. Educational interventions can partially improve the knowledge levels of the patients.

目的炎症性肠病（IBD）患者对妊娠的看法和态度可能会影响他们的生育计划和疾病进展。我们在全国范围内对消化内科医生和 IBD 患者进行了一次妊娠相关知识的多中心调查，以研究特定的教育干预措施能否改善他们对妊娠的理解并广泛影响生育计划。方法在中国的 63 个 IBD 中心开展了关于妊娠相关知识的横断面问卷调查。共收集了 185 名医生和 609 名患者的问卷。随后，患者接受了有关 IBD 期间妊娠的教育，并再次填写了相同的问卷。比较教育前后患者对 IBD 期间妊娠的了解程度。结果与医生相比，患者对生育（39.1% 对 70.8%）、影像学检查（22.8% 对 72.4%）、妊娠期内镜检查（19.9% 对 71.4%）和婴儿疫苗接种（16.6% 对 46.5%）的了解明显有限（所有 P 均为 0.001）。消化内科医生对 IBD 患者妊娠期间的分娩方式（36.8%）、药物治疗（36.8%）和急诊手术（26.5%）缺乏了解。经过教育后，患者对药物（26.7% vs 51.7%）、生育（45.0% vs 63.3%）、遗传性（40.0% vs 58.3%）、急诊手术指征（15.0% vs 53.3%）、孕期影像学检查（20.0% vs 40.0%）和婴儿疫苗接种（26.7% vs 45.0%）的了解有了显著提高（所有 P 均为 0.05）。结论中国部分消化内科医生和患者对妊娠期特异性 IBD 的认识有待提高。教育干预可部分提高患者的知识水平。

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引用次数: 0

Liver cirrhosis and antibiotic therapy but not TIPS application leads to a shift of the intestinal bacterial communities: A controlled, prospective study 肝硬化和抗生素治疗（而非 TIPS）会导致肠道细菌群落发生变化：前瞻性对照研究

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-10 DOI: 10.1111/1751-2980.13262

Thomas Heller, Daniel P. R. Herlemann, Anabel Plieth, Jens-Christian Kröger, Marc-André Weber, Johannes Reiner, Robert Jaster, Bernd Kreikemeyer, Georg Lamprecht, Holger Schäffler

Objectives

The gut–liver axis is discussed to play an important role in hepatic cirrhosis. Decompensated liver cirrhosis is associated with portal hypertension, which can lead to a variety of complications. Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment option for the complications of portal hypertension. In this study we focused on the effect of TIPS on intestinal microbial composition in cirrhotic patients.

Methods

Thirty patients with liver cirrhosis were compared to 18 healthy adults. Seventeen patients with cirrhosis and portal hypertension received a TIPS. Clinical characteristics, including age, sex, and liver function measured with a Child-Pugh score and model for end-stage liver disease score, were obtained. Intestinal microbial composition was assessed via 16S rRNA gene amplicon sequencing from stool probes before and after TIPS.

Results

TIPS led to a reduction of hepatic venous pressure gradient. However, TIPS did not cause a shift in the intestinal bacterial communities. Independent from the application of TIPS, antibiotic therapy was associated with a significant difference in the intestinal bacterial microbiota and also a reduced α-diversity. In addition, a significant difference was observed in the intestinal bacterial composition between patients with liver cirrhosis and healthy controls.

Conclusion

The presence of liver cirrhosis and the use of antibiotic therapy, but not the application of TIPS, were associated with a significant shift of the intestinal bacterial communities, showing a high impact on the microbiota of patients with liver cirrhosis.

目的据讨论，肠肝轴在肝硬化中发挥着重要作用。失代偿期肝硬化伴有门静脉高压，可导致多种并发症。经颈静脉肝内门体分流术（TIPS）是治疗门静脉高压并发症的一种成熟疗法。在这项研究中，我们重点研究了 TIPS 对肝硬化患者肠道微生物组成的影响。17名肝硬化合并门脉高压症患者接受了 TIPS 治疗。临床特征包括年龄、性别、肝功能（通过 Child-Pugh 评分和终末期肝病模型评分）。结果TIPS导致肝静脉压力梯度降低。然而，TIPS 并未导致肠道细菌群落发生变化。与 TIPS 的应用无关，抗生素治疗与肠道细菌微生物群的显著差异和 α 多样性的降低有关。此外，肝硬化患者与健康对照组之间的肠道细菌组成也存在明显差异。结论肝硬化的存在和抗生素治疗的使用与肠道细菌群落的明显变化有关，但与 TIPS 的应用无关，这表明肝硬化患者的微生物群落受到很大影响。

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引用次数: 0

Therapeutic drug monitoring in patients with inflammatory bowel disease on ustekinumab 使用乌司替尼的炎症性肠病患者的治疗药物监测

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-08 DOI: 10.1111/1751-2980.13264

Adam Saleh, Rachel Stading, Natalia Miroballi, Kerri Glassner, Bincy P. Abraham

Objective

Therapeutic drug monitoring is used clinically to guide anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD), but its use for ustekinumab (UST) remains unclear. This study aimed to determine predictive variables of UST levels.

Methods

In this retrospective cohort of patients with IBD, UST trough levels were drawn at maintenance dosing. Relationships between UST trough levels and demographics, therapy, and outcomes were analyzed. Machine-learning models were used to infer combinatorial traits predictive of UST levels.

Results

Altogether 177 patients with IBD on UST had a mean UST trough level of 4.742 μg/mL. The injection schedule correlated significantly (P < 0.001) with UST levels. Naiveté to anti-TNFs correlated with higher UST levels (P = 0.048). Univariate analysis revealed that higher inflammatory biomarkers significantly correlated to lower UST levels and a lower Simple Endoscopic Score to Crohn's Disease to adequate UST levels (P = 0.018). Multivariate analysis identified body mass index (BMI), previous anti-TNF failure, and laboratory flare as predictors of UST levels with an area under the receiver operating characteristic curve (AUROC) of 0.72. The UST cut-off level of 5.77 μg/mL yielded a 0.79 AUROC, 80% sensitivity, and 81% specificity for predicting endoscopic remission of Crohn's disease. For the clinical remission end-point in ulcerative colitis, UST level of 4.73 μg/mL yielded a 0.69 AUROC, 53% sensitivity, and 86% specificity.

Conclusions

Higher UST levels correlated with less disease activity. BMI was an important consideration for UST response as well. Therefore, UST dose adjustments to reach target levels may optimize response.

目的临床上使用治疗药物监测来指导炎症性肠病（IBD）的抗肿瘤坏死因子（TNF）治疗，但其在乌司他单抗（UST）中的应用仍不明确。本研究旨在确定 UST 水平的预测变量。方法在这项回顾性 IBD 患者队列中，在维持用药时提取 UST 谷值。研究分析了UST谷值水平与人口统计学、治疗和预后之间的关系。结果 177 名服用 UST 的 IBD 患者的平均 UST 谷值为 4.742 μg/mL。注射时间与 UST 水平密切相关（P < 0.001）。抗肿瘤坏死因子的耐受性与较高的 UST 水平相关（P = 0.048）。单变量分析显示，较高的炎症生物标志物与较低的 UST 水平显著相关，而较低的克罗恩病简单内镜评分与足够的 UST 水平相关（P = 0.018）。多变量分析发现，体重指数（BMI）、既往抗肿瘤坏死因子（anti-TNF）失败和实验室复发是 UST 水平的预测因素，接收者操作特征曲线下面积（AUROC）为 0.72。UST 临界值为 5.77 μg/mL 时，预测克罗恩病内镜缓解的接收器工作特征曲线面积为 0.79，灵敏度为 80%，特异度为 81%。结论 UST水平越高，疾病活动越少。BMI也是影响UST反应的一个重要因素。因此，调整 UST 剂量以达到目标水平可能会优化反应。

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引用次数: 0

High-dose dual therapy versus bismuth-containing quadruple therapy for the eradication of Helicobacter pylori: A systematic review and meta-analysis 根除幽门螺旋杆菌的大剂量双重疗法与含铋四联疗法：系统综述和荟萃分析

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-04-05 DOI: 10.1111/1751-2980.13263

Hui Wang, Qing Zhou Kong, Yue Yue Li, Xiao Yun Yang, Xiu Li Zuo

Objective

To update evidence-based data comparing the efficacy and safety of high-dose dual therapy (HDDT) and bismuth-containing quadruple therapy (BQT) in eradicating Helicobacter pylori infection through meta-analysis.

Methods

Multiple databases were systematically searched for randomized controlled trials (RCTs) published up to May 18, 2023. Dichotomous data were evaluated using risk ratio (RR) and 95% confidence interval (CI). Subgroup analysis, sensitivity analysis, risk of bias assessment, and quality of evidence evaluation were performed.

Results

Twenty RCTs containing 7891 subjects were included in the analysis. There was no statistically significant difference in H. pylori eradication rate between HDDT and BQT in the intention-to-treat (ITT) analysis (86.31% vs 84.88%; RR 1.02, 95% CI 1.00–1.04, P = 0.12). In the per-protocol (PP) analysis, the eradication rates for HDDT and BQT were 90.27% and 89.94%, respectively (RR 1.01, 95% CI 0.99–1.03, P = 0.44). Adverse events were significantly lower with HDDT than with BQT (RR 0.44, 95% CI 0.38–0.51, P < 0.00001). Patient adherence was significantly different between the two groups (RR 1.01, 95% CI 1.00–1.03, P = 0.02). Subgroup analysis based on antibiotic combinations within the BQT group showed a significantly higher eradication rate for HDDT than for BQT only when BQT used amoxicillin combined with clarithromycin (P = 0.0009).

Conclusions

HDDT showed comparable efficacy with BQT for H. pylori eradication, with fewer adverse effects and higher compliance. Due to regional differences, antibiotic resistance rates, and combined BQT antibiotics, more studies are needed for further validation and optimization of HDDT.

方法系统检索了多个数据库中截至 2023 年 5 月 18 日发表的随机对照试验 (RCT)。使用风险比（RR）和 95% 置信区间（CI）对二分法数据进行评估。进行了亚组分析、敏感性分析、偏倚风险评估和证据质量评价。在意向性治疗（ITT）分析中，HDDT 和 BQT 的幽门螺杆菌根除率没有明显的统计学差异（86.31% vs 84.88%；RR 1.02，95% CI 1.00-1.04，P = 0.12）。在按方案（PP）分析中，HDDT和BQT的根除率分别为90.27%和89.94%（RR 1.01，95% CI 0.99-1.03，P = 0.44）。HDDT的不良事件明显低于BQT（RR 0.44，95% CI 0.38-0.51，P <0.00001）。两组患者的依从性有明显差异（RR 1.01，95% CI 1.00-1.03，P = 0.02）。结论HDDT与BQT根除幽门螺杆菌的疗效相当，不良反应较少，依从性较高。由于地区差异、抗生素耐药率以及联合使用 BQT 抗生素等原因，需要进行更多的研究来进一步验证和优化 HDDT。

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引用次数: 0

Efficacy of exclusive enteral nutrition on the mucosal healing of different gastrointestinal segments in children with Crohn's disease 纯肠内营养对克罗恩病患儿不同胃肠节段粘膜愈合的疗效。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-03-31 DOI: 10.1111/1751-2980.13260

Wen Juan Tang, Peng Shi, Hai Jiao Xia, Jie Wu, Yu Huan Wang, Ying Huang

Objective

To investigate the association between disease location and segmental mucosal healing (SMH) following exclusive enteral nutrition (EEN) in children with Crohn's disease (CD).

Methods

Treatment-naive pediatric patients with endoscopically active CD treated with EEN alone as induction therapy were retrospectively enrolled from January 1, 2017 to June 30, 2022. The simple endoscopic score for CD (SES-CD) was employed to score disease activity in the upper gastrointestinal (GI) tract (esophagus, stomach, duodenum), rectum, left colon, transverse colon, right colon, and terminal ileum. While the Lewis score assessed that of the small bowel from the jejunum to the proximal ileum (except the terminal ileum). The variation in the total scores for each segment and SES-CD subscores for each ileocolonic segment from baseline to 1 year after EEN therapy and the segmental endoscopic outcomes and potential predictors associated with SMH for the segments scored by SES-CD were evaluated.

Results

Overall, 82 children with CD were enrolled. Except for the upper GI segment, scores in other segments declined significantly from baseline to EEN completion (all P < 0.001). We analyzed 486 segments (79, 80, 81, 82, 82 and 82 from upper GI tract, terminal ileum, right colon, transverse colon, left colon, and rectum) and found that the segmental SES-CD at baseline (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.55–0.70, P < 0.001) and upper GI location (OR 0.25, 95% CI 0.11–0.55, P = 0.001) were associated with SMH at EEN completion.

Conclusion

Disease location of the upper GI segment in pediatric CD was associated with SMH following EEN therapy.

目的研究克罗恩病（CD）患儿在接受纯肠内营养（EEN）治疗后，疾病部位与节段黏膜愈合（SMH）之间的关系：回顾性入组了2017年1月1日至2022年6月30日期间内镜下活动性CD的未接受治疗的儿童患者，仅以EEN作为诱导治疗。采用CD简单内镜评分（SES-CD）对上消化道（食管、胃、十二指肠）、直肠、左结肠、横结肠、右结肠和回肠末端的疾病活动性进行评分。而 Lewis 评分则评估从空肠到回肠近端（回肠末端除外）的小肠。评估了从基线到 EEN 治疗 1 年后每个节段的总分和每个回结肠节段的 SES-CD 子分数的变化，以及 SES-CD 评分节段的节段内镜结果和与 SMH 相关的潜在预测因素：结果：共有82名CD患儿参加了此次研究。除上消化道节段外，其他节段的评分从基线到 EEN 结束时均显著下降（均为 P 结论：SES-CD 的节段内镜结果与 SMH 相关的潜在预测因素有关：小儿 CD 上消化道部分的疾病位置与 EEN 治疗后的 SMH 有关。

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