Journal of Digestive Diseases最新文献_第9页

Two-year outcomes of anti-reflux mucosectomy in treating gastroesophageal reflux disease: A Chinese prospective cohort study 抗反流粘膜切除术治疗胃食管反流病的两年疗效：一项中国前瞻性队列研究。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-11-01 DOI: 10.1111/1751-2980.13238

Jun Nan Hu, Song Feng Chen, Xing Yu Jia, Yu Luo, Xiang Bin Xing, Nian Di Tan, Meng Yu Zhang, Qian Jun Zhuang, Jin Hui Wang, Ying Lian Xiao

Objectives

Anti-reflux mucosectomy (ARMS) is an emerging and promising endoscopic treatment for gastroesophageal reflux disease (GERD). In the current study we aimed to evaluate the safety and efficacy of ARMS in treating Chinese GERD patients.

Methods

This was a single-center prospective cohort study. ARMS was performed in GERD patients by an experienced endoscopist. The patients were required to undergo symptom assessment as well as endoscopic examination, high-resolution manometry (HRM), and impedance-pH monitoring before and after ARMS.

Results

Twelve patients were enrolled. Follow-up was completed by all patients at 3 and 6 months, 11 patients at 1 year, and 8 patients at 2 years after ARMS, respectively. Symptom improvement was achieved in 66.7%, 75.0%, 72.7%, and 50.0% of the patients at 3 months, 6 months, 1 year, and 2 years after ARMS, respectively. Postoperative dysphagia was reported by 25.0%, 25.0%, 27.3%, and 25.0% of patients at 3 months, 6 months, 1 year, and 2 years after surgery, none of whom required additional invasive treatment. All patients with preoperative esophagitis healed after ARMS. For impedance-pH monitoring parameters, number of acidic reflux episodes and the proportion of patients with acid exposure time (AET) >4.0% decreased significantly after ARMS.

Conclusions

ARMS was safe and effective in Chinese GERD patients. The efficacy of ARMS was not short-term and remained evident throughout the 2-year follow-up. Further multicenter studies with larger sample sizes are needed to verify our findings.

背景：抗反流粘膜切除术（ARMS）是一种新兴的、有前途的胃食管反流病（GERD）内镜治疗方法。本研究旨在评估ARMS治疗中国GERD患者的安全性和有效性。方法：这是一项单中心前瞻性队列研究。由经验丰富的内镜医生对入选的GERD患者进行ARMS。这些患者在ARMS前后需要接受症状评估、内窥镜检查、高分辨率测压（HRM）和阻抗pH监测。结果：共有12名患者入选，均在3个月和6个月完成随访，其中11名患者在1年时完成随访，8名患者在2个月时完成随访 ARMS之后的几年。在3个月、6个月、1年、2个月时症状改善的患者比例 ARMS后年分别为66.7%、75.0%、72.7%、50.0%。25.0%、25.0%、27.3%、25.0%的患者在术后3个月、6个月、1年和2个月出现吞咽困难术后数年，没有一例患者需要额外的侵入性治疗。术前食管炎患者均经ARMS治疗后痊愈。对于阻抗pH监测参数，酸反流发作次数和酸暴露时间（AET）患者比例%> 结论：本研究证明ARMS对中国GERD患者是安全有效的。ARMS的疗效不是短期的，在本研究的2年随访期内仍然明显。进一步的多中心研究和更大的样本量仍然需要验证我们的发现。这篇文章受版权保护。保留所有权利。

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引用次数: 0

Treatment of functional dyspepsia in Chinese adult patients with domperidone: A multicenter, randomized, double-blind, placebo-controlled pilot study 多潘立酮治疗中国成年功能性消化不良：一项多中心、随机、双盲、安慰剂对照的初步研究。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-10-30 DOI: 10.1111/1751-2980.13237

Xiu Cai Fang, Zhi Hui Lin, Yong Dong Wu, De An Tian, Shi Liu, Dong Sheng Wu, Han Lin, Fan Dong Meng, Mei Liu, Fan Du, Hui Jun Shu, Zhi Feng Wang, Jian Min Zhuo, Ping Wang, Meng Yu Li, Jian Xu

Objective

This pilot study aimed to evaluate the efficacy and safety of domperidone for the treatment of Chinese patients with functional dyspepsia (FD) who were diagnosed according to the Rome IV criteria and to identify the FD subtypes that potentially responded better to domperidone.

Methods

This multicenter prospective study was conducted in China from August 2018 to July 2020, consisting of a 1-week screening phase and a 2-week double-blind treatment phase. Participants were randomized to receive domperidone 10 mg or matching placebo tablets thrice daily for 14 days. The primary end-point was the overall treatment effect (OTE) response rate after 2-week therapy.

Results

Altogether 160 patients were included, with 80 patients in each group. The OTE response rate after 2-week therapy was significantly higher for domperidone compared with placebo (60.7% vs 46.0%; relative risk [RR] 1.318, 95% confidence interval [CI] 0.972–1.787). Moreover, the OTE response rate after 2-week domperidone or placebo treatment was 60.3% versus 54.9% for postprandial distress syndrome (PDS) (RR 1.098, 95% CI 0.750–1.607) and 60.6% versus 35.2% for overlapping PDS–epigastric pain syndrome (EPS) (RR 1.722, 95% CI 0.995–2.980). Adverse events were reported by seven patients in the domperidone group and 12 patients in the placebo group. None of the adverse events in the domperidone group were serious.

Conclusion

Domperidone showed a positive pattern regarding OTE response rates after 2-week therapy compared to placebo in patients with FD, as well as in subtypes of PDS and overlapping PDS–EPS. No new safety issue was observed.

目的：这项初步研究旨在评估多潘立酮治疗根据罗马IV标准诊断的中国功能性消化不良（FD）患者的疗效，包括确定可能对多潘立醇反应更好的FD亚型。方法：本研究于2018年8月至2020年7月在中国的医院进行。该研究包括为期1周的筛选阶段和为期2周的双盲治疗阶段。参与者被随机分配服用10 mg多潘立酮或匹配的安慰剂，每天3次，共14次天。主要终点是2年后的总体治疗效果（OTE）反应率数周的治疗。结果：本研究纳入160名患者，每组80名。2后的OTE响应率与安慰剂（46.0%）相比，多潘立酮（60.7%）的治疗周数更高（相对风险[RR]，1.318；95%置信区间[CI]，0.972-1.787）根据FD亚型，多潘立酮和安慰剂的餐后痛苦综合征（PDS）的周数分别为60.3%vs 54.9%（RR，1.098；95%CI，0.750-1.607）和重叠PDS上腹痛综合征（EPS）的周率分别为60.6%vs 35.2%（RR，1.722；95%CI，0.995-2.980）。多潘立酮组有7名患者和安慰剂组有12名患者报告了不良事件。多潘立酮组无严重或意外的不良事件。结论：多潘立酮在2小时后显示出OTE应答率的阳性模式 FD患者以及PDS和重叠PDS-EPS亚型患者的治疗周数与安慰剂相比。未观察到新的安全信号。这篇文章受版权保护。保留所有权利。

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引用次数: 0

Ileocecal involvement in intestinal Behçet's disease and Crohn's disease: comparison of clinicopathological and immunophenotypic features 肠白塞病和克罗恩病的盲肠受累：临床病理和免疫表型特征的比较。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-10-21 DOI: 10.1111/1751-2980.13236

Yan Chuang Wu, Yu Juan Fu, Hai Jiao Xia, Jia Zhu, Ying Huang, Zhi Nong Jiang

Objectives

Intestinal Behçet's disease (BD) predominantly affects the ileocecal region and is currently diagnosed based on endoscopic features and clinical manifestations. It is difficult to distinguish between intestinal BD and Crohn's disease (CD) due to similar patient populations, gastrointestinal involvement, extraintestinal manifestations, and long-term recurrent course. In this study we aimed to compare the clinicopathological and immunophenotypic features of intestinal BD to CD.

Methods

The medical and pathological records of 29 cases of intestinal BD and 120 cases of CD diagnosed at Sir Run Run Shaw Hospital were retrospectively analyzed. Immunohistochemistry for CD3, CD20, FOXP3, myeloperoxidase, and quantitative analysis of the infiltrating inflammatory cells was conducted.

Results

Intestinal BD with ileocecal ulcer had a higher incidence of abdominal pain and a higher erythrocyte sedimentation rate than CD, while chronic diarrhea was more common in CD. Excessive neutrophils in the mucosal lamina propria, neutrophilic exudate on the ulcer surface, and prominent lymphocytic infiltration in ulcer tissues were statistically more frequent in intestinal BD than in CD. The numbers of FOXP3⁺T cells, CD3⁺T cells, and CD20⁺B cells in biopsy tissue from intestinal BD were significantly higher than CD, but the ratio of FOXP3⁺T cells to CD3⁺T cells was not statistically different.

Conclusion

Besides the typical clinical and endoscopic findings, diagnostic biopsies from the ileocecal region in intestinal BD show some histological and immunophenotypic features that are different from CD, which may be useful in distinguishing these two entities.

背景：肠白塞病（BD）主要影响回盲部，目前根据内镜特征和临床表现进行诊断。由于患者群体相似、胃肠道受累、肠外表现和长期复发，很难区分BD和克罗恩病（CD）。方法：回顾性分析邵逸夫医院诊断的29例肠BD和120例CD的临床病理资料。对CD3、CD20、FOXP3、髓过氧化物酶进行免疫组化，并对浸润的炎症细胞进行定量分析。结果：肠BD伴回盲部溃疡的腹痛发生率和平均红细胞沉降率高于CD，而CD的慢性腹泻发生率显著高于CD。粘膜固有层中性粒细胞过多、溃疡表面中性粒细胞渗出物和溃疡组织中显著的淋巴细胞浸润在统计学上比CD更常见。肠BD活检组织中FOXP3+T细胞、CD3+T细胞和CD20+B细胞的数量显著高于CD，但FOXP3+/CD3+T细胞的比例没有统计学差异。结论：除了典型的临床和内镜检查外，肠BD回盲部的诊断性活检显示出一些不同于CD的组织学和免疫表型特征，这可能有助于区分这两种实体。这篇文章受版权保护。保留所有权利。

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引用次数: 0

Establishment and validation of symptomatic patients colorectal screening score for predicting colorectal neoplasia risk 症状患者结肠直肠筛查评分预测结肠肿瘤风险的建立和验证。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-10-17 DOI: 10.1111/1751-2980.13235

Xu Wang, Xi Zhang, Jiani Liu, Tian Yu Liu, Bang Mao Wang, Wen Tian Liu, Xin Xu, Jie Zhang, Hai Long Cao

Objectives

Currently, most colorectal neoplasia (CRN) screening strategies target asymptomatic individuals. However, studies on patients with non-specific gastrointestinal symptoms (NSGS) are limited. We aimed to develop a CRN risk score specifically for patients with NSGS.

Methods

We prospectively enrolled patients who underwent initial colonoscopy between June 2020 and June 2021. A new risk scoring system was constructed and its applicability was evaluated.

Results

A total of 1522 consecutive patients were enrolled, among whom 1016 symptomatic patients were randomly divided into a training cohort and a validation cohort at a ratio of 7:3. The constructed Symptomatic Patients Colorectal Screening (SPCS) score showed higher diagnostic efficacy and sensitivity than several previous scoring systems. Using the SPCS score, the patients were divided into a low-risk group (−2 to 3 points) and a high-risk group (4–10 points) for CRN. Additionally, the detection rate of CRN in the training and validation cohorts of the high-risk group were 41.7% and 37.0%, respectively. The SPCS score detected 79.3% (188/237) of CRN and 87.5% (42/48) of advanced CRN in the high-risk group, which reduced the workload of colonoscopy to 45.9% (466/1016).

Conclusion

An effective CRN risk scoring system was established and validated for symptomatic patients, which accurately classified individuals into low-risk and high-risk groups for CRN and might be used to optimize colonoscopic resource allocation.

背景：目前，大多数结直肠肿瘤（CRN）筛查策略都针对无症状患者。目前尚不清楚有非特异性胃肠道症状的患者是否应接受CRN的风险分层。目的：制定专门针对有非特异性消化道症状患者的CRN风险评分。方法：我们前瞻性地收集了2020年6月至2021年6月期间接受首次结肠镜检查的患者的数据。构建了一个新的风险评分，并对其适用性进行了评估。结果：共有1522名连续患者入选，其中1016名有症状的患者按7:3的比例随机分为训练队列和验证队列。我们构建的症状患者结肠直肠筛查（SPCS）评分显示出比以前报道的几种评分系统更高的诊断疗效和敏感性。我们将SPCS评分分为低风险组（-2～3分）和高风险组（4～10分）。在高危组的训练和验证队列中，CRN的检测率分别为41.7%和37.0%。SPCS评分在高危组中检测到79.3%的CRN（188/237）和87.5%的晚期CRN（42/48），这将结肠镜检查的工作量减少到仅45.9%（466/1016），它准确地将个体分为低风险和高风险组，并优化结肠镜检查资源分配。这篇文章受版权保护。保留所有权利。

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引用次数: 0

Association between inflammatory bowel disease, nephrolithiasis, tubulointerstitial nephritis, and chronic kidney disease: A propensity score-matched analysis of US nationwide inpatient sample 2016–2018 炎症性肠病、肾结石、肾小管间质性肾炎和慢性肾脏疾病之间的关系：2016-2018年美国全国住院患者样本的倾向得分匹配分析。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-10-12 DOI: 10.1111/1751-2980.13233

Wei Wei Zheng, Quan Zhou, Meng Li Xue, Xing Yu, Jin Tong Chen, Lu Ao, Cheng Dang Wang

Objectives

The incidence and prevalence of inflammatory bowel disease (IBD), mainly including ulcerative colitis (UC) and Crohn's disease (CD), are increasing globally. We aimed to evaluate the potential association between IBD and nephrolithiasis, tubulointerstitial nephritis, and chronic kidney disease (CKD).

Methods

Data of hospitalized adults ≥20 years of age were extracted from the U.S. National Inpatient Sample (NIS) during 2016–2018. Patients with UC, CD, or CKD were identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes. Propensity score matching (PSM) analysis (1:1) was conducted to balance the characteristics between groups. Logistic regression analyses were performed to determine the relationships between UC or CD and kidney conditions.

Results

Three cohorts were included for analysis after PSM analysis. Cohorts 1, 2 and 3 contained 235 262 subjects (117 631 with CD or without IBD), 140 856 subjects (70 428 with UC or without IBD), and 139 098 subjects (69 549 with CD or UC), respectively. Multivariate analysis revealed that compared to non-IBD individuals, CD patients were significantly associated with greater odds for nephrolithiasis (adjusted odds ratio [aOR] 2.25, 95% confidence interval [CI] 2.08–2.43), tubulointerstitial nephritis (aOR 1.31, 95% CI 1.24–1.38), CKD at any stage (aOR 1.28, 95% CI 1.24–1.32), and moderate-to-severe CKD (aOR 1.22, 95% CI 1.17–1.26), while UC was associated with a higher rate of nephrolithiasis. Compared to UC, CD was associated with higher odds for all such kidney conditions.

Conclusions

Patients with CD are more likely to have nephrolithiasis, tubulointerstitial nephritis, CKD at any stage, and moderate-to-severe CKD compared to non-IBD individuals.

目的：炎症性肠病（IBD），包括溃疡性结肠炎（UC）和克罗恩病（CD），正在全球范围内增加。我们旨在评估IBD与流行的肾结石、肾小管间质性肾炎和慢性肾脏疾病（CKD）之间的潜在联系。方法：住院成人≥20例从2016年至2018年的美国国家住院患者样本（NIS）中提取了年。UC、CD和CKD患者通过国际疾病分类第十版（ICD-10）代码进行识别。进行倾向评分匹配（PSM）以平衡比较组之间的特征。进行Logistic回归以确定UC、CD和感兴趣的肾脏状况之间的关系。结果：在排除和1:1 PSM后，我们得出了三个队列：队列1包含235 262名受试者（117名 631具有CD或不具有IBD）；队列2包含140 856名受试者（70 428例UC或无IBD）；队列3包含139 098名受试者（69 549与CD或UC）。多因素分析显示，与无IBD相比，CD与更大的肾结石发生几率显著相关（aOR = 2.25，95%可信区间：2.08-2.43），肾小管间质性肾炎（aOR = 1.31，95%可信区间：1.24-1.38），任何阶段的CKD（aOR = 1.28，95%可信区间：1.24-1.32），以及中重度CKD（aOR = 1.22，95%CI:1.17-1.26），而UC与更多的肾结石有关。与UC相比，CD与所有这些肾脏疾病的更高几率相关。结论：这项大型流行病学研究表明，CD患者尤其容易患肾结石、肾小管间质性肾炎、任何阶段的CKD和中重度CKD。

{"title":"Association between inflammatory bowel disease, nephrolithiasis, tubulointerstitial nephritis, and chronic kidney disease: A propensity score-matched analysis of US nationwide inpatient sample 2016–2018","authors":"Wei Wei Zheng, Quan Zhou, Meng Li Xue, Xing Yu, Jin Tong Chen, Lu Ao, Cheng Dang Wang","doi":"10.1111/1751-2980.13233","DOIUrl":"10.1111/1751-2980.13233","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The incidence and prevalence of inflammatory bowel disease (IBD), mainly including ulcerative colitis (UC) and Crohn's disease (CD), are increasing globally. We aimed to evaluate the potential association between IBD and nephrolithiasis, tubulointerstitial nephritis, and chronic kidney disease (CKD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of hospitalized adults ≥20 years of age were extracted from the U.S. National Inpatient Sample (NIS) during 2016–2018. Patients with UC, CD, or CKD were identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes. Propensity score matching (PSM) analysis (1:1) was conducted to balance the characteristics between groups. Logistic regression analyses were performed to determine the relationships between UC or CD and kidney conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three cohorts were included for analysis after PSM analysis. Cohorts 1, 2 and 3 contained 235 262 subjects (117 631 with CD or without IBD), 140 856 subjects (70 428 with UC or without IBD), and 139 098 subjects (69 549 with CD or UC), respectively. Multivariate analysis revealed that compared to non-IBD individuals, CD patients were significantly associated with greater odds for nephrolithiasis (adjusted odds ratio [aOR] 2.25, 95% confidence interval [CI] 2.08–2.43), tubulointerstitial nephritis (aOR 1.31, 95% CI 1.24–1.38), CKD at any stage (aOR 1.28, 95% CI 1.24–1.32), and moderate-to-severe CKD (aOR 1.22, 95% CI 1.17–1.26), while UC was associated with a higher rate of nephrolithiasis. Compared to UC, CD was associated with higher odds for all such kidney conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with CD are more likely to have nephrolithiasis, tubulointerstitial nephritis, CKD at any stage, and moderate-to-severe CKD compared to non-IBD individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"24 11","pages":"572-583"},"PeriodicalIF":3.5,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41202745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Favorable impact of a novel endoscopic auxiliary system (NEAS) on fluoroscopy-guided lithotripsy for difficult bile duct stones: A pilot study 新型内窥镜辅助系统（NEAS）对荧光镜引导下胆管结石碎石术的有利影响：一项初步研究。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-10-12 DOI: 10.1111/1751-2980.13234

Yu Qing Mao, Jian Bo Ni, Yi Neng Yu, Kui Peng, Ying Qu, You Chen Xia, Sheng Zheng Luo, Seng Wang Fu, Ni Xie, Lun Gen Lu, Xin Jian Wan, Bai Wen Li

Objectives

Laser lithotripsy under fluoroscopic guidance is difficult to perform and risky due to its invisibility. In this study we aimed to investigate the efficacy and safety of a novel endoscopic auxiliary system (NEAS)-assisted lithotripsy under fluoroscopy for treating difficult common bile duct (CBD) stones.

Methods

Patients with difficult CBD stones who were treated with NEAS-assisted laser lithotripsy (NEAS group) or conventional mechanical lithotripsy (ML) under fluoroscopy (ML group) were retrospectively evaluated. The primary outcome was the complete stone clearance rate and the secondary outcomes included operation time, complications, and medical cost.

Results

Seventeen patients were treated with NEAS-assisted laser lithotripsy and 144 patients underwent ML. Using the propensity score matching analysis, 17 pairs of cases treated with NEAS-assisted lithotripsy and ML were included. Patients in the NEAS group showed a higher stone clearance rate than the ML group (94.1% vs 58.8%, P = 0.039), as well as shorter operation time (41.9 min vs 49.4 min, P < 0.001) and lower medical cost (USD 4607 vs USD 5014, P < 0.001). There was no significant difference in the complication rate between the two groups (5.9% vs 17.6%, P = 0.601).

Conclusion

NEAS-assisted fluoroscopy-guided laser lithotripsy is feasible and safe, which may be a promising technique in fluoroscopy-guided laser lithotripsy for difficult CBD stones.

目的：由于荧光镜下激光纤维的不可见性，在荧光镜引导下进行激光碎石术既困难又危险。本研究旨在探讨一种新型内窥镜辅助系统（NEAS）辅助碎石在荧光镜下治疗难治性胆总管（CBD）结石的可行性。方法：对接受NEAS辅助激光碎石术（NEAS组）或荧光镜下常规机械碎石术（ML组）治疗的难治性CBD结石患者进行回顾性评价。主要结果是结石完全清除率，次要结果包括手术时间、并发症和费用。结果：17例患者接受了NEAS辅助激光碎石术治疗，144例患者接受ML.采用倾向评分匹配设计，我们选择了17对接受NEAS辅助碎石术和ML.NEAS组患者的结石清除率高于ML组（94.1%vs.58.8%，p = 0.039），以及更短的手术时间（41.9分钟vs.49.4分钟，P结论：我们的研究表明，NEAS辅助荧光镜引导的激光碎石术是可行和安全的，这可能是一种很有前途的荧光镜引导下的激光碎石术治疗难治CBD结石的技术。本文受版权保护。保留所有权利。

{"title":"Favorable impact of a novel endoscopic auxiliary system (NEAS) on fluoroscopy-guided lithotripsy for difficult bile duct stones: A pilot study","authors":"Yu Qing Mao, Jian Bo Ni, Yi Neng Yu, Kui Peng, Ying Qu, You Chen Xia, Sheng Zheng Luo, Seng Wang Fu, Ni Xie, Lun Gen Lu, Xin Jian Wan, Bai Wen Li","doi":"10.1111/1751-2980.13234","DOIUrl":"10.1111/1751-2980.13234","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Laser lithotripsy under fluoroscopic guidance is difficult to perform and risky due to its invisibility. In this study we aimed to investigate the efficacy and safety of a novel endoscopic auxiliary system (NEAS)-assisted lithotripsy under fluoroscopy for treating difficult common bile duct (CBD) stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with difficult CBD stones who were treated with NEAS-assisted laser lithotripsy (NEAS group) or conventional mechanical lithotripsy (ML) under fluoroscopy (ML group) were retrospectively evaluated. The primary outcome was the complete stone clearance rate and the secondary outcomes included operation time, complications, and medical cost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen patients were treated with NEAS-assisted laser lithotripsy and 144 patients underwent ML. Using the propensity score matching analysis, 17 pairs of cases treated with NEAS-assisted lithotripsy and ML were included. Patients in the NEAS group showed a higher stone clearance rate than the ML group (94.1% vs 58.8%, <i>P</i> = 0.039), as well as shorter operation time (41.9 min vs 49.4 min, <i>P</i> < 0.001) and lower medical cost (USD 4607 vs USD 5014, <i>P</i> < 0.001). There was no significant difference in the complication rate between the two groups (5.9% vs 17.6%, <i>P</i> = 0.601).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NEAS-assisted fluoroscopy-guided laser lithotripsy is feasible and safe, which may be a promising technique in fluoroscopy-guided laser lithotripsy for difficult CBD stones.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"24 11","pages":"630-637"},"PeriodicalIF":3.5,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41202746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Low-grade inflammation for predicting severe acute pancreatitis in patients with hypertriglyceridemic acute pancreatitis 预测高甘油三酯血症急性胰腺炎患者重症急性胰腺炎的低度炎症。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-10-05 DOI: 10.1111/1751-2980.13231

Xue Yan Lin, Yong Xing Lai, Yi Lin, Zhi Hui Lin

Objectives

We aimed to evaluate the association between low-grade inflammation (LGI) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP).

Methods

We retrospectively reviewed 311 patients with HTG-AP who were admitted to the Department of Gastroenterology, Fujian Provincial Hospital between April 2012 and March 2021. Inpatient medical and radiological records were reviewed to collect the clinical manifestations, disease severity, and comorbidities. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were considered LGI components and were combined to calculate a standardized LGI score. The association between the LGI score and the severity of HTG-AP was analyzed using univariate and multivariate logistic regression analyses.

Results

Of the 311 patients with HTG-AP, 47 (15.1%) had mild acute pancreatitis (MAP), 184 (59.2%) had moderately severe acute pancreatitis (MSAP), and 80 (25.7%) had severe acute pancreatitis (SAP), respectively. Patients with MSAP and SAP had a higher LGI score than those with MAP (1.50 vs −6.00, P < 0.001). Univariate logistic regression analysis revealed that patients with LGI scores in the fourth quartile were more likely to have MSAP and SAP (odds ratio [OR] 21.925, 95% confidence interval [CI] 5.014–95.867, P < 0.001). The multivariate logistic regression analysis confirmed that low calcium (OR 0.105, 95% CI 0.011–0.969, P = 0.047) and high LGI score (OR 1.253, 95% CI 1.066–1.473, P = 0.006) were associated with MSAP and SAP. When predicting the severity of acute pancreatitis, the LGI score had the highest area under the receiver operating characteristic (ROC) curve (0.7737) compared to its individual components.

Conclusion

An elevated LGI score was associated with a higher risk of SAP in patients with HTG-AP.

目的：我们旨在评估LGI与HTG-AP患者严重程度之间的关系。对住院患者的医疗和放射学记录进行审查，以确定临床特征、严重程度和并发症。C反应蛋白（CRP）水平、白细胞（WBC）计数、血小板（PLT）计数和中性粒细胞与淋巴细胞比率（NLR）被认为是低度炎症的生物标志物，并被合并为标准化的LGI评分。使用单变量和多变量逻辑回归分析LGI评分与HTG-AP严重程度风险之间的相关性。结果：在研究的311名HTG-AP患者中，47名（15.1%）患者患有轻度急性胰腺炎（MAP），184名（59.2%）患者患有中重度急性胰腺炎（MSAP），80名（25.7%）患者患有重症急性胰腺炎（SAP）。MSAP和SAP患者的LGI评分更高（中位数为1.50 vs.6.00；P结论：本研究发现，HTG-AP患者LGI评分升高与SAP风险升高相关。

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引用次数: 0

Incidence and disease-related risk factors for cerebrovascular accidents in patients with inflammatory bowel diseases: A systematic review and meta-analysis 炎症性肠病患者脑血管意外的发病率和疾病相关危险因素：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 : 2023-10-05 DOI: 10.1111/1751-2980.13232

Jian Wan, Xuan Wang, Yu Jie Zhang, Yue Yin, Zhuo Wang, Xiao Che, Min Chen, Jie Liang, Kai Chun Wu

Objectives

Risk of cerebrovascular accidents (CVAs) in patients with inflammatory bowel disease (IBD) remains inconclusive. In this systematic review and meta-analysis, we aimed to estimate the incidence of and identify the risk factors for CVA in patients with IBD.

Methods

PubMed, EMBASE and Web of Science were searched for articles published up to January 13, 2023 to identify those reported the incidence of CVA in IBD patients, along with the total person-years or related data to calculate it. The main outcomes were the incidence of and risk factors for CVA in IBD.

Results

Based on the analysis of 10 studies, the pooled incidence of CVA in IBD patients was 2.74 per 1000 person-years (95% confidence interval [CI] 1.83–4.10 person-years; I² = 99.2%), which was higher than that in the general population (incidence rate ratio [IRR] 1.21, 95% CI 1.09–1.34, P = 0.0002; I² = 84.8%). Risk factors for CVA in IBD patients were age (significance in different definitions), ulcerative colitis (IRR 1.214, 95% CI 1.000–1.474, P = 0.0499; I² = 81.9%), disease flares (IRR 1.699, 95% CI 1.359–2.122, P < 0.0001; I² = 28.7%) and chronic activity (IRR 2.202, 95% CI 1.378–3.519, P = 0.0010; I² = 83.0%).

Conclusions

The risk of CVA modestly increased in IBD patients. Both the traditional and IBD-related risk factors should be managed to prevent CVA in these patients. Since the effects of risk factors were derived from pooled results of only 2–3 studies, further research is needed to confirm our results.

目的：炎症性肠病（IBD）患者发生脑血管意外（CVA）的风险存在争议，包括溃疡性结肠炎（UC）和克罗恩病（CD）。本研究旨在估计IBD患者CVA的发病率并确定其风险因素。方法：检索PubMed、Embase和Web of Science，直到2023年1月13日，以确定报告IBD患者发生CVA的研究，以及计算CVA的总人年数或相关数据。主要结果是IBD患者CVA的发生率和危险因素。结果：根据对10项研究的分析，IBD患者CVA的合并发病率为2.74（95%CI 1.83-4.10，I2= 99.2%），高于普通人群（发病率比率[IRR]1.21，95%CI 1.09-1.34，I2= 84.8%，p=0.0002）。UC和CD患者的风险也有所增加。IBD患者CVA的风险因素为年龄（不同定义中的显著性）、UC类型（IRR 1.21，95%CI 1.00-1.47，I2= 81.9%，p=0.0499），闪焰（内部收益率1.70，95%置信区间1.36-2.12，I2= 28.7%，第2页= 83.0%，p=0.0010）。结论：IBD患者发生CVA的风险略有增加。应对传统的和IBD相关的危险因素进行管理，以防止IBD患者发生CVA。由于风险因素的影响仅来自2-3项研究的汇总结果，因此需要进一步的研究来证实我们的结果。这篇文章受版权保护。保留所有权利。

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引用次数: 0

Fibroblast-specific adipocyte enhancer binding protein 1 is a potential pathological trigger and prognostic marker for liver fibrosis independent of etiology 成纤维细胞特异性脂肪细胞增强子结合蛋白1是肝纤维化的潜在病理触发因素和预后标志物，与病因无关。

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-09-30 DOI: 10.1111/1751-2980.13230

Wen Zhang, Yu Jia Li, Ning Zhang, Shu Yan Chen, Xiao Fei Tong, Bing Qiong Wang, Tao Huang, Hong You, Wei Chen

Objectives

Aortic carboxypeptidase-like protein (ACLP) is an extracellular protein involved in adipogenesis, epithelial-mesenchymal transition, epithelial cell hyperplasia, and collagen fibrogenesis. This study mainly aimed to analyze the potential role of adipocyte enhancer binding protein 1 (AEBP1), the ACLP-encoding gene, as a pathological target or prognostic marker for liver fibrosis regardless of etiology.

Methods

Dysregulation pattern, clinical relevance, and biological significance of AEBP1 gene in liver fibrosis were analyzed using publicly available transcriptomic profiles, different liver fibrosis mouse models, biological databases, and AEBP1 gene silencing followed by RNA sequencing in human hepatic stellate cells (HSCs).

Results

AEBP1 gene expression was upregulated and positively correlated with liver fibrogenesis independent of etiology, the protein of which was further verified in liver fibrosis mouse models induced by different pathogenic factors. A higher expression of liver AEBP1 gene had the potential to predict poor prognosis in liver fibrosis. Systematic bioinformatic analyses revealed that AEBP1 expression was HSCs-specific and associated with extracellular matrix (ECM) remodeling and its downstream mechanical–chemical signaling transition. AEBP1 knockdown by specific small interfering RNAs (siRNAs) in HSCs inhibited ECM-receptor interaction and immune-related pathways as well as HSC proliferation or activation.

Conclusion

A high expression of AEBP1 was specifically associated with liver fibrosis and was related to a poor prognosis and predicted the role of AEBP1 in HSCs, providing a new insight for understanding AEBP1 in liver fibrosis.

目的：主动脉羧肽酶样蛋白（ACLP）是一种参与脂肪生成、上皮-间质转化、上皮细胞增生和胶原纤维生成的细胞外蛋白。主要研究目的是分析ACLP编码基因（AEBP1）作为肝纤维化的病理靶点或预后标志物的潜力，无论病因如何。方法：利用公开的转录组学图谱、不同的肝纤维化小鼠模型、生物学数据库、，结果：人肝星状细胞（HSCs）中AEBP1基因上调，与肝纤维化呈正相关，与任何病因无关，其蛋白在不同致病因素诱导的肝纤维化小鼠模型中得到了进一步验证。肝AEBP1基因的高表达有可能预测肝纤维化的不良预后。系统生物信息学分析显示，AEBP1的表达是HSC特异性的，并与ECM重塑及其下游的机械化学信号转导有关。HSC中特异性siRNA敲低AEBP1抑制ECM受体相互作用和免疫相关途径以及HSC增殖或激活。结论：我们目前的研究证实了AEBP1的高表达与肝纤维化特异性相关，并预测了其不良预后和AEBP1在HSC中的作用，为理解AEBP1与肝纤维化的关系提供了新的见解。这篇文章受版权保护。保留所有权利。

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引用次数: 0

Ripretinib for the treatment of advanced, imatinib-resistant gastrointestinal stromal tumors 瑞普替尼治疗晚期伊马替尼耐药性胃肠道间质瘤。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-09-14 DOI: 10.1111/1751-2980.13229

Wei Zhen Liu, Yu Qiang Du, Qian Shen, Kai Xiong Tao, Peng Zhang

Discovery of constitutive activation of KIT/PDGFRA tyrosine kinases in gastrointestinal stromal tumors (GISTs) leads to the development of the targeted drug imatinib. However, the inevitable development of imatinib resistance remains a major issue. Ripretinib is a novel targeted drug that inhibits the activities of a broad spectrum of drug-resistant KIT/PDGFRA mutants. It was approved in 2020 and is currently recommended by major international guidelines as the fourth-line and beyond therapy for advanced GISTs. Emerging evidence shows that ripretinib is superior to sunitinib as a second-line treatment for KIT exon 11-mutated GISTs due to its activity against highly heterogeneous frequently occurring secondary mutations. This review summarizes current data on the use of ripretinib to treat advanced imatinib-resistant GISTs. We also propose future research directions to improve the targeted GIST treatment.

胃肠道间质瘤（GISTs）中KIT/PDGFRA酪氨酸激酶组成型激活的发现导致靶向药物伊马替尼的开发。然而，伊马替尼耐药性的不可避免的发展仍然是一个主要问题。瑞普替尼是一种新型靶向药物，可抑制广谱耐药KIT/PDGFRA突变体的活性。它于2020年获得批准，目前被主要国际指南推荐为晚期GIST的第四线及以上治疗。新出现的证据表明，里皮替尼作为KIT外显子11突变GIST的二线治疗药物优于舒尼替尼，因为它对高度异质性的频繁发生的二次突变具有活性。这篇综述总结了目前使用瑞普替尼治疗晚期伊马替尼耐药GIST的数据。我们还提出了改进靶向GIST治疗的未来研究方向。

引用次数: 0