Pub Date : 2023-10-11DOI: 10.3390/gastroent14040035
Tobias Kratz, Jan Dauvergne, Anne-Sophie Kronberg, David Katzer, Rainer Ganschow, Marit Bernhardt, Sarah Westeppe, Benjamin Bierbach, Joanna Strohm, Christina Oetzmann von Sochaczewski
Biomechanics are gaining ground in gastroenterology in the creation of educational models and to describe the necessary forces to perforate hallow organs during endoscopy. We thus investigated the breaking forces of porcine intestinal segments and whether they could be predicted based on body weight or crown–rump length. Based on a priori power-analyses, 10 pigs were included. The breaking forces were determined with a motorized test stand. We found that the breaking forces of intestinal segments were different (H(6) = 33.7, p < 0.0001): Ileal breaking force (x¯ = 24.14 N) was higher than jejunal (x¯ = 14.24 N, p = 0.0082) and colonic (x¯ = 11.33 N, p < 0.0001) breaking force. The latter was also smaller than cecal breaking force (x¯ = 24.6 N, p = 0.0044). Likewise, rectal (x¯ = 23.57 N) breaking force was higher than jejunal (p = 0.0455) and colonic (p = 0.0006) breaking force. Breaking forces were not correlated to body weight or crown–rump length (R < 0.49, p > 0.148). Intestinal segments differ in their breaking forces. The colon had the least resistance to traction forces. It remains to be determined if similar relationships exist in humans in order to validate porcine models for endoscopy and surgery.
生物力学在胃肠病学教育模型的创建和描述内窥镜检查时穿孔中空器官的必要力量方面取得了进展。因此，我们研究了猪肠段的断裂力，以及它们是否可以根据体重或冠臀长来预测。根据先验功率分析，共纳入10头猪。断裂力由机动试验台测定。我们发现肠段断裂力不同(H(6) = 33.7, p <0.0001):回肠破肠力(x¯= 24.14 N)高于空肠(x¯= 14.24 N, p = 0.0082)和结肠(x¯= 11.33 N, p <0.0001)断裂力。后者也小于盲肠断裂力(x¯= 24.6 N, p = 0.0044)。同样，直肠(x¯= 23.57 N)破断力高于空肠(p = 0.0455)和结肠(p = 0.0006)破断力。断裂力与体重或冠臀长度无关(R <0.49, p >0.148)。肠段的断裂力不同。结肠对牵引力的阻力最小。为了验证内窥镜检查和手术的猪模型，人类是否存在类似的关系仍有待确定。
{"title":"Not All Porcine Intestinal Segments Are Equal in Terms of Breaking Force, but None Were Associated to Allometric Parameters","authors":"Tobias Kratz, Jan Dauvergne, Anne-Sophie Kronberg, David Katzer, Rainer Ganschow, Marit Bernhardt, Sarah Westeppe, Benjamin Bierbach, Joanna Strohm, Christina Oetzmann von Sochaczewski","doi":"10.3390/gastroent14040035","DOIUrl":"https://doi.org/10.3390/gastroent14040035","url":null,"abstract":"Biomechanics are gaining ground in gastroenterology in the creation of educational models and to describe the necessary forces to perforate hallow organs during endoscopy. We thus investigated the breaking forces of porcine intestinal segments and whether they could be predicted based on body weight or crown–rump length. Based on a priori power-analyses, 10 pigs were included. The breaking forces were determined with a motorized test stand. We found that the breaking forces of intestinal segments were different (H(6) = 33.7, p < 0.0001): Ileal breaking force (x¯ = 24.14 N) was higher than jejunal (x¯ = 14.24 N, p = 0.0082) and colonic (x¯ = 11.33 N, p < 0.0001) breaking force. The latter was also smaller than cecal breaking force (x¯ = 24.6 N, p = 0.0044). Likewise, rectal (x¯ = 23.57 N) breaking force was higher than jejunal (p = 0.0455) and colonic (p = 0.0006) breaking force. Breaking forces were not correlated to body weight or crown–rump length (R < 0.49, p > 0.148). Intestinal segments differ in their breaking forces. The colon had the least resistance to traction forces. It remains to be determined if similar relationships exist in humans in order to validate porcine models for endoscopy and surgery.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136210176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-10DOI: 10.3390/gastroent14040034
Daniel Vasile Balaban, Laura Ioana Coman, Iulia Cristina Enache, Cristian Mihail Mardan, Alina Dima, Ciprian Jurcuț, Marina Balaban, Raluca Simona Costache, Florentina Ioniță-Radu, Alina Popp, Mariana Jinga
Introduction: Despite being one of the most frequent chronic digestive diseases worldwide, with a prevalence of 1%, celiac disease (CD) remains severely underdiagnosed. Among the instruments used to improve its diagnostic rate, hematologic parameters have been proposed as screening tests to select patients with an increased probability of having CD. Assessment of coagulation is included in routine check-ups, and CD has been reported to be associated with coagulopathy. We aimed to assess if subtle changes in coagulation tests could be used in clinical practice to prompt testing for CD. Methods: We retrospectively recruited all patients with clinical suspicion for CD during a study period of 7 years (between 2015 and 2022), who were tested using IgA tissue transglutaminase (tTG) serology and serum total IgA (IgG tTG in case of IgA deficiency) and who underwent upper gastrointestinal endoscopy with multiple biopsy sampling of the duodenal bulb and distal duodenum. We stratified patients into three groups: newly diagnosed CD, gluten-free diet-treated CD, and non-CD controls. Results: Altogether, there were 133 CD patients (71 newly diagnosed, 62 GFD-treated) and 57 non-CD controls. Mean age and gender distribution were similar among the three groups: 43.3 years for newly diagnosed CD, 41.6 years for non-CD controls, and 44 years for GFD-treated CD patients, with a male gender distribution of 21.1%, 28%, and 24.1%, respectively. Among the included newly diagnosed CD patients, 14% had a prolonged INR. The mean INR was slightly higher in newly diagnosed CD patients, compared to GFD-treated CD patients and non-CD controls: 1.12 ± 0.30, 1.02 ± 0.83, and 1.00 ± 0.08, respectively (p = 0.009). Consequently, prothrombin activity was slightly lower in newly diagnosed CD patients, compared to GFD-treated CD and non-CD controls: 94.9 ± 19.3%, 102.3 ± 12.8%, and 101.9 ± 15.15, respectively. Interestingly, after GFD, the mean INR and prothrombin activity of CD individuals reached a value similar to that of non-CD controls. Conclusions: Subtle changes in INR, defined as a value within the normal range, but closer to the upper limit, could be an indicator of probability for CD.
{"title":"Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study","authors":"Daniel Vasile Balaban, Laura Ioana Coman, Iulia Cristina Enache, Cristian Mihail Mardan, Alina Dima, Ciprian Jurcuț, Marina Balaban, Raluca Simona Costache, Florentina Ioniță-Radu, Alina Popp, Mariana Jinga","doi":"10.3390/gastroent14040034","DOIUrl":"https://doi.org/10.3390/gastroent14040034","url":null,"abstract":"Introduction: Despite being one of the most frequent chronic digestive diseases worldwide, with a prevalence of 1%, celiac disease (CD) remains severely underdiagnosed. Among the instruments used to improve its diagnostic rate, hematologic parameters have been proposed as screening tests to select patients with an increased probability of having CD. Assessment of coagulation is included in routine check-ups, and CD has been reported to be associated with coagulopathy. We aimed to assess if subtle changes in coagulation tests could be used in clinical practice to prompt testing for CD. Methods: We retrospectively recruited all patients with clinical suspicion for CD during a study period of 7 years (between 2015 and 2022), who were tested using IgA tissue transglutaminase (tTG) serology and serum total IgA (IgG tTG in case of IgA deficiency) and who underwent upper gastrointestinal endoscopy with multiple biopsy sampling of the duodenal bulb and distal duodenum. We stratified patients into three groups: newly diagnosed CD, gluten-free diet-treated CD, and non-CD controls. Results: Altogether, there were 133 CD patients (71 newly diagnosed, 62 GFD-treated) and 57 non-CD controls. Mean age and gender distribution were similar among the three groups: 43.3 years for newly diagnosed CD, 41.6 years for non-CD controls, and 44 years for GFD-treated CD patients, with a male gender distribution of 21.1%, 28%, and 24.1%, respectively. Among the included newly diagnosed CD patients, 14% had a prolonged INR. The mean INR was slightly higher in newly diagnosed CD patients, compared to GFD-treated CD patients and non-CD controls: 1.12 ± 0.30, 1.02 ± 0.83, and 1.00 ± 0.08, respectively (p = 0.009). Consequently, prothrombin activity was slightly lower in newly diagnosed CD patients, compared to GFD-treated CD and non-CD controls: 94.9 ± 19.3%, 102.3 ± 12.8%, and 101.9 ± 15.15, respectively. Interestingly, after GFD, the mean INR and prothrombin activity of CD individuals reached a value similar to that of non-CD controls. Conclusions: Subtle changes in INR, defined as a value within the normal range, but closer to the upper limit, could be an indicator of probability for CD.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136358386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-08DOI: 10.3390/gastroent14040033
Martin Janičko, Sylvia Dražilová, Jakub Gazda, Martin Tomáš, Martin Kučera, Želmíra Šuchová, Peter Jarčuška
The overall prevalence of hyponatremia in cirrhotics is around 50%. Hypovolemic hyponatremia is a result of excessive fluid loss caused mostly by diuretic treatment or diarrhea. More common is hypervolemic hyponatremia, which results from excessive activation of water and sodium-retaining mechanisms caused by effective arterial hypovolemia. This review focuses on the associations of hyponatremia with clinical outcomes and reviews the available data on its management. Hyponatremia is a strong predictor of mortality and is also associated with an increased probability of hepatorenal syndrome, disturbance of consciousness, infections, and unfavorable post-transplant outcomes. In the management of hyponatremia, it is crucial to distinguish between hypovolemic and hypervolemic hyponatremia. The treatment of hypervolemic hyponatremia should be started only in symptomatic patients. The cessation of the treatment with traditional diuretics and fluid restriction may prevent further decrease in natremia. Pharmacological treatment is directed towards cirrhosis itself, precipitating factor, or hyponatremia directly. Currently, only albumin infusions can be recommended routinely. Other possibilities, such as vaptans, splanchnic vasoconstrictors, niravoline, or osmotic diuretics, are restricted to specific use cases (e.g., imminent liver transplantation) or need more research to determine their efficacy. We tried to summarize the management of hyponatremia into a concise flowchart.
{"title":"Clinical Significance and Management of Hyponatremia in Liver Cirrhosis","authors":"Martin Janičko, Sylvia Dražilová, Jakub Gazda, Martin Tomáš, Martin Kučera, Želmíra Šuchová, Peter Jarčuška","doi":"10.3390/gastroent14040033","DOIUrl":"https://doi.org/10.3390/gastroent14040033","url":null,"abstract":"The overall prevalence of hyponatremia in cirrhotics is around 50%. Hypovolemic hyponatremia is a result of excessive fluid loss caused mostly by diuretic treatment or diarrhea. More common is hypervolemic hyponatremia, which results from excessive activation of water and sodium-retaining mechanisms caused by effective arterial hypovolemia. This review focuses on the associations of hyponatremia with clinical outcomes and reviews the available data on its management. Hyponatremia is a strong predictor of mortality and is also associated with an increased probability of hepatorenal syndrome, disturbance of consciousness, infections, and unfavorable post-transplant outcomes. In the management of hyponatremia, it is crucial to distinguish between hypovolemic and hypervolemic hyponatremia. The treatment of hypervolemic hyponatremia should be started only in symptomatic patients. The cessation of the treatment with traditional diuretics and fluid restriction may prevent further decrease in natremia. Pharmacological treatment is directed towards cirrhosis itself, precipitating factor, or hyponatremia directly. Currently, only albumin infusions can be recommended routinely. Other possibilities, such as vaptans, splanchnic vasoconstrictors, niravoline, or osmotic diuretics, are restricted to specific use cases (e.g., imminent liver transplantation) or need more research to determine their efficacy. We tried to summarize the management of hyponatremia into a concise flowchart.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"2016 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135197486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-02DOI: 10.3390/gastroent14040032
Yoanna Slabakova, Stavros Gerasoudis, Dimitrina Miteva, Monika Peshevska-Sekulovska, Hristiana Batselova, Violeta Snegarova, Georgi V. Vasilev, Georgi H. Vasilev, Metodija Sekulovski, Snezhina Lazova, Milena Gulinac, Latchezar Tomov, Tsvetelina Velikova
The gastrointestinal (GI) tract may be a significant entrance or interaction site for SARS-CoV-2; therefore, the gut mucosal immune system participates in virus interaction as a first-line physical and immunological defense, leading to GI involvement and symptoms. This review focuses on the GI symptoms associated with SARS-CoV-2 infection while providing specific results on variant-specific signs and syndromes related to coronavirus disease 2019 (COVID-19). The pattern of symptoms changed during the virus evolution, since the data provided a current and thorough picture of the symptoms experienced by SARS-CoV-2 infected people, and variations in symptom patterns occurred as the Alpha, Delta, and Omicron variants have spread. Since the beginning of the pandemic, GI symptoms have been linked to SARS-CoV-2 infections, even though most infected people do not report them. For example, diarrhea (28.2%) was the most frequently reported GI symptom in the early phase of the pandemic. The most observed GI tract symptoms during COVID-19 were anorexia (loss of appetite), nausea, vomiting, diarrhea, and abdominal pain, usually in at least one-third of the patients. Mesenteric ischemia and GI bleeding were less observed but more severe. While GI symptoms are not associated with increased mortality, they complicate the disease, increase the duration of the illness, and result in worse outcomes. Nevertheless, it is accepted that symptoms between variants differ significantly, i.e., the Omicron variant causes milder COVID-19 than the Delta. Still, the rate of GI symptoms has declined in the following variant-dominated phases of the pandemic (Alpha: 19.4%, Delta: 17.9%, Omicron: 13.8%), which was also demonstrated for other GI signs associated with COVID-19.
{"title":"SARS-CoV-2 Variant-Specific Gastrointestinal Symptoms of COVID-19: 2023 Update","authors":"Yoanna Slabakova, Stavros Gerasoudis, Dimitrina Miteva, Monika Peshevska-Sekulovska, Hristiana Batselova, Violeta Snegarova, Georgi V. Vasilev, Georgi H. Vasilev, Metodija Sekulovski, Snezhina Lazova, Milena Gulinac, Latchezar Tomov, Tsvetelina Velikova","doi":"10.3390/gastroent14040032","DOIUrl":"https://doi.org/10.3390/gastroent14040032","url":null,"abstract":"The gastrointestinal (GI) tract may be a significant entrance or interaction site for SARS-CoV-2; therefore, the gut mucosal immune system participates in virus interaction as a first-line physical and immunological defense, leading to GI involvement and symptoms. This review focuses on the GI symptoms associated with SARS-CoV-2 infection while providing specific results on variant-specific signs and syndromes related to coronavirus disease 2019 (COVID-19). The pattern of symptoms changed during the virus evolution, since the data provided a current and thorough picture of the symptoms experienced by SARS-CoV-2 infected people, and variations in symptom patterns occurred as the Alpha, Delta, and Omicron variants have spread. Since the beginning of the pandemic, GI symptoms have been linked to SARS-CoV-2 infections, even though most infected people do not report them. For example, diarrhea (28.2%) was the most frequently reported GI symptom in the early phase of the pandemic. The most observed GI tract symptoms during COVID-19 were anorexia (loss of appetite), nausea, vomiting, diarrhea, and abdominal pain, usually in at least one-third of the patients. Mesenteric ischemia and GI bleeding were less observed but more severe. While GI symptoms are not associated with increased mortality, they complicate the disease, increase the duration of the illness, and result in worse outcomes. Nevertheless, it is accepted that symptoms between variants differ significantly, i.e., the Omicron variant causes milder COVID-19 than the Delta. Still, the rate of GI symptoms has declined in the following variant-dominated phases of the pandemic (Alpha: 19.4%, Delta: 17.9%, Omicron: 13.8%), which was also demonstrated for other GI signs associated with COVID-19.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135831102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intrahepatic cholangiocarcinoma (iCCA) represents the second most frequent type of primary liver neoplasm. The diagnosis and treatment of patients with iCCA involves many challenges. To date, surgical resection with negative margins is the main curative option, achieving an acceptable long-term survival. Despite enabling a considerable improvement in the outcome, iCCA recurrence after surgery is still common. Tumor extension and the histological subtype, as well as vascular and lymph node involvements, are key factors used to define the prognosis. In this narrative review, we aimed to discuss the potential benefits of using different surgical strategies in the field of iCCA, including vascular resection, the mini-invasive approach, liver transplantation, the mechanism used to enable future liver remnant augmentation, and lymph node dissection. We also discussed the new protocols developed in the field of systemic treatment, including immunotherapy and molecular targeted therapy. Recent advancements in the diagnosis, surgical treatment, and understanding of tumor biology have changed the landscape in terms of treatment options. Creating a multidisciplinary tumor board is essential to achieving the best patient outcomes. Further investigational trials are required with the intent of tailoring the treatments and establishing the right patient population who would benefit from the use of new therapeutics algorithms.
{"title":"New Insights into Surgical Management of Intrahepatic Cholangiocarcinoma in the Era of “Transplant Oncology”","authors":"Fabio Melandro, Davide Ghinolfi, Gaetano Gallo, Silvia Quaresima, Riccardo Aurelio Nasto, Massimo Rossi, Gianluca Mennini, Quirino Lai","doi":"10.3390/gastroent14030030","DOIUrl":"https://doi.org/10.3390/gastroent14030030","url":null,"abstract":"Intrahepatic cholangiocarcinoma (iCCA) represents the second most frequent type of primary liver neoplasm. The diagnosis and treatment of patients with iCCA involves many challenges. To date, surgical resection with negative margins is the main curative option, achieving an acceptable long-term survival. Despite enabling a considerable improvement in the outcome, iCCA recurrence after surgery is still common. Tumor extension and the histological subtype, as well as vascular and lymph node involvements, are key factors used to define the prognosis. In this narrative review, we aimed to discuss the potential benefits of using different surgical strategies in the field of iCCA, including vascular resection, the mini-invasive approach, liver transplantation, the mechanism used to enable future liver remnant augmentation, and lymph node dissection. We also discussed the new protocols developed in the field of systemic treatment, including immunotherapy and molecular targeted therapy. Recent advancements in the diagnosis, surgical treatment, and understanding of tumor biology have changed the landscape in terms of treatment options. Creating a multidisciplinary tumor board is essential to achieving the best patient outcomes. Further investigational trials are required with the intent of tailoring the treatments and establishing the right patient population who would benefit from the use of new therapeutics algorithms.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.3390/gastroent14030028
Mohammad Shehab, Ranim Almatar, Rawan Almohammad, Ahmad Alfadhli
Introduction: Patients with inflammatory bowel disease (IBD) on biologic therapies are at increased risk of infections, emphasizing the importance of immunization. This study aimed to assess vaccination prevalence among patients with IBD on specific biologic therapies. Methods: A survey-based cross-sectional study was conducted at an IBD center, including patients receiving different biologic therapies from 1 January 2022 to the 30 April 2023. Demographic and vaccination data were collected using patient electronic records and patient interviews. Results: A total 394 patients (100%) received the measles, mumps, rubella (MMR), tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine. A total of 79 patients (20%) received the influenza vaccine, 40 patients (10.2%) were vaccinated against hepatitis A (HAV), and 34 patients (8.6%) received the pneumococcal vaccine. From the 103 female patients who are eligible to take human papillomavirus (HPV) vaccine, only 7 (6.8%) received it. Out of the 100 eligible patients above the age of 50, only 9 (9%) received the herpes zoster (HZ) vaccine. Conclusion: The uptake of certain vaccines such as Hepatitis B (HBV), seasonal influenza, HAV, pneumococcal, HZ and HPV vaccines among patients with IBD were below expectations. These findings highlight the need for interventions to improve patients’ awareness and adherence to prevent infectious complications in patients with IBD.
{"title":"Adherence to Recommended Immunization Schedules in Patients with Inflammatory Bowel Disease on Biologics and Small Molecule Therapies","authors":"Mohammad Shehab, Ranim Almatar, Rawan Almohammad, Ahmad Alfadhli","doi":"10.3390/gastroent14030028","DOIUrl":"https://doi.org/10.3390/gastroent14030028","url":null,"abstract":"Introduction: Patients with inflammatory bowel disease (IBD) on biologic therapies are at increased risk of infections, emphasizing the importance of immunization. This study aimed to assess vaccination prevalence among patients with IBD on specific biologic therapies. Methods: A survey-based cross-sectional study was conducted at an IBD center, including patients receiving different biologic therapies from 1 January 2022 to the 30 April 2023. Demographic and vaccination data were collected using patient electronic records and patient interviews. Results: A total 394 patients (100%) received the measles, mumps, rubella (MMR), tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine. A total of 79 patients (20%) received the influenza vaccine, 40 patients (10.2%) were vaccinated against hepatitis A (HAV), and 34 patients (8.6%) received the pneumococcal vaccine. From the 103 female patients who are eligible to take human papillomavirus (HPV) vaccine, only 7 (6.8%) received it. Out of the 100 eligible patients above the age of 50, only 9 (9%) received the herpes zoster (HZ) vaccine. Conclusion: The uptake of certain vaccines such as Hepatitis B (HBV), seasonal influenza, HAV, pneumococcal, HZ and HPV vaccines among patients with IBD were below expectations. These findings highlight the need for interventions to improve patients’ awareness and adherence to prevent infectious complications in patients with IBD.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"213 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134912689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.3390/gastroent14030029
Laura N. Phan, Karen J. Murphy, Karma L. Pearce, Cuong D. Tran, Kelton P. Tremellen
The association between H. pylori and small intestinal permeability (IP) on serum testosterone levels in men as mediated by metabolic endotoxemia remains unclear. We sought to explore relationships using correlational analysis between H. pylori IgG class antibody levels and small IP via dual sugar probe analysis on T levels in 50 male participants of reproductive age. Sleep quality, physical activity levels, and Irritable Bowel Syndrome (IBS) symptom severity were measured as potential confounders. Measures for H. pylori (antibodies) increased small IP (lactulose/rhamnose ratio), and hypogonadism (testosterone) did not exceed diagnostic cut-off values for respective pathologies. There was no correlation between lactulose/rhamnose e ratio and GI function markers, zonulin, H. pylori, and IBS questionnaire scores; inflammatory markers, high-sensitivity C-reactive Protein (hsCRP) and Lipopolysaccharide-Binding Protein (LBP); nor endocrine markers, testosterone, Luteinizing hormone (LH), and Follicle-stimulating hormone (FSH). There was a moderate inverse relationship revealed between IBS symptom severity and LBP (r = −0.457, p = 0.004); and hsCRP and testosterone (r = −0.398, p = 0.004). This was independent of physical activity level and sleep quality, but not BMI, which supports the existing link between adiposity, inflammation, and hypogonadism currently present in the literature.
代谢性内毒素血症介导的幽门螺杆菌和小肠通透性(IP)对男性血清睾酮水平的影响尚不清楚。我们试图通过对50名育龄男性受试者的T水平进行双糖探针分析，探讨幽门螺杆菌IgG类抗体水平与小IP之间的关系。睡眠质量、体力活动水平和肠易激综合征(IBS)症状严重程度作为潜在混杂因素进行测量。幽门螺杆菌(抗体)的检测增加了小IP(乳果糖/鼠李糖比率)，性腺功能减退(睾酮)没有超过各自病理的诊断临界值。乳果糖/鼠李糖e比值与GI功能标志物、zonulin、幽门螺杆菌和IBS问卷评分无相关性;炎症标志物、高敏c反应蛋白(hsCRP)和脂多糖结合蛋白(LBP);也没有内分泌标志物，睾酮，促黄体生成素(LH)和促卵泡激素(FSH)。IBS症状严重程度与LBP呈中度负相关(r = - 0.457, p = 0.004);hsCRP和睾酮(r = - 0.398, p = 0.004)。这与身体活动水平和睡眠质量无关，但与BMI无关，这支持了目前文献中存在的肥胖、炎症和性腺功能减退之间的联系。
{"title":"The Potential Relationship between Gastric and Small Intestinal-Derived Endotoxin on Serum Testosterone in Men","authors":"Laura N. Phan, Karen J. Murphy, Karma L. Pearce, Cuong D. Tran, Kelton P. Tremellen","doi":"10.3390/gastroent14030029","DOIUrl":"https://doi.org/10.3390/gastroent14030029","url":null,"abstract":"The association between H. pylori and small intestinal permeability (IP) on serum testosterone levels in men as mediated by metabolic endotoxemia remains unclear. We sought to explore relationships using correlational analysis between H. pylori IgG class antibody levels and small IP via dual sugar probe analysis on T levels in 50 male participants of reproductive age. Sleep quality, physical activity levels, and Irritable Bowel Syndrome (IBS) symptom severity were measured as potential confounders. Measures for H. pylori (antibodies) increased small IP (lactulose/rhamnose ratio), and hypogonadism (testosterone) did not exceed diagnostic cut-off values for respective pathologies. There was no correlation between lactulose/rhamnose e ratio and GI function markers, zonulin, H. pylori, and IBS questionnaire scores; inflammatory markers, high-sensitivity C-reactive Protein (hsCRP) and Lipopolysaccharide-Binding Protein (LBP); nor endocrine markers, testosterone, Luteinizing hormone (LH), and Follicle-stimulating hormone (FSH). There was a moderate inverse relationship revealed between IBS symptom severity and LBP (r = −0.457, p = 0.004); and hsCRP and testosterone (r = −0.398, p = 0.004). This was independent of physical activity level and sleep quality, but not BMI, which supports the existing link between adiposity, inflammation, and hypogonadism currently present in the literature.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":"174 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134912315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-08DOI: 10.3390/gastroent14030027
Sorina I. Stan, Teodora Biciusca, V. Biciușcă, R. Cioboată, D. Clenciu, A. Mitrea, Alice Elena Ghenea, Suzana Dănoiu
(1) Background: The relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) is bidirectional: NAFLD increases the risk of T2DM, and T2DM promotes the progression of the disease into non-alcoholic steatohepatitis (NASH). (2) Material and methods: We performed a retrospective, open study that included 59 patients with NAFLD and T2DM who were distributed into two groups: 44 (74.57%) patients were diagnosed with hepatic steatosis (HS) and 15 (25.42%) patients were diagnosed with NASH. (3) Results: Among the non-specific inflammatory biomarkers, serum ferritin (SF) and the neutrophil-percentage-to-albumin ratio (NPAR) showed higher and statistically significant mean values (p = 0.003 respectively p = 0.03) in the group of patients with NASH and T2DM. Conclusions: Consequently, it is essential to identify alternative markers for the inflammatory process, particularly in individuals with diabetes, as it is a key characteristic of NASH. This need arises from the desire to avoid the risks associated with liver biopsy procedures (LBP) and to prevent the unpredictable and unfavorable progression of NAFLD in patients with T2DM.
(1)背景:非酒精性脂肪性肝病(NAFLD)与2型糖尿病(T2DM)之间的关系是双向的:NAFLD增加发生T2DM的风险，T2DM促进疾病向非酒精性脂肪性肝炎(NASH)发展。(2)材料与方法:我们对59例NAFLD合并T2DM患者进行回顾性、开放式研究，分为两组:44例(74.57%)诊断为肝脂肪变性(HS)， 15例(25.42%)诊断为NASH。(3)结果:在非特异性炎症生物标志物中，NASH合并T2DM组血清铁蛋白(SF)和中性粒细胞百分比-白蛋白比(NPAR)的平均值更高，且具有统计学意义(p = 0.003 p = 0.03)。结论:因此，有必要确定炎症过程的替代标志物，特别是糖尿病患者，因为这是NASH的一个关键特征。这一需求源于避免与肝活检手术(LBP)相关的风险的愿望，以及防止T2DM患者NAFLD不可预测和不利的进展。
{"title":"A Current Approach to Non-Alcoholic Steatohepatitis in Type 2 Diabetes Mellitus Patients","authors":"Sorina I. Stan, Teodora Biciusca, V. Biciușcă, R. Cioboată, D. Clenciu, A. Mitrea, Alice Elena Ghenea, Suzana Dănoiu","doi":"10.3390/gastroent14030027","DOIUrl":"https://doi.org/10.3390/gastroent14030027","url":null,"abstract":"(1) Background: The relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) is bidirectional: NAFLD increases the risk of T2DM, and T2DM promotes the progression of the disease into non-alcoholic steatohepatitis (NASH). (2) Material and methods: We performed a retrospective, open study that included 59 patients with NAFLD and T2DM who were distributed into two groups: 44 (74.57%) patients were diagnosed with hepatic steatosis (HS) and 15 (25.42%) patients were diagnosed with NASH. (3) Results: Among the non-specific inflammatory biomarkers, serum ferritin (SF) and the neutrophil-percentage-to-albumin ratio (NPAR) showed higher and statistically significant mean values (p = 0.003 respectively p = 0.03) in the group of patients with NASH and T2DM. Conclusions: Consequently, it is essential to identify alternative markers for the inflammatory process, particularly in individuals with diabetes, as it is a key characteristic of NASH. This need arises from the desire to avoid the risks associated with liver biopsy procedures (LBP) and to prevent the unpredictable and unfavorable progression of NAFLD in patients with T2DM.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47241716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-04DOI: 10.3390/gastroent14030026
Tadej Durič, I. Cibulková, Jan Hajer
GI endoscopy forms an important part in the daily practice of a gastroenterologist. Musculoskeletal injuries related to GI endoscopy are on the rise. Observational studies and surveys depict the importance of a proper ergonomic environment when performing GI endoscopy. Our aim is to describe the pathophysiology, risk factors and possible preventive measures to reduce the risk of musculoskeletal injuries during gastrointestinal (GI) endoscopy. We review the most relevant studies that outline the gravity of the problem. A detailed analysis of proposed ergonomic recommendations is performed, outlining crucial steps in injury prevention. Proper ergonomic education is a key step in preventing occupational injury. Robotics and other mechanical solutions offer a variety of approaches to tackling the ergonomic challenge. Implementing proper ergonomic education and mechanical solutions lowers the possibility of occupational injury. The strategies and appliances presented are beneficial to all GI endoscopy practitioners.
{"title":"Musculoskeletal Injuries in the Endoscopy Practitioner Risk Factors, Ergonomic Challenges and Prevention—Narrative Review and Perspectives","authors":"Tadej Durič, I. Cibulková, Jan Hajer","doi":"10.3390/gastroent14030026","DOIUrl":"https://doi.org/10.3390/gastroent14030026","url":null,"abstract":"GI endoscopy forms an important part in the daily practice of a gastroenterologist. Musculoskeletal injuries related to GI endoscopy are on the rise. Observational studies and surveys depict the importance of a proper ergonomic environment when performing GI endoscopy. Our aim is to describe the pathophysiology, risk factors and possible preventive measures to reduce the risk of musculoskeletal injuries during gastrointestinal (GI) endoscopy. We review the most relevant studies that outline the gravity of the problem. A detailed analysis of proposed ergonomic recommendations is performed, outlining crucial steps in injury prevention. Proper ergonomic education is a key step in preventing occupational injury. Robotics and other mechanical solutions offer a variety of approaches to tackling the ergonomic challenge. Implementing proper ergonomic education and mechanical solutions lowers the possibility of occupational injury. The strategies and appliances presented are beneficial to all GI endoscopy practitioners.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46616513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-21DOI: 10.3390/gastroent14030025
Argjira Juniku-Shkololli, Suzana Manxhuka-Kërliu, Valon Hamza, M. Basholli
Background: Rising incidence of inflammatory bowel disease (IBD) is an increasing concern among patients of young age worldwide and its most important complication is colitis-associated cancer (CAC). Vitamin D (VD) deficiency is common in IBD and inversely associated with disease activity; meanwhile, vitamin D receptor (VDR) signaling in the gut protects the mucosal epithelial barrier and inhibits inflammation in the colon. This study aims to investigate the connection between VDR expression and IBD in human colorectal tissues. Research design and methods: Using a cross-sectional analysis, this study investigated VDR nuclear immunohistochemistry expression in 35 subjects. The expression level was measured in patients with IBD, and compared with healthy controls (cut off 36.29%). Results: VDR nuclear expression was significantly down-regulated in colorectal tissues of patients with IBD, compared with controls (p = 0.025). Under-expression of VDR was more remarkable in colon cells of patients with UC (p = 0.023). These results confirm the protective role of VD for colonic mucosa in human colon as well, and suggest a benefit from VD supplementation in IBD patients. Conclusions: Our findings add to the body of evidence regarding the positive effect of VD in colorectal mucosal integrity. This study contributes in establishing one of the proposed markers related to disease activity, which can also predict the risk for complications.
{"title":"VDR Immunohistochemistry Expression Is Down-Regulated in Colorectal Cells of Patients with IBD and Could Rank the Patients According to Their Complications Risk","authors":"Argjira Juniku-Shkololli, Suzana Manxhuka-Kërliu, Valon Hamza, M. Basholli","doi":"10.3390/gastroent14030025","DOIUrl":"https://doi.org/10.3390/gastroent14030025","url":null,"abstract":"Background: Rising incidence of inflammatory bowel disease (IBD) is an increasing concern among patients of young age worldwide and its most important complication is colitis-associated cancer (CAC). Vitamin D (VD) deficiency is common in IBD and inversely associated with disease activity; meanwhile, vitamin D receptor (VDR) signaling in the gut protects the mucosal epithelial barrier and inhibits inflammation in the colon. This study aims to investigate the connection between VDR expression and IBD in human colorectal tissues. Research design and methods: Using a cross-sectional analysis, this study investigated VDR nuclear immunohistochemistry expression in 35 subjects. The expression level was measured in patients with IBD, and compared with healthy controls (cut off 36.29%). Results: VDR nuclear expression was significantly down-regulated in colorectal tissues of patients with IBD, compared with controls (p = 0.025). Under-expression of VDR was more remarkable in colon cells of patients with UC (p = 0.023). These results confirm the protective role of VD for colonic mucosa in human colon as well, and suggest a benefit from VD supplementation in IBD patients. Conclusions: Our findings add to the body of evidence regarding the positive effect of VD in colorectal mucosal integrity. This study contributes in establishing one of the proposed markers related to disease activity, which can also predict the risk for complications.","PeriodicalId":43586,"journal":{"name":"Gastroenterology Insights","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43730433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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