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Gastrointestinal: Esophageal Achalasia With Unusual Endoscopic Findings 胃肠道:食管贲门失弛缓症的内镜异常表现。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-18 DOI: 10.1111/jgh.16852
Kazuya Sumi, Haruhiro Inoue
<p>A 61-year-old male patient presented to our hospital with dysphagia, chest pain, and weight loss of 4 kg over the past 3 months, with no regurgitation. He had been receiving medical treatment for hypertension, dyslipidemia, and hyperuricemia. He was administered a calcium channel blocker (amlodipine 5 mg) for the management of hypertension. He reported no history of allergies, smoking, surgeries, or endoscopic interventions such as balloon dilation, and he had occasional alcohol consumption.</p><p>Esophagogastroduodenoscopy revealed circumferential erythematous changes at gastric folds and the squamocolumnar junction (SCJ) of the esophagus with passage resistance through a narrow distal segment and no hiatal hernia (Figure 1a–c). Biopsies of the mucosa revealed no malignant findings. Laboratory examinations, including tumor markers, revealed no apparent abnormalities, and computed tomography (CT) did not reveal any obvious neoplastic lesions. A positron emission tomography (PET) revealed no abnormal accumulation. Proton pump inhibitor was prescribed considering the possibility of gastroesophageal reflux disease (GERD), but symptoms showed no improvement. Barium esophagram revealed a narrow distal segment and dilation of 4 cm in transverse diameter, indicating barium outflow obstruction (Figure 1d). High-resolution manometry (HRM) (Starlet system, Star Medical, Tokyo, Japan) demonstrated an integrated relaxation pressure of 26.2 mmHg with panesophageal pressurization (Figure 1e).</p><p>The endoscopic findings showed features not typically seen in classical achalasia. Although there were no elevated tumor markers and CT or PET scans did not reveal any obvious masses, the rapid progression of symptoms necessitated ruling out a malignant tumor that progresses diffusely in the submucosa, known as pseudoachalasia. Bite-on-bite biopsies performed during a subsequent endoscopic examination ruled out malignant pseudoachalasia with negative results. Based on these results, a diagnosis of Type 2 esophageal achalasia (Chicago Classification v3.0), characterized by gastric folds and visible SCJ, was established.</p><p>Peroral endoscopic myotomy (POEM) was performed after discussing potential postprocedural complications, such as GERD, with the patient. The POEM was successfully performed without any complications, with myotomy of 3 cm on the gastric side. Two months after POEM, the patient's Eckardt score improved from 7 to 0. Although GERD-related symptoms were very mild, endoscopic examination revealed severe erosions, which were effectively managed with esomeprazole 20 mg daily. The patient has been under continuous follow-up for 7 years and remains in remission, with no recurrence of symptoms to date (Figure 2a–c).</p><p>Esophageal achalasia is a rare disorder characterized by impaired relaxation of the lower esophageal sphincter (LES). This case exhibited impaired relaxation at the upper margin of the gastric folds rather than the LES, with a clearly
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引用次数: 0
Clinical Significance of Lymphatic Involvement in Intramucosal (pT1a) Gastric Cancer Resected by Endoscopic Submucosal Dissection 内镜下粘膜下剥离术切除粘膜内淋巴结累及胃癌的临床意义。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-18 DOI: 10.1111/jgh.16854
Katsunori Matsueda, Yoshiyasu Kono, Koji Miyahara, Masahiro Nakagawa, Hirokazu Mouri, Kazuhiro Matsueda, Kenta Hamada, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Motoyuki Otsuka

Background and Aim

Lymphatic involvement is sometimes detected during routine examination of intramucosal (pT1a) gastric cancer resected endoscopically. However, its clinical significance and association with the risk of metastasis remain unknown.

Methods

This was a retrospective cohort study of 6797 consecutive patients with pT1a gastric cancers treated by endoscopic submucosal dissection (ESD) at three institutions in Japan from January 2005 to August 2023. Patients with 49 uncommon-type gastric cancer types were excluded. The risk of metastasis for pT1a cancers with lymphatic involvement was quantified by comparing lymph node metastasis and/or metastatic recurrence in patient groups who underwent additional surgery post-ESD or did not undergo surgery but were followed up for > 3 years.

Results

Among the 6748 pT1a cancers treated by ESD, 41 lesions (0.6%) had histologically confirmed lymphatic involvement. Among the 41 patients, 1 was excluded from the analysis of metastasis risk because the follow-up period after ESD without additional surgery was ≤ 3 years. Metastasis was identified in 1 of 40 patients analyzed (2.5%; 95% confidence interval [CI] 0.4%–12.9%), and was not detected in any of the 25 patients with pure differentiated-type lesions (0.0%; 95% CI 0.0%–13.7%).

Conclusions

The low prevalence of metastasis after ESD for pT1a gastric cancer with lymphatic involvement, particularly in patients with pure differentiated-type lesions, suggests a low risk of metastatic recurrence.

背景和目的:在内镜下切除的粘膜内(pT1a)胃癌的常规检查中,有时会发现淋巴受累。然而,其临床意义及其与转移风险的关系尚不清楚。方法:本研究是一项回顾性队列研究,对2005年1月至2023年8月在日本三家机构接受内镜粘膜下剥离(ESD)治疗的6797例连续pT1a胃癌患者进行研究。排除49例不常见型胃癌患者。通过比较在esd后接受额外手术或未接受手术但随访10 ~ 30年的患者组的淋巴结转移和/或转移复发,量化pT1a癌伴淋巴累及的转移风险。结果:在6748例接受ESD治疗的pT1a肿瘤中,组织学证实有41例(0.6%)淋巴结受损伤。41例患者中有1例因ESD术后未加手术的随访时间≤3年而被排除在转移风险分析之外。40例患者中有1例(2.5%;95%可信区间[CI] 0.4%-12.9%),且在25例纯分化型病变中均未检出(0.0%;95% ci 0.0%-13.7%)。结论:pT1a伴淋巴累及的胃癌,尤其是单纯分化型病变的患者,ESD术后转移率低,提示转移复发风险低。
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引用次数: 0
Natural History and Prognosis of Chronic Hepatitis B Patients in the Indeterminate Phase 不确定期慢性乙型肝炎患者的自然史和预后。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-18 DOI: 10.1111/jgh.16849
Hao Jiang, Hongsheng Yu, Yinan Huang, Mingkai Li, Bilan Yang, Xiaoli Xi, Yiming Lei, Bin Wu, Yidong Yang

Background and Aims

In chronic hepatitis B (CHB), an indeterminate phase exists outside the typical predefined phases. Our study investigates this indeterminate phase's natural history and prognosis, focusing on antiviral treatment outcomes.

Methods

We conducted a retrospective cohort study to compare the risk of transitioning to immune active phase between inactive and indeterminate CHB and the incidence of hepatocellular carcinoma (HCC) and cirrhosis between untreated patients with indeterminate CHB (at baseline and throughout follow-up) and those who received treatment, following standard AASLD 2018 guidance.

Results

The risk of transitioning to the immune active phase over 3, 5, and 10 years was 6.3%, 8.9%, and 14.2%, respectively, for inactive phase patients (n = 104). For HBeAg-negative indeterminate phase patients (n = 194), the risk was significantly higher at 23.0%, 31.9%, and 38.2%, and for HBeAg-positive indeterminate phase patients (n = 140), it was 40.4%, 52.0%, and 55.0% (p < 0.001). Inverse probability of treatment weighting (IPTW) was utilized to balance the groups of treated and untreated indeterminate patients. Following IPTW adjustment, the Kaplan–Meier curve analysis indicates that the risk of HCC and cirrhosis among untreated patients (n = 294) is higher than that among treated patients (n = 76), (p = 0.015 and 0.007, respectively). In the multivariable analysis, antiviral therapy remained an independent predictor of a reduced risk of HCC (aHR 0.128, 95% CI 0.031–0.522, p = 0.005) and cirrhosis (aHR 0.148, 95% CI 0.044–0.496, p = 0.002).

Conclusion

The indeterminate phase patients had a high-risk transition to active phase, and antiviral therapy can reduce the incidence of developing HCC and cirrhosis.

背景和目的:在慢性乙型肝炎(CHB)中,在典型的预定义阶段之外存在不确定阶段。我们的研究调查了这一不确定期的自然历史和预后,重点是抗病毒治疗的结果。方法:我们进行了一项回顾性队列研究,比较非活动性和不确定性CHB患者过渡到免疫活动性期的风险以及不确定性CHB患者(基线和随访期间)与接受治疗的患者(遵循AASLD 2018标准指南)之间肝细胞癌(HCC)和肝硬化的发生率。结果:非活跃期患者在3、5和10年内转入免疫活跃期的风险分别为6.3%、8.9%和14.2% (n = 104)。hbeag阴性不确定期患者(n = 194)的风险分别为23.0%、31.9%和38.2%,而hbeag阳性不确定期患者(n = 140)的风险分别为40.4%、52.0%和55.0% (p)。结论:不确定期患者有向活动期过渡的高风险,抗病毒治疗可降低发生HCC和肝硬化的发生率。
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引用次数: 0
A Simple Prediction Model for Clostridioides difficile Infection: A Hospital-Based Administrative Database Study 艰难梭菌感染的简单预测模型:基于医院管理数据库的研究。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-18 DOI: 10.1111/jgh.16851
Kenta Watanabe, Tsuyotoshi Tsuji, Hisanori Matsuzawa, Yohei Saruta, Yosuke Shimodaira, Katsunori Iijima

Background and Aim

Few prediction scores for Clostridioides difficile infection (CDI), a potentially life-threatening nosocomial diarrhea, combine high accuracy with simplicity. A simple prediction score for routine clinical practice is needed.

Methods

We conducted a retrospective cohort study of all inpatients aged ≥ 18 at a secondary care hospital in Japan. The derivation and validation cohorts consisted of patients from January 2016 to December 2020 and January 2021 to September 2022, respectively. Demographic and clinical data were retrieved using electronic medical records and an administrative database. The primary outcome was to derive and validate an accurate, simple prediction score for primary hospital-onset CDI. A derived prediction score by logistic regression analysis was calibrated and validated.

Results

CDI developed in 102 of 25 517 and 25 of 6259 patients in the derived and validation cohorts (2.7 cases/10 000 patient-days). The derived model for predicting CDI, including antibiotic use, acid suppressant (proton pump inhibitors or vonoprazan) use, Charlson comorbidity index, and Barthel index, yielded c-statistics of 0.89 and 0.82 in the derivation and validation cohort. The model was well calibrated.

Conclusions

This simple prediction score enables early medical intervention and modification of treatment plans to reduce the risk of developing primary hospital-onset CDI.

背景与目的:难辨梭菌感染(CDI)是一种可能危及生命的医院性腹泻,其预测评分既准确又简单。常规临床实践需要一个简单的预测评分。方法:我们对日本一家二级护理医院所有年龄≥18岁的住院患者进行了回顾性队列研究。推导和验证队列分别由2016年1月至2020年12月和2021年1月至2022年9月的患者组成。使用电子病历和行政数据库检索人口统计和临床数据。主要结局是得出并验证一个准确、简单的原发性医院发病CDI预测评分。通过逻辑回归分析得出的预测评分进行校准和验证。结果:在衍生和验证队列中,25517例患者中有102例发生CDI, 6259例患者中有25例发生CDI(2.7例/ 10000患者-天)。预测CDI的衍生模型,包括抗生素使用、酸抑制剂(质子泵抑制剂或伏诺哌嗪)使用、Charlson共病指数和Barthel指数,在推导和验证队列中产生的c统计量分别为0.89和0.82。这个模型校正得很好。结论:这一简单的预测评分使得早期医疗干预和修改治疗计划能够降低发生原发性医院源性CDI的风险。
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引用次数: 0
Development of Deep Learning–Based Virtual Lugol Chromoendoscopy for Superficial Esophageal Squamous Cell Carcinoma 基于深度学习的虚拟Lugol色内镜在浅表食管鳞状细胞癌中的应用。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-17 DOI: 10.1111/jgh.16843
Yosuke Toya, Sho Suzuki, Yusuke Monno, Ryo Arai, Takahiro Dohmen, Makoto Eizuka, Masatoshi Okutomi, Takayuki Matsumoto

Background

Lugol chromoendoscopy has been shown to increase the sensitivity of detection of esophageal squamous cell carcinoma (ESCC). We aimed to develop a deep learning–based virtual lugol chromoendoscopy (V-LCE) method.

Methods

We developed still V-LCE images for superficial ESCC using a cycle-consistent generative adversarial network (CycleGAN). Six endoscopists graded the detection and margins of ESCCs using white-light endoscopy (WLE), real lugol chromoendoscopy (R-LCE), and V-LCE on a five-point scale ranging from 1 (poor) to 5 (excellent). We also calculated and compared the color differences between cancerous and non-cancerous areas using WLE, R-LCE, and V-LCE.

Results

Scores for the detection and margins were significantly higher with R-LCE than V-LCE (detection, 4.7 vs. 3.8, respectively; p < 0.001; margins, 4.3 vs. 3.0, respectively; p < 0.001). There were nonsignificant trends towards higher scores with V-LCE than WLE (detection, 3.8 vs. 3.3, respectively; p = 0.089; margins, 3.0 vs. 2.7, respectively; p = 0.130). Color differences were significantly greater with V-LCE than WLE (p < 0.001) and with R-LCE than V-LCE (p < 0.001) (39.6 with R-LCE, 29.6 with V-LCE, and 18.3 with WLE).

Conclusions

Our V-LCE has a middle performance between R-LCE and WLE in terms of lesion detection, margin, and color difference. It suggests that V-LCE potentially improves the endoscopic diagnosis of superficial ESCC.

背景:研究表明,鲁戈尔色内镜检查可提高食管鳞状细胞癌(ESCC)的检测灵敏度。我们旨在开发一种基于深度学习的虚拟鲁戈尔色内镜(V-LCE)方法:我们使用循环一致性生成对抗网络(CycleGAN)为浅表 ESCC 开发了静态 V-LCE 图像。六位内镜医师使用白光内镜(WLE)、真实鲁戈尔色内镜(R-LCE)和 V-LCE 对 ESCC 的检测和边缘进行了评分,评分分为五级,从 1 分(差)到 5 分(优)不等。我们还使用 WLE、R-LCE 和 V-LCE 计算并比较了癌变区域和非癌变区域的颜色差异:结果:R-LCE 的检出率和边缘得分明显高于 V-LCE(检出率分别为 4.7 和 3.8;P 结论:我们的 V-LCE 具有中等水平的性能:我们的 V-LCE 在病灶检测、边缘和色差方面的表现介于 R-LCE 和 WLE 之间。这表明 V-LCE 有可能改善浅表 ESCC 的内窥镜诊断。
{"title":"Development of Deep Learning–Based Virtual Lugol Chromoendoscopy for Superficial Esophageal Squamous Cell Carcinoma","authors":"Yosuke Toya,&nbsp;Sho Suzuki,&nbsp;Yusuke Monno,&nbsp;Ryo Arai,&nbsp;Takahiro Dohmen,&nbsp;Makoto Eizuka,&nbsp;Masatoshi Okutomi,&nbsp;Takayuki Matsumoto","doi":"10.1111/jgh.16843","DOIUrl":"10.1111/jgh.16843","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lugol chromoendoscopy has been shown to increase the sensitivity of detection of esophageal squamous cell carcinoma (ESCC). We aimed to develop a deep learning–based virtual lugol chromoendoscopy (V-LCE) method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed still V-LCE images for superficial ESCC using a cycle-consistent generative adversarial network (CycleGAN). Six endoscopists graded the detection and margins of ESCCs using white-light endoscopy (WLE), real lugol chromoendoscopy (R-LCE), and V-LCE on a five-point scale ranging from 1 (poor) to 5 (excellent). We also calculated and compared the color differences between cancerous and non-cancerous areas using WLE, R-LCE, and V-LCE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Scores for the detection and margins were significantly higher with R-LCE than V-LCE (detection, 4.7 vs. 3.8, respectively; <i>p</i> &lt; 0.001; margins, 4.3 vs. 3.0, respectively; <i>p</i> &lt; 0.001). There were nonsignificant trends towards higher scores with V-LCE than WLE (detection, 3.8 vs. 3.3, respectively; <i>p</i> = 0.089; margins, 3.0 vs. 2.7, respectively; <i>p</i> = 0.130). Color differences were significantly greater with V-LCE than WLE (<i>p</i> &lt; 0.001) and with R-LCE than V-LCE (<i>p</i> &lt; 0.001) (39.6 with R-LCE, 29.6 with V-LCE, and 18.3 with WLE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our V-LCE has a middle performance between R-LCE and WLE in terms of lesion detection, margin, and color difference. It suggests that V-LCE potentially improves the endoscopic diagnosis of superficial ESCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"706-711"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837174","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
Natural History and Predictors of Clinical Outcomes in Autoimmune Liver Diseases: A Multicenter Study 自身免疫性肝病的自然史和临床结果预测因素:一项多中心研究
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-17 DOI: 10.1111/jgh.16850
Dujinthan Jayabalan, Yi Huang, Luis Calzadilla-Bertot, Leon A. Adams, Wendy Cheng, Simon Hazeldine, Briohny W. Smith, Gerry C. MacQuillan, Michael C. Wallace, George Garas, Gary P. Jeffrey

Background and Aim

Prognosis in autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) has historically been poor. This multicenter retrospective cohort study investigated the natural history and assessed the predictors of outcomes in patients with AIH, PBC, and PSC.

Methods

AIH, PBC, and PSC patients were identified from the state-wide Hepascore and Clinical Outcome cohort. Overall death or transplant, liver-related mortality (liver-related death or transplant), and liver-related decompensation were determined using a population-based data linkage system. Baseline Liver Outcome Score (LOS), Hepascore, and MELD were examined for predicting outcomes.

Results

Two-hundred thirty-seven AIH patients (24% male, median age 56.6 years [range, 14.3–94.0]), 157 PBC patients (8.3% male, median age 60.5 years [range, 25.6–87.1]), and 167 PSC patients (52.7% male, median age 55.6 years [range, 18.4–88.6]) were enrolled. Five-year transplant-free survival was 88% (95%CI: 81–92%) in AIH, 92% (95%CI: 85–96%) in PBC, and 61% (95%CI: 51–69%) in PSC. PSC had a significantly worse overall death or transplant, liver-related mortality, and liver-related decompensation when compared to AIH and PBC (p < 0.0001). LOS was a significant independent predictor of overall death or transplant, liver-related mortality, and liver-related decompensation among patients with AIH and PBC. LOS was a significant independent predictor of overall death or transplant in patients with PSC, and Hepascore was a significant independent predictor of liver-related mortality and liver-related decompensation.

Conclusions

Outcomes for AIH and PBC are excellent but remain poor in PSC. LOS is a predictor of outcomes in autoimmune liver disease.

背景与目的:自身免疫性肝炎(AIH)、原发性胆道炎(PBC)和原发性硬化性胆管炎(PSC)的预后历来较差。这项多中心回顾性队列研究调查了AIH、PBC和PSC患者的自然病史,并评估了预后的预测因素。方法:AIH、PBC和PSC患者从全国范围内的Hepascore和临床结果队列中确定。总体死亡或移植、肝脏相关死亡率(肝脏相关死亡或移植)和肝脏相关失代偿是通过基于人群的数据链接系统确定的。基线肝脏预后评分(LOS)、Hepascore和MELD用于预测预后。结果:纳入2737例AIH患者(24%男性,中位年龄56.6岁[范围,14.3-94.0]),157例PBC患者(8.3%男性,中位年龄60.5岁[范围,25.6-87.1])和167例PSC患者(52.7%男性,中位年龄55.6岁[范围,18.4-88.6])。AIH的5年无移植生存率为88% (95%CI: 81-92%), PBC为92% (95%CI: 85-96%), PSC为61% (95%CI: 51-69%)。与AIH和PBC相比,PSC的总死亡或移植、肝脏相关死亡率和肝脏相关失代偿明显更差(p结论:AIH和PBC的结果很好,但PSC的结果仍然很差。LOS是自身免疫性肝病预后的预测因子。
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引用次数: 0
Comparison of Risk-Scoring Models to Predict Gastrointestinal Bleeding in Patients With Direct Oral Anticoagulants 预测直接口服抗凝药物患者消化道出血的风险评分模型的比较。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-17 DOI: 10.1111/jgh.16853
Ilsoo Kim, Joon Sung Kim, Dae Young Cheung, Byung-Wook Kim, Jong-Uk Hou

Background and Aim

The risk of gastrointestinal bleeding (GIB) remains a concern with the use of direct oral anticoagulants (DOAC). We evaluated the efficacy of four risk-scoring models (HAS-BLED, ATRIA, VTE-BLEED, and ORBIT) in predicting GIB according to the concomitant use of antiplatelet therapy in DOAC users.

Methods

Patients prescribed DOAC between December 2014 and October 2020 were enrolled in two university-affiliated hospitals. The performance of the four models was compared based on the concomitant use of antiplatelet therapy. The primary outcomes were likelihood ratios and the area under the receiver operating characteristic (AUROC) curve to predict GIB.

Results

A total of 4494 patients were included in the study. The AUROC values for the entire cohort were 0.643 (95% CI: 0.601–0.686) for HAS-BLED, 0.693 (95% CI: 0.649–0.737) for ATRIA, 0.708 (95% CI: 0.665–0.750) for VTE-BLEED, and 0.709 (95% CI: 0.667–0.751) for ORBIT. The AUROC for all scoring models increased in patients without antiplatelet therapy compared to the entire cohort and patients with antiplatelet therapy. The specificity and diagnostic accuracy for all scoring models increased in patients without antiplatelet therapy compared to patients with antiplatelet.

Conclusions

Our results confirmed that current risk-scoring models for predicting GIB perform better in patients without antiplatelet therapy than in those on concomitant antiplatelet therapy. This suggests that future risk prediction models should consider the concomitant use of antiplatelet therapy for diagnostic accuracy.

背景和目的:胃肠道出血(GIB)的风险仍然与使用直接口服抗凝剂(DOAC)有关。我们评估了四种风险评分模型(ha - bled、ATRIA、VTE-BLEED和ORBIT)在预测DOAC使用者同时使用抗血小板治疗的GIB中的疗效。方法:选取2014年12月至2020年10月在两所大学附属医院使用DOAC的患者。在同时使用抗血小板治疗的基础上,比较四种模型的性能。主要结果是似然比和受试者工作特征曲线下面积(AUROC)预测GIB。结果:共纳入4494例患者。整个队列的AUROC值为:hs - bled为0.643 (95% CI: 0.601-0.686), ATRIA为0.693 (95% CI: 0.649-0.737), VTE-BLEED为0.708 (95% CI: 0.665-0.750), ORBIT为0.709 (95% CI: 0.667-0.751)。与整个队列和接受抗血小板治疗的患者相比,未接受抗血小板治疗的所有评分模型的AUROC均增加。与接受抗血小板治疗的患者相比,未接受抗血小板治疗的患者所有评分模型的特异性和诊断准确性均有所提高。结论:我们的研究结果证实,目前用于预测GIB的风险评分模型在未接受抗血小板治疗的患者中比同时接受抗血小板治疗的患者表现更好。这表明,未来的风险预测模型应考虑同时使用抗血小板治疗以提高诊断准确性。
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引用次数: 0
Gastrointestinal: Successful Management of Refractory Achalasia Complicated by Delayed Diagnosis and Prolonged Sepsis 胃肠道:成功治疗因延迟诊断和长期败血症而并发的难治性食道闭锁。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-15 DOI: 10.1111/jgh.16855
Dauda Bawa, Rajvinder Singh

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引用次数: 0
Postcholecystectomy Gut Microbiome Changes and the Clinical Impact: A Systematic Review With Narrative Synthesis 胆囊切除术后肠道微生物组的变化及其临床影响:系统性综述与叙述性综合。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-15 DOI: 10.1111/jgh.16846
Tiing Leong Ang, Seok Hwee Koo, Daphne Ang, Chin Kimg Tan, Lai Mun Wang, Sunny Hei Wong, Pierce K. H. Chow

Background

Cholecystectomy (CCE) can affect the enterohepatic circulation of bile acids and result in gut microbiome changes. This systematic review aimed to clarify the effect of CCE on gut microbiome composition and its clinical impact.

Method

A systematic search was conducted in PubMed, Web of Science, and Scopus, combining keywords such as “cholecystectomy” or “post-cholecystectomy” with “gut microbiome,” “stool microbiome,” or “gut dysbiosis.” Data were extracted and synthesized using narrative review. Study quality was assessed using the Newcastle-Ottawa scale.

Results

A total of 1373 articles were screened and 14 studies were selected. Significant but inconsistent microbiome changes were reported. Changes were observed in alpha and beta diversity. At phylum level, an increase in Bacteroides and Ascomycota, decrease in Firmicutes, Actinomycetes, and Basidiomycota, and both increase and decrease in Fusobacteria were reported. At genus level, an increase in Prevotella and a decrease in Faecalibacterium were reported. In post-CCE diarrhea, decreased beta diversity, a decreased F/B ratio, an increase in Prevotella, an increase in Phocaeicola vulgatus, and a decrease in Prevotella copri were noted. For post-CCE syndrome, a higher abundance of Proteobacteria and decreased Firmicutes/Bacteroides (F/B) ratio were reported. A decreased relative abundance of Bifidobacterium longum subsp. longum from controls to CCE without colonic neoplasia to CCE with colonic neoplasia, and an increased abundance of Candida glabrata from controls, to CCE without colonic neoplasia and CCE with colonic neoplasia, were reported.

Conclusion

Patients who underwent CCE had significant gut dysbiosis. However, current studies could not clarify the detailed gut microbial structural and functional changes associated with CCE.

背景:胆囊切除术(CCE)会影响胆汁酸的肠肝循环,导致肠道微生物组发生变化。本系统综述旨在阐明 CCE 对肠道微生物组组成的影响及其临床影响:在 PubMed、Web of Science 和 Scopus 上进行了系统性检索,将 "胆囊切除术 "或 "胆囊切除术后 "等关键词与 "肠道微生物组"、"粪便微生物组 "或 "肠道菌群失调 "相结合。采用叙事性综述对数据进行提取和综合。研究质量采用纽卡斯尔-渥太华量表进行评估:结果:共筛选出 1373 篇文章,14 项研究入选。据报道,微生物组发生了显著但不一致的变化。α和β多样性发生了变化。据报道,在门一级,乳酸菌和子囊菌增加,固着菌、放线菌和担子菌减少,而镰刀菌有增有减。在属的层面上,报告了普雷沃茨菌(Prevotella)的增加和粪杆菌(Faecalibacterium)的减少。欧洲共同体中毒后腹泻中,贝塔多样性减少,F/B 比值降低,普雷沃茨菌增加,Phocaeicola vulgatus 增加,Prevotella copri 减少。据报告,在 "CCE 后综合征 "中,变形菌的丰度较高,而固醇菌/半固醇菌(F/B)比值下降。据报道,从对照组到无结肠肿瘤的 CCE,再到有结肠肿瘤的 CCE,长双歧杆菌亚种的相对丰度均有所下降;从对照组到无结肠肿瘤的 CCE,再到有结肠肿瘤的 CCE,白色念珠菌的丰度均有所上升:结论:接受 CCE 的患者存在严重的肠道菌群失调。结论:接受 CCE 的患者存在严重的肠道菌群失调问题,但目前的研究还无法明确与 CCE 相关的肠道微生物结构和功能变化的具体情况。
{"title":"Postcholecystectomy Gut Microbiome Changes and the Clinical Impact: A Systematic Review With Narrative Synthesis","authors":"Tiing Leong Ang,&nbsp;Seok Hwee Koo,&nbsp;Daphne Ang,&nbsp;Chin Kimg Tan,&nbsp;Lai Mun Wang,&nbsp;Sunny Hei Wong,&nbsp;Pierce K. H. Chow","doi":"10.1111/jgh.16846","DOIUrl":"10.1111/jgh.16846","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cholecystectomy (CCE) can affect the enterohepatic circulation of bile acids and result in gut microbiome changes. This systematic review aimed to clarify the effect of CCE on gut microbiome composition and its clinical impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A systematic search was conducted in PubMed, Web of Science, and Scopus, combining keywords such as “cholecystectomy” or “post-cholecystectomy” with “gut microbiome,” “stool microbiome,” or “gut dysbiosis.” Data were extracted and synthesized using narrative review. Study quality was assessed using the Newcastle-Ottawa scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1373 articles were screened and 14 studies were selected. Significant but inconsistent microbiome changes were reported. Changes were observed in alpha and beta diversity. At phylum level, an increase in Bacteroides and Ascomycota, decrease in Firmicutes, Actinomycetes, and Basidiomycota, and both increase and decrease in Fusobacteria were reported. At genus level, an increase in <i>Prevotella</i> and a decrease in <i>Faecalibacterium</i> were reported. In post-CCE diarrhea, decreased beta diversity, a decreased F/B ratio, an increase in <i>Prevotella</i>, an increase in <i>Phocaeicola vulgatus</i>, and a decrease in <i>Prevotella copri</i> were noted. For post-CCE syndrome, a higher abundance of Proteobacteria and decreased Firmicutes/Bacteroides (F/B) ratio were reported. A decreased relative abundance of <i>Bifidobacterium longum</i> <i>subsp</i>. <i>longum</i> from controls to CCE without colonic neoplasia to CCE with colonic neoplasia, and an increased abundance of <i>Candida glabrata</i> from controls, to CCE without colonic neoplasia and CCE with colonic neoplasia, were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients who underwent CCE had significant gut dysbiosis. However, current studies could not clarify the detailed gut microbial structural and functional changes associated with CCE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 3","pages":"574-583"},"PeriodicalIF":3.7,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16846","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correction to “Menstrual blood-derived mesenchymal stem cells attenuate inflammation and improve the mortality of acute liver failure combining with A2AR agonist in mice” 月经血间充质干细胞与 A2AR 激动剂合用可减轻炎症反应并改善小鼠急性肝衰竭的死亡率》的更正。
IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-15 DOI: 10.1111/jgh.16848

D. Chen, R. Zeng, G. Teng, C. Cai, T. Pan, H. Tu, H. Lin, Q. Du, H. Wang, Y. Chen, “ Menstrual blood-derived mesenchymal stem cells attenuate inflammation and improve the mortality of acute liver failure combining with A2AR agonist in mice,” Journal of Gastroenterology and Hepatology 36 (2021): 26192627.

We apologize for this error.

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引用次数: 0
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Journal of Gastroenterology and Hepatology
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