JGH Open最新文献_第7页

Endoscopic characteristics and performance of WASP classification in the diagnosis of colorectal sessile-serrated lesions in Vietnamese patients 越南患者结直肠无柄锯齿状病变的内镜特征和 WASP 分类在诊断中的表现。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-24 DOI: 10.1002/jgh3.13109

Nhu Thi Hanh Vu, Huy Minh Le, Diem Thi-Ngoc Vo, Nhan Quang Le, Dung Dang Quy Ho, Duc Trong Quach

Background/Aims

Sessile-serrated lesions (SSLs) are challenging to detect due to their typically subtle appearance. The Workgroup serrAted polypS and Polyposis (WASP) classification was developed to diagnose SSLs endoscopically. This study aimed to evaluate the endoscopic characteristics of SSLs and the performance of the WASP classification in the Vietnamese population.

Methods

This cross-sectional study was carried out on patients with lower gastrointestinal symptoms who underwent colonoscopy at a Vietnamese tertiary hospital. Univariate and multivariate analyses were performed to identify endoscopic features associated with SSLs. The performance of the WASP classification for diagnosing SSLs was assessed, and SSLs were diagnosed according to the 2019 World Health Organization (WHO) criteria.

Results

There were 2489 patients, with a mean age of 52.1 ± 13.1 years and a female-to-male ratio of 1:1.1. A total of 121 specimens from 105 patients were diagnosed with SSLs. According to multivariate analysis, the endoscopic features significantly associated with SSLs were proximal location (odds ratio [OR]: 2.351; 95% confidence interval [CI]: 1.475–3.746), size >5 mm (OR: 2.447; 95% CI: 1.551–3.862), flat morphology (OR: 2.781; 95% CI: 1.533–5.044), irregular shape (OR: 4.516; 95% CI: 2.173–9.388), varicose microvascular vessels (OR: 5.030; 95% CI: 2.657–9.522), and dark spots inside the crypts (OR: 5.955; 95% CI: 3.291–10.776). The accuracy of the WASP classification for diagnosing SSLs was 94.0% (95% CI: 92.8%–95.0%).

Conclusion

Proximal location, size >5 mm, flat morphology, irregular shape, varicose microvascular vessels, and dark spots inside the crypts were significantly associated with SSLs. The WASP classification had high accuracy in the diagnosis of SSLs.

背景/目的：无细锯齿状病变（SSLs）由于其典型的细微外观而难以检测。为在内镜下诊断SSL，开发了 "有细锯齿息肉和息肉病工作组（WASP）"分类。本研究旨在评估 SSL 的内镜特征以及 WASP 分类在越南人群中的表现：这项横断面研究的对象是在越南一家三级医院接受结肠镜检查的下消化道症状患者。进行了单变量和多变量分析，以确定与 SSL 相关的内镜特征。对WASP分类诊断SSL的性能进行了评估，并根据2019年世界卫生组织（WHO）标准对SSL进行了诊断：共有 2489 名患者，平均年龄为（52.1 ± 13.1）岁，男女比例为 1:1.1。共有来自 105 名患者的 121 份标本被确诊为 SSL。根据多变量分析，与 SSL 显著相关的内镜特征是近端位置（几率比 [OR]：2.351；95% 置信区间 [CI]：1.475-3.746）、大小 >5 mm（OR：2.447；95% CI：1.551-3.862）、形态扁平（OR：2.781；95% CI：1.533-5.044）、形状不规则（OR：4.516；95% CI：2.173-9.388）、微血管曲张（OR：5.030；95% CI：2.657-9.522）、隐窝内有黑点（OR：5.955；95% CI：3.291-10.776）。WASP分类诊断SSL的准确率为94.0%（95% CI：92.8%-95.0%）：结论：近端位置、大小大于 5 毫米、扁平形态、不规则形状、曲张的微血管和隐窝内的黑点与 SSL 显著相关。WASP 分类对 SSL 的诊断具有很高的准确性。

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引用次数: 0

The clinical management of hepatic sarcoidosis: A systematic review 肝肉瘤病的临床治疗：系统综述。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-20 DOI: 10.1002/jgh3.13076

Ram Prasad Sinnanaidu, Vikneshwaran Chandra Kumar, Ranita Hisham Shunmugam, Sanjiv Mahadeva

Background

Hepatic sarcoidosis is an uncommon clinical condition in which clear recommendations are lacking in its treatment. We aimed to review systematically the literature on hepatic sarcoidosis treatment to guide clinicians.

Methods

Using MEDLINE, PubMed, CINAHL, Cochrane Library, and Google Scholar databases, we searched original articles on clinical studies reporting the outcome of adult hepatic sarcoidosis patients following treatment with various pharmacological agents. The primary end point was focused on assessing symptomatic relief and biochemical improvement posttreatment.

Results

Out of 614 retrieved references, 34 published studies were eligible, providing data for a total of 268 patients with hepatic sarcoidosis. First-line therapy with corticosteroids alone was reported in 187 patients, whilst ursodeoxycholic acid (UDCA) was used in 40 patients. Symptomatic and biochemical responses were reported among 113(60.4%) and 80(42.8%) cases of corticosteroids respectively, whereas UDCA showed a complete response in 23(57.5%) patients. Second-line therapy was used in steroid-refractory cases, with most cases being reported for azathioprine (n = 32) and methotrexate (n = 28). Notably, 15(46.9%) and 11(39.2%) patients showed both clinical and biochemical responses respectively. Biological therapy including anti-tumor necrosis factor (anti-TNF) was used as third line therapy in twelve cases with a 72.7% symptomatic and biochemical response rate each.

Conclusion

The quality of evidence for the treatment of hepatic sarcoidosis was poor. Nevertheless, it appears that corticosteroid or UDCA may be utilized as first-line therapy. For cases that are refractory to corticosteroids, steroid-sparing immunosuppressive agents and anti-TNF have shown some promising results, but further high-quality studies are required.

背景：肝肉样瘤病是一种不常见的临床疾病，其治疗缺乏明确的建议。我们旨在系统回顾有关肝肉样瘤病治疗的文献，为临床医生提供指导：我们使用 MEDLINE、PubMed、CINAHL、Cochrane Library 和 Google Scholar 数据库，检索了报告成人肝肉样变性患者接受各种药物治疗后疗效的临床研究原始文章。主要终点集中在评估治疗后症状的缓解和生化指标的改善：在检索到的 614 篇参考文献中，有 34 篇已发表的研究符合条件，共提供了 268 名肝肉样瘤病患者的数据。187名患者接受了单纯皮质类固醇的一线治疗，40名患者接受了熊去氧胆酸（UDCA）治疗。皮质类固醇治疗的 113 例（60.4%）和 80 例（42.8%）患者分别出现了症状反应和生化反应，而 UDCA 治疗的 23 例（57.5%）患者则出现了完全反应。类固醇类药物难治性病例采用二线疗法，大多数病例使用硫唑嘌呤（32 例）和甲氨蝶呤（28 例）。值得注意的是，分别有 15 例（46.9%）和 11 例（39.2%）患者出现了临床和生化反应。包括抗肿瘤坏死因子（anti-TNF）在内的生物疗法作为三线疗法用于12例患者，症状和生化应答率分别为72.7%：结论：治疗肝肉瘤病的证据质量不高。尽管如此，皮质类固醇或 UDCA 似乎仍可作为一线疗法。对于皮质类固醇类药物难治的病例，稀释类固醇的免疫抑制剂和抗肿瘤坏死因子已显示出一些有希望的结果，但还需要进一步的高质量研究。

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引用次数: 0

Comparison of the effects of abdominal massage and osteopathic manipulative treatment home program on constipation in children with cerebral palsy 比较腹部按摩和整骨疗法家庭计划对脑瘫儿童便秘的影响。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-19 DOI: 10.1002/jgh3.13102

Aisel T Chatip, Gönül Acar, Ayfer A Akçay

Background and Aim

The aim of this study is to compare the effects of osteopathic manipulative therapy home program (OMT-H) versus abdominal massage home program (AMHP) in treating constipation in children with cerebral palsy (CP).

Methods

Twenty-nine children with CP with a mean age of 12.2 ± 3.76 years, who were constipated and were not on medication, were divided into three randomized groups: (i) control group (n = 10), (ii) AMHP (n = 10), and (iii) OMT-H (n = 9). In AMHP and OMT-H groups, treatment was applied as 20-min sessions every other day for 10 sessions for 3 weeks. Modified Constipation Assessment Scale (MCAS), Rome III criteria, and the Bristol Stool Form Scale (BSFS) were used for evaluation before treatment and once a week during treatment.

Results

While there was no change in constipation symptoms in the control group, there was an improvement in constipation symptoms after treatment in the AMHP and OMT-H groups (AMHP, P = 0.003; OMT-H, P = 0.000014). While the treatment showed to be effective from the first week in the OMT-H group, the change in BSFS (P = 0.026) and MCAS sub-parameters was found to be superior.

Conclusion

AMHP and OMT-H are effective and beneficial in treating constipation. In children with CP, OMT-H was found to be quicker and more successful compared with AMHP. The OMT-H can be effectively used in clinical practice in relieving constipation in CP.

背景和目的：本研究旨在比较骨科手法治疗家庭计划（OMT-H）与腹部按摩家庭计划（AMHP）治疗脑瘫（CP）儿童便秘的效果：29名平均年龄为（12.2±3.76）岁的CP患儿被随机分为三组：(i) 对照组（n = 10），(ii) AMHP（n = 10），(iii) OMT-H（n = 9）。AMHP组和OMT-H组的治疗方法为隔天一次，每次20分钟，共10次，持续3周。改良便秘评估量表（MCAS）、罗马III标准和布里斯托粪便形式量表（BSFS）用于治疗前和治疗期间每周一次的评估：对照组的便秘症状没有变化，而 AMHP 组和 OMT-H 组的便秘症状在治疗后有所改善（AMHP，P = 0.003；OMT-H，P = 0.000014）。OMT-H组的治疗从第一周开始就显示出效果，而BSFS（P = 0.026）和MCAS子参数的变化则更优：结论：AMHP和OMT-H治疗便秘有效且有益。结论：AMHP 和 OMT-H 对治疗便秘有效且有益。在临床实践中，OMT-H 可有效缓解 CP 便秘。

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引用次数: 0

Usefulness of a long hood for the detection of bleeding sites in colonic diverticular hemorrhage: A randomized controlled trial 用长头罩检测结肠憩室出血部位的实用性：随机对照试验

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-19 DOI: 10.1002/jgh3.13099

Rie Shiomi, Junko Nagata, Yoshikazu Tsuzuki, Masashi Yokota, Hisashi Matsumoto, Kazuya Miyaguchi, Hideki Ohgo, Shingo Tsuda, Hiroyuki Ito, Seiichiro Kojima, Nobutaka Hirooka, Hidetomo Nakamoto, Takayoshi Suzuki, Hiroyuki Imaeda

Background and Aim

The use of a hood at the tip of a colonoscope enables aspiration, inversion of the diverticulum, and observation of the inside of the diverticulum. In most previous studies, a short hood was used; however, observation of the diverticulum is often inadequate. Long food is promising by previous research, but it was a retrospective study using propensity matching and has some limitations. We compared the identification rate of stigmata of recent hemorrhage (SRH) between the long and standard hoods in cases of suspected colonic diverticular hemorrhage (CDH) to confirm the usefulness of long hood by prospective randomized controlled trial.

Methods

Eighty patients (42 in the long hood group [L group] and 38 in the short hood group [S group]) who visited the Saitama Medical University Hospital and Tokai University Hachioji Hospital between December 2018 and July 2021 with a chief complaint of bloody stool and suspected CDH, based on the clinical course and imaging studies, were included. Patients were randomly assigned to the L or S group.

Results

Regarding patient background, age was significantly higher in the L group; however, no significant differences were found in medical history or history of antithrombotic medication or nonsteroidal anti-inflammatory drug use. Identification rate of SRH was significantly higher in the L group (58.5%, 24/42 patients) than in the S group (26.3%, 10/38 patients) (P < 0.05). All patients were treated using the clip method, and the rate of rebleeding within 1 month was not significantly different between the two groups.

Conclusion

A long hood was more useful compared with a short hood in identifying SRH of CDH (UMIN000034603).

背景和目的在结肠镜顶端使用套管可以抽吸、倒转憩室和观察憩室内部。在以前的大多数研究中，使用的都是短头罩；但对憩室的观察往往不够。从以往的研究来看，长型食品很有前景，但这是一项采用倾向匹配的回顾性研究，存在一定的局限性。我们比较了长头罩和标准头罩在疑似结肠憩室出血（CDH）病例中对近期出血（SRH）征象的识别率，通过前瞻性随机对照试验证实长头罩的实用性。方法纳入2018年12月至2021年7月期间在埼玉医科大学附属医院和东海大学八王子医院就诊的80例患者（长头罩组[L组]42例，短头罩组[S组]38例），这些患者的主诉为大便带血，根据临床病程和影像学检查结果怀疑为CDH。患者被随机分配到 L 组或 S 组。结果在患者背景方面，L 组患者的年龄明显更高；但在病史、抗血栓药物或非类固醇抗炎药物使用史方面未发现明显差异。L 组（58.5%，24/42 例患者）的 SRH 识别率明显高于 S 组（26.3%，10/38 例患者）（P < 0.05）。所有患者均采用夹子法治疗，两组患者 1 个月内再出血率无明显差异。结论在识别 CDH 的 SRH 时，长头罩比短头罩更有用 (UMIN000034603)。

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引用次数: 0

Usefulness of health checkup-based indices in identifying metabolic dysfunction-associated steatotic liver disease 基于健康检查的指数在识别代谢功能障碍相关脂肪性肝病方面的实用性。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-17 DOI: 10.1002/jgh3.13110

Takao Miwa, Satoko Tajirika, Nanako Imamura, Miho Adachi, Ryo Horita, Tatsunori Hanai, Cheng Han Ng, Mohammad Shadab Siddiqui, Taku Fukao, Masahito Shimizu, Mayumi Yamamoto

Aims

The application of indices in the context of metabolic dysfunction-associated steatotic liver disease (MASLD) remains unexplored. We aimed to validate the ability of alanine aminotransferase (ALT), fatty liver index (FLI), and hepatic steatosis index (HSI) to identify MASLD during health checkups.

Methods

We recruited 627 participants and utilized their health checkup data and ultrasound to assess the potential of using ALT, FLI, and HSI as indices for MASLD; this was indicated by the area under the curve (AUC) and restricted cubic spline (RCS) model. The optimal, rule-out (sensitivity ≥90%), and rule-in (specificity ≥90%) cutoff values of each index for identifying MASLD were reported.

Results

Among participants with a median age of 46 years, the prevalence of MASLD was 28% in total (38% in males and 18% in females). RCS models confirmed a linear association between indices and MASLD. ROC analyses indicated that the AUC of ALT in identifying MASLD was 0.79 for the total cohort, 0.81 for males, and 0.69 for females. The optimal, rule-out, and rule-in cutoff values for ALT were 21, 13, and 29, respectively. Similarly, the AUC of FLI/HSI in identifying MASLD was 0.90/0.88 for the total cohort, 0.86/0.85 for males, and 0.93/0.90 for females. Considering the reference cutoff values, distinct cutoff values were observed between the sexes for FLI, while HSI had similar cutoff values.

Conclusion

This study demonstrated that ALT > 30 IU/L is a reasonable cutoff value to rule-in MASLD. ALT, FLI, and HSI are reliable indices for identifying MASLD during health checkups.

目的：在代谢功能障碍相关性脂肪性肝病（MASLD）中应用指数的问题仍未得到探讨。我们的目的是验证丙氨酸氨基转移酶（ALT）、脂肪肝指数（FLI）和肝脏脂肪变性指数（HSI）在健康体检中识别 MASLD 的能力：我们招募了 627 名参与者，利用他们的健康体检数据和超声波检查评估了将 ALT、FLI 和 HSI 作为 MASLD 指数的潜力；曲线下面积（AUC）和受限立方样条曲线（RCS）模型表明了这一点。报告了每种指标用于鉴别 MASLD 的最佳、排除（灵敏度≥90%）和排除（特异度≥90%）临界值：结果：在中位年龄为 46 岁的参与者中，MASLD 的患病率为 28%（男性为 38%，女性为 18%）。RCS模型证实了指数与MASLD之间的线性关系。ROC分析表明，ALT在鉴别MASLD方面的AUC值在整个队列中为0.79，在男性中为0.81，在女性中为0.69。ALT的最佳临界值、排除临界值和纳入临界值分别为21、13和29。同样，FLI/HSI 鉴别 MASLD 的 AUC 总值为 0.90/0.88，男性为 0.86/0.85，女性为 0.93/0.90。考虑到参考截断值，FLI的性别截断值不同，而HSI的性别截断值相似：本研究表明，ALT>30 IU/L是排除MASLD的合理临界值。ALT、FLI 和 HSI 是健康体检中识别 MASLD 的可靠指标。

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引用次数: 0

Clinical practice and outcome of patients with elderly-onset ulcerative colitis: Insights from a nationwide claims database study in Japan 老年溃疡性结肠炎患者的临床实践和疗效：日本全国索赔数据库研究的启示。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-17 DOI: 10.1002/jgh3.13103

Rintaro Moroi, Yoichi Kakuta, Hiroshi Nagai, Yusuke Shimoyama, Takeo Naito, Hisashi Shiga, Yoshitaka Kinouchi, Atsushi Masamune

Background and Aim

The number of older patients with ulcerative colitis is increasing; however, limited data exist regarding the differences between elderly- and non-elderly-onset ulcerative colitis. We aimed to compare the clinical practice and course of elderly-onset ulcerative colitis with those of non-elderly-onset ulcerative colitis.

Methods

We selected older patients with ulcerative colitis and divided them into the elderly- and non-elderly-onset ulcerative colitis groups according to their age at onset. We compared the cumulative systemic steroid-free, molecular targeting drug-free, and surgery-free rates between the two groups. We performed a multivariate analysis to identify the clinical factors related to systemic steroid administration, the use of molecular targeting drugs, surgery, and death.

Results

We collected data of 2669 and 277 elderly and non-elderly-onset ulcerative colitis patients, respectively. The cumulative systemic steroid-free rate of elderly-onset ulcerative colitis was significantly lower than that of non-elderly-onset ulcerative colitis. However, no difference was observed in the cumulative molecular targeting drugs and surgery-free rates between the two groups. Elderly-onset ulcerative colitis significantly increased the risk of systemic steroid administration and death but not the use of molecular targeting drugs and surgery.

Conclusion

The disease severity of ulcerative colitis and clinical practice may not differ between the elderly- and non-elderly-onset groups. However, elderly-onset ulcerative colitis was associated with increased mortality risk. Thus, we need to pay attention to the patients' condition and appropriate timing of surgery for patients with elderly-onset ulcerative colitis.

背景和目的：老年溃疡性结肠炎患者的人数在不断增加，但有关老年和非老年溃疡性结肠炎之间差异的数据却很有限。我们旨在比较老年溃疡性结肠炎与非老年溃疡性结肠炎的临床实践和病程：方法：我们选择了老年溃疡性结肠炎患者，并根据其发病年龄将其分为老年和非老年溃疡性结肠炎组。我们比较了两组患者无全身类固醇、无分子靶向药物和无手术的累积率。我们进行了多变量分析，以确定与全身类固醇用药、使用分子靶向药物、手术和死亡相关的临床因素：我们分别收集了2669名老年溃疡性结肠炎患者和277名非老年溃疡性结肠炎患者的数据。老年溃疡性结肠炎患者的累计全身无类固醇比率明显低于非老年溃疡性结肠炎患者。不过，两组患者的累计分子靶向药物和无手术率并无差异。老年性溃疡性结肠炎会显著增加全身使用类固醇和死亡的风险，但不会增加使用分子靶向药物和手术的风险：结论：老年溃疡性结肠炎和非老年溃疡性结肠炎的疾病严重程度和临床实践可能没有区别。然而，老年溃疡性结肠炎与死亡风险增加有关。因此，我们需要关注老年溃疡性结肠炎患者的病情和适当的手术时机。

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引用次数: 0

Clinical value of the Systemic Inflammatory Response Index for predicting acute pancreatitis severity in Vietnamese setting 系统炎症反应指数对预测越南急性胰腺炎严重程度的临床价值

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-14 DOI: 10.1002/jgh3.13101

Yen H T Dao, Tien M Huynh, Duy T Tran, Phat T Ho, Thong D Vo

Background and Aim

Accurate prediction of severe acute pancreatitis (SAP) is crucial for timely intervention. This study focuses on the Systemic Inflammatory Response Index (SIRI) to assess its clinical value in predicting the severity of AP in the Vietnamese context.

Methods

A cross-sectional prospective study was conducted with acute pancreatitis patients at a national hospital in Ho Chi Minh City. The patients were classified into nonsevere and severe groups, and the clinical characteristics were analyzed. The predictive abilities of SIRI, calculated using neutrophil × monocyte/lymphocyte, was assessed for predictive abilities. Multivariate regression and receiver operating characteristics (ROC) curves evaluated the prognostic factors and predictive accuracy.

Results

Among 207 patients, 78.7% had nonsevere AP, and 21.3% had SAP. The severe group exhibited a significantly higher median SIRI (12.0) than the nonsevere group (4.9) (P < 0.001). Multivariate regression identified SIRI (odds ratio [OR] = 1.623) as an independent predictor of SAP. The ROC curve determined a SIRI cutoff of 7.82 with an area under the curve (AUC) of 0.737. Combining the SIRI and Bedside Index for Severity in Acute Pancreatitis (BISAP) score improved the predictive ability (AUC = 0.820) with increased sensitivity (90.91%) (P < 0.001).

Conclusion

SIRI, particularly when combined with the BISAP score, shows significant potential to predict SAP severity in the Vietnamese clinical setting, providing valuable information for effective patient management.

背景和目的准确预测重症急性胰腺炎（SAP）对及时干预至关重要。本研究重点关注全身炎症反应指数（SIRI），以评估其在预测越南急性胰腺炎严重程度方面的临床价值。方法对胡志明市一家国立医院的急性胰腺炎患者进行了横断面前瞻性研究。研究人员将患者分为非重症组和重症组，并对其临床特征进行了分析。以中性粒细胞×单核细胞/淋巴细胞计算的 SIRI 预测能力进行了评估。多变量回归和接收者操作特征曲线（ROC）评估了预后因素和预测准确性。结果 207 名患者中，78.7% 患有非重度 AP，21.3% 患有 SAP。重症组的 SIRI 中位数（12.0）明显高于非重症组（4.9）（P < 0.001）。多变量回归确定 SIRI（几率比 [OR] = 1.623）是 SAP 的独立预测因子。ROC 曲线确定 SIRI 临界值为 7.82，曲线下面积 (AUC) 为 0.737。将 SIRI 与急性胰腺炎床旁严重程度指数 (BISAP) 评分相结合可提高预测能力（AUC = 0.820），并增加灵敏度（90.91%）（P < 0.001）。结论 SIRI，尤其是与 BISAP 评分相结合时，在越南临床环境中显示出预测 SAP 严重程度的巨大潜力，为有效管理患者提供了宝贵的信息。

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引用次数: 0

Clinical performance of fecal calprotectin, lactoferrin, and hemoglobin for evaluating the disease activity of IBD and detecting colorectal tumors 粪便钙蛋白、乳铁蛋白和血红蛋白在评估 IBD 疾病活动性和检测结肠直肠肿瘤方面的临床表现

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-04 DOI: 10.1002/jgh3.13077

Tsukasa Yamakawa, Takakazu Miyake, Yoshihiro Yokoyama, Tomoe Kazama, Yuki Hayashi, Daisuke Hirayama, Shinji Yoshii, Hiro-o Yamano, Satoshi Takahashi, Hiroshi Nakase

Background and Aim

Recently, noninvasive fecal markers have been used as indicators of intestinal inflammation in patients with inflammatory bowel disease (IBD). We conducted a clinical validation study to measure fecal calprotectin (Cp), lactoferrin (Lf), and hemoglobin (Hb) levels using an all-in-one kit in patients with IBD and colorectal tumors and aimed to clarify the utility of these fecal markers.

Methods

In this study, 104 patients were analyzed, including 25 patients with ulcerative colitis (UC), 20 with Crohn's disease (CD), 48 with colorectal tumors, and 13 healthy controls (HC). Of the 48 patients with colorectal tumors, 14 had invasive cancer. We validated the utility of fecal Cp, Lf, and Hb levels by simultaneously measuring fecal markers in patients with IBD and colorectal tumors.

Results

Fecal Cp and Lf had almost equivalent abilities in detecting clinical remission in patients with UC; however, fecal Cp was slightly superior to Lf. Regarding colorectal tumors, fecal Cp and Lf levels tended to be higher in patients with adenomas and colorectal cancer than in HCs. Although fecal Hb alone had the best sensitivity and specificity for detecting colorectal cancer, it had relatively low sensitivity for detecting advanced neoplasms and colorectal cancer.

Conclusion

Fecal Cp and Lf can be used as almost equivalent biomarkers to assess the clinical activity in patients with UC. Fecal Hb is the most useful marker for screening colorectal cancer; however, adding fecal Cp and Lf may compensate for the low sensitivity of detecting for advanced colorectal tumors based on Hb alone.

背景和目的最近，无创粪便标记物被用作炎症性肠病（IBD）患者肠道炎症的指标。我们开展了一项临床验证研究，使用一体化试剂盒测量 IBD 和结直肠肿瘤患者的粪便钙蛋白（Cp）、乳铁蛋白（Lf）和血红蛋白（Hb）水平，旨在明确这些粪便标记物的效用。方法本研究分析了 104 名患者，包括 25 名溃疡性结肠炎（UC）患者、20 名克罗恩病（CD）患者、48 名结直肠肿瘤患者和 13 名健康对照组（HC）患者。在 48 名结肠直肠肿瘤患者中，14 人患有浸润性癌症。我们通过同时测量 IBD 和结直肠肿瘤患者的粪便标记物，验证了粪便 Cp、Lf 和 Hb 水平的实用性。结果在检测 UC 患者的临床缓解方面，粪便 Cp 和 Lf 的能力几乎相当；但粪便 Cp 略优于 Lf。在结直肠肿瘤方面，腺瘤和结直肠癌患者的粪便Cp和Lf水平往往高于HC患者。虽然粪便 Hb 单独检测结直肠癌的灵敏度和特异性最高，但检测晚期肿瘤和结直肠癌的灵敏度相对较低。结论粪便 Cp 和 Lf 几乎可以作为同等的生物标记物来评估 UC 患者的临床活动。粪便 Hb 是筛查结直肠癌最有用的标志物；但是，如果增加粪便 Cp 和 Lf，则可弥补仅靠 Hb 检测晚期结直肠肿瘤灵敏度低的不足。

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引用次数: 0

Arterial structure and function in children with inflammatory bowel disease 炎症性肠病患儿的动脉结构和功能。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-03 DOI: 10.1002/jgh3.13100

Asha Jois, Diana Zannino, Anthony G Catto-Smith, Meg Kaegi, Jonathan P Mynard, Jeremy Rosenbaum, Mark Oliver, Winita Hardikar, George Alex, David Burgner

Background and Aim

People with inflammatory bowel disease (IBD) have an increased risk of cardiovascular disease, including in younger adulthood. This may arise in part from chronic, systemic low-grade inflammation. The process of atherosclerosis may begin in childhood. We sought to determine whether pediatric IBD is associated with adverse changes in arterial structure and function as a marker of early increased cardiovascular risk.

Methods

We performed a case–control study comparing children with IBD for a median disease duration of 2.49 (interquartile range 1.23, 4.38) years with healthy children. In a single visit, we collected baseline clinical and anthropometric data, and measured blood pressure, pulse wave velocity, carotid artery distensibility, and aortic and carotid intima-media thickness. High-sensitivity C-reactive protein and fasting lipids were measured.

Results

We enrolled 81 children with IBD (40 with Crohn's disease, 40 with ulcerative colitis, and 1 with unspecified IBD) and 82 control participants. After adjusting for age, sex, body mass index z-score, blood pressure, and low-density lipoprotein cholesterol, there was no difference in measures of arterial structure and function in children with IBD compared with controls, nor between those with Crohn's disease or ulcerative colitis.

Conclusion

We did not show any differences in arterial structure and function in children with a history of IBD for less than 5 years compared with healthy controls. IBD diagnosed in childhood may provide a window of opportunity to actively reduce standard cardiovascular risk factors and improve future cardiovascular outcomes.

背景和目的：炎症性肠病（IBD）患者罹患心血管疾病的风险增加，包括在年轻的成年期。这可能部分源于慢性、全身性低度炎症。动脉粥样硬化的过程可能始于儿童时期。我们试图确定小儿 IBD 是否与动脉结构和功能的不良变化有关，以此作为早期心血管风险增加的标志：我们进行了一项病例对照研究，将中位病程为 2.49 年（四分位距为 1.23-4.38 年）的 IBD 患儿与健康儿童进行了比较。在一次就诊中，我们收集了基线临床和人体测量数据，并测量了血压、脉搏波速度、颈动脉扩张性、主动脉和颈动脉内膜厚度。还测量了高敏C反应蛋白和空腹血脂：我们招募了81名IBD患儿（40名克罗恩病患儿、40名溃疡性结肠炎患儿和1名不明IBD患儿）和82名对照组参与者。在对年龄、性别、体重指数 Z 值、血压和低密度脂蛋白胆固醇进行调整后，IBD 患儿的动脉结构和功能指标与对照组相比没有差异，克罗恩病和溃疡性结肠炎患儿之间也没有差异：结论：与健康对照组相比，我们没有发现患 IBD 病史不足 5 年的儿童在动脉结构和功能方面存在任何差异。在儿童时期确诊的 IBD 可能为积极减少标准心血管风险因素和改善未来心血管预后提供了机会之窗。

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引用次数: 0

From pill to pain: Alendronate-induced esophageal injury—A case report and review 从药片到疼痛：阿仑膦酸钠诱发的食管损伤--病例报告和综述

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-06-02 DOI: 10.1002/jgh3.13080

Zhen Fan, Hayat Khizar, Jinjiao Lu, Anhua Wang, Tong Xun, Xiao Zhang, Hongfeng Zhao

Background

Alendronate is used to treat Paget's bone disease, glucocorticoid-induced osteoporosis, and postmenopausal osteoporosis because it suppresses osteoclast activity to stop bone resorption.

Case report

We present an exceptional case of esophagitis caused by alendronate. Blood tests and other data were normal when the patient was taken to the hospital, but an endoscopic examination revealed significant esophageal redness, erosion, and ulceration, along with pseudomembrane. The patient was given medicine after receiving a diagnosis of alendronate pill-induced esophagitis based on the pathological findings.

Conclusion

This case report is a timely reminder of the importance of thorough pharmacovigilance, patient education, and smart therapeutic decision-making in the context of alendronate use. To properly treat and prevent problems with the esophagus caused by alendronate, additional research is required.

背景阿仑膦酸钠用于治疗 Paget 骨病、糖皮质激素诱导的骨质疏松症和绝经后骨质疏松症，因为它能抑制破骨细胞的活性以阻止骨吸收。病例报告我们报告了一例阿仑膦酸钠引起食管炎的特殊病例。患者被送往医院时，血液化验和其他数据均正常，但内镜检查发现食管明显发红、糜烂和溃疡，并伴有假膜。根据病理检查结果，患者被诊断为阿仑膦酸钠药片诱发的食管炎，随后接受了药物治疗。结论本病例报告及时提醒了在使用阿仑膦酸钠时进行彻底的药物警戒、患者教育和明智的治疗决策的重要性。要正确治疗和预防阿仑膦酸钠引起的食道问题，还需要更多的研究。

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引用次数: 0