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Tofacitinib, celiac disease and the elderly: mind the gut! 托法替尼、乳糜泻和老年人:注意肠道!
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-07-01 DOI: 10.51821/86.3.12207
N Boutrid, H Rahmoune
To the Editor, We read with great attention the interesting case report by Lenfant et al. narrating the successful use of tofacitinib in a patient with microscopic colitis and celiac disease (1), and we would point some insights about this peculiar situation. In fact, tofacitinib depicts potential side effects, including a higher risk of malignancies, and the FDA has even issued a warning about this drug’s hazard (2). Actually, a randomized open-label trial published in the New England Journal of Medicine in 2021 found that patients with rheumatoid arthritis who took tofacitinib had a higher risk of developing cancer than those who took a tumor necrosis factor (TNF) inhibitor (3). Recently, two recent randmoized controlled trials from the ORAL Surveillance Trial and published in the Annals of the Rheumatic Diseases in 2023 also contributed to shed the light on this potential risk : that patients with rheumatoid arthritis aged > 50 with cardiovascular risk who took tofacitinib had a higher risk of developing any type of cancer than those who took a TNF inhibitor (4), and secondary stratification found that they were more likely to develop cancer if they were over the age of 65 years (5). Adding insult to injury, the maligancies are also driven by the two peculiar forms of celiac disease : seronegative and refractory celiac disease (RCD), and this risk is also increased in CD diagnosed at adulthood : particularly, elder patients are prone to present a RCD, and giving immune checkpoint therapy might increase this risk (6). In conclusion, RCD ought to be definetly ruled out before starting JAK inhibitor therapy, especially in aged population with seronegative celiac disease and microscopic colitis, two well-known conditions associated with RCD.
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引用次数: 0
Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review. 减肥手术后的倾倒综合征:患病率、病理生理学和在减肥中的作用——一项系统综述。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-07-01 DOI: 10.51821/86.3.11476
A D'hoedt, T Vanuytsel

Background: Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. However, there is much uncertainty regarding the exact pathophysiology of dumping. It has been speculated that the syndrome is a desired consequence of bariatric surgery and contributes to more efficient weight loss, but supporting data are scarce.

Methods: A systematic search was conducted in PubMed in July-August 2021. The prevalence of dumping after the most frequently performed bariatric procedures was analyzed, as well as underlying pathophysiology and its role in weight reduction.

Results: Roux-en-Y gastric bypass (RYGB) is associated with the highest postoperative prevalence of dumping. The fast transit induces neurohumoral changes which contribute to an imbalance between postprandial glucose and insulin levels, resulting in hypoglycemia which is the hallmark of late dumping. Early dumping can, when received in a positive way, become a tool to maintain a strict dietary pattern, but no significant relationship to the degree of weight loss has been shown. However, late dumping is detrimental and promotes overall higher caloric intake.

Conclusion: Dumping syndrome is common after bariatric surgery, especially after RYGB. The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.

背景:倾倒综合征是减肥手术后常见且众所周知的不良事件,涵盖了早期和晚期倾倒的动态范围。胃排空加速通常被认为是胃肠道和血管舒缩性疾病的原因。然而,倾倒的确切病理生理学还有很多不确定性。据推测,该综合征是减肥手术的理想结果,有助于更有效地减肥,但支持数据很少。方法:于2021年7-8月在PubMed进行系统检索。分析了最常见的减肥手术后倾倒的发生率,以及潜在的病理生理学及其在减肥中的作用。结果:Roux-en-Y胃分流术(RYGB)与术后倾倒发生率最高有关。快速转运诱导神经体液变化,导致餐后血糖和胰岛素水平失衡,导致低血糖,这是晚倾倒的标志。如果以积极的方式接受,早期倾倒可以成为保持严格饮食模式的工具,但与减肥程度没有显著关系。然而,延迟倾倒是有害的,并促进整体更高的热量摄入。结论:Dumping综合征常见于减肥手术后,尤其是RYGB手术后。病理生理学是复杂和模糊的。目前可用的数据不支持倾倒作为减肥手术后诱导体重减轻的必要条件。
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引用次数: 0
A remarkable presentation of a massive Budd-Chiari syndrome. 一个巨大的布-加综合征的显著表现。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-07-01 DOI: 10.51821/86.3.11994
K Ferdinande, H Degroote, A Geerts, H Van Vlierberghe, X Verhelst, S Raevens
A 59-year-old female presented to the emergency department with malaise, significant weight loss, abdominal discomfort, dyspnoea and severely swollen peripheral extremities. She had a past medical history of sickle cell anaemia, a latent tuberculosis infection and a chronic hepatitis B that was treated with PEG-interferon alpha-2 in 2008. Since 2018, she was lost to follow-up. The patient was critically ill, sarcopenic and lethargic. Clinical examination revealed icteric sclerae and a markedly distended and diffusely tender abdomen and peripheral oedemas. Her vital signs included a blood pressure of 105/64 mmHg, tachycardia of 130 bpm, hypothermia of 35.6°C and a SpO2 of 100% in ambient air. Laboratory workup demonstrated a total bilirubin of 12.9 mg/dL, AST 500 U/L, ALT 218 U/L, ALP 178 U/L and GGT 126 U/L, a thrombocytopenia of 34 x10E3/ μL, 16,01 x10E3/μL leukocytes, a CRP of 94.8 mg/L and a lactate of 10,12 mmol/L. The serum creatinine was 1.04 mg/dL, eGFR 54.1 ml/min. The INR was 2.77 and there was a severe hypoalbuminemia (22 g/L). D-dimers were >20 000 ng/ml. The patient presented also with spontaneous hypoglycaemia. A multiphasic contrast-enhanced thoracic and abdominal computed tomography (CT) was performed (figure 1). Given the results of the CT, a 2D echocardiogram was urgently requested (figure 2).
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引用次数: 0
Tofacitinib for celiac disease and microscopic colitis: killing two birds with one stone. 托法替尼治疗乳糜泻和显微镜下结肠炎:一举两得。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-04-01 DOI: 10.51821/86.2.11639
M Lenfant, G De Hertogh, B Verstockt

Microscopic colitis is a chronic inflammatory condition of the colon. Firstline treatment consists of budesonide, with the consideration of biological agents in refractory cases. Celiac disease is a chronic immune mediated and gluten-induced enteropathy, with treatment consisting of a gluten-free diet. There is an association between microscopic colitis and instead of xand celiac disease, especially in refractory cases they can coincide. In this manuscript, we report for the first time the efficacy of tofacitinib, a pan Janus kinase inhibitor, in the treatment of concomitant microscopic colitis and celiac disease, resulting in persistent clinical and histological remission.

显微镜下结肠炎是结肠的一种慢性炎症性疾病。一线治疗包括布地奈德,在难治性病例中考虑使用生物制剂。乳糜泻是一种慢性免疫介导和麸质诱导的肠病,其治疗方法包括无麸质饮食。显微镜下结肠炎和乳糜泻之间存在关联,尤其是在难治性病例中,它们可以同时发生。在这篇手稿中,我们首次报道了泛Janus激酶抑制剂托法替尼治疗并发显微镜下结肠炎和乳糜泻的疗效,从而导致持续的临床和组织学缓解。
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引用次数: 2
Motorized spiral enteroscopy: effectiveness when used for new indications. 电动螺旋肠镜检查:用于新适应症的有效性。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-04-01 DOI: 10.51821/86.2.11779
H Colin, A Donati, L Monino, T G Moreels

Background and study aims: Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications. The aim of this study was to identify new indications for the motorized spiral enteroscope.

Methods: Monocentric retrospective analysis of 115 patients who underwent enteroscopy using PSF-1 motorized spiral enteroscope between January 2020 and December 2022.

Results: A total of 115 patients underwent PSF-1 enteroscopy. 44 (38%) were antegrade procedures and 24 (21%) were retrograde procedures in patients with normal gastrointestinal anatomy with conventional enteroscopy indications. The remaining 47 (41%) patients underwent PSF-1 procedures for secondary less conventional indications: n=25 (22%) enteroscopy-assisted ERCP, n=8 (7%) endoscopy of the excluded stomach after Roux-en-Y gastric bypass, n=7 (6%) retrograde enteroscopy after previous incomplete conventional colonoscopy and n=7 (6%) antegrade panenteroscopy of the entire small bowel. In this group of secondary indications, technical success rate was significantly lower (72.5%) as compared to technical success rates in the conventional groups (98-100%, p<0.001 Chi-square). Minor adverse events occurred in 17/115 patients (15%), all treated conservatively (AGREE I and II).

Conclusion: This study demonstrates the capabilities of PSF-1 motorized spiral enteroscope for secondary indications. PSF-1 is useful to complete colonoscopy in case of long redundant colon, to reach the excluded stomach after Roux-en-Y gastric bypass, to perform unidirectional pan-enteroscopy and to perform ERCP in patients with surgically altered anatomy. However, technical success rates are lower as compared to conventional antegrade and retrograde enteroscopy procedures, with only minor adverse events.

背景与研究目的:电动螺旋肠镜在顺行和逆行肠镜检查中是有效的。然而,人们对其在不常见适应症中的应用知之甚少。本研究的目的是确定电动螺旋肠镜的新适应症。方法:对2020年1月至2022年12月期间使用PSF-1电动螺旋肠镜进行肠镜检查的115例患者进行单中心回顾性分析。结果:115例患者行PSF-1肠镜检查。44例(38%)为顺行手术,24例(21%)为逆行手术,患者胃肠道解剖正常,常规肠镜检查指征。其余47例(41%)患者接受PSF-1手术治疗继发的非常规适应症:25例(22%)采用肠镜辅助ERCP, 8例(7%)采用Roux-en-Y胃旁路术后排除胃内窥镜检查,7例(6%)采用不完全常规结肠镜检查后逆行肠镜检查,7例(6%)采用整个小肠顺行全肠镜检查。在这组次要适应症中,技术成功率(72.5%)明显低于常规组的技术成功率(98-100%)。结论:本研究证明了PSF-1电动螺旋肠镜在次要适应症中的能力。PSF-1在长结肠冗余情况下完成结肠镜检查,Roux-en-Y胃旁路手术后到达被排除的胃,单向泛肠镜检查和手术改变解剖结构的患者进行ERCP时都是有用的。然而,与传统的顺行和逆行肠镜检查相比,技术成功率较低,只有轻微的不良事件。
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引用次数: 0
A retrospective analysis of the histology of resected polyps and colonoscopy quality parameters in Belgium. 回顾性分析比利时切除息肉的组织学和结肠镜检查质量参数。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-04-01 DOI: 10.51821/86.2.10880
E Macken, S Van Dongen, G Van Hal

Background and aims: adenoma detection rate is a well known quality parameter for colonoscopy. However recently other quality parameters have emerged. We wanted to evaluate the histology of the resected polyps, different quality indicators of colonoscopy and post colonoscopy colorectal cancer (PCCRC) in Belgium and analyzed data about colonoscopies performed between 2008-2015.

Methods: Reimbursement data on colorectal related medical procedures from the Intermutualistic Agency were linked with data on clinical and pathological staging of colorectal cancer and with histologic data of resected polyps available at the Belgian Cancer Registry over a period covering 8 years (2008-2015).

Results: 298,246 polyps were resected in 294,923 colonoscopies, of which 275,182 were adenomas (92 %) and 13,616 were SSLs (4%). There was a significant but small correlation between the different quality parameters and PCCRC. Post colonoscopy colorectal cancer rate after 3 years was 7.29 %. There were marked geographic differences in Belgium concerning adenoma detection rate, sessile adenoma detection rate and post colonoscopy colorectal cancer.

Conclusion: Most resected polyps were adenomas, only a small percentage involved sessile serrated lesions. There was a significant correlation between adenoma detection rate and other quality parameters, and a small but significant correlation between PCCRC and the different quality parameters. The lowest post colonoscopy colorectal cancer rate was reached with an ADR of 31.4 % and a SSL-DR of 1.2 %.

背景与目的:腺瘤检出率是结肠镜检查的一个重要质量指标。然而,最近出现了其他质量参数。我们想要评估比利时切除息肉的组织学,结肠镜检查和结肠镜检查后结直肠癌(PCCRC)的不同质量指标,并分析2008-2015年结肠镜检查的数据。方法:将Intermutualistic Agency提供的结直肠癌相关医疗程序的报销数据与比利时癌症登记处提供的结直肠癌临床和病理分期数据以及切除息肉的组织学数据相关联,时间跨度为8年(2008-2015年)。结果:294,923例结肠镜检查共切除息肉298,246例,其中腺瘤275,182例(92%),ssl16例(4%)。不同质量参数与PCCRC之间存在显著但较小的相关性。结肠镜检查后3年结直肠癌发生率为7.29%。比利时在腺瘤检出率、无底腺瘤检出率和结肠镜后结直肠癌方面存在显著的地理差异。结论:大部分切除的息肉为腺瘤,只有一小部分为无根的锯齿状病变。腺瘤检出率与其他质量参数相关性显著,PCCRC与不同质量参数相关性虽小但显著。结肠镜检查后结直肠癌发生率最低,ADR为31.4%,SSL-DR为1.2%。
{"title":"A retrospective analysis of the histology of resected polyps and colonoscopy quality parameters in Belgium.","authors":"E Macken,&nbsp;S Van Dongen,&nbsp;G Van Hal","doi":"10.51821/86.2.10880","DOIUrl":"https://doi.org/10.51821/86.2.10880","url":null,"abstract":"<p><strong>Background and aims: </strong>adenoma detection rate is a well known quality parameter for colonoscopy. However recently other quality parameters have emerged. We wanted to evaluate the histology of the resected polyps, different quality indicators of colonoscopy and post colonoscopy colorectal cancer (PCCRC) in Belgium and analyzed data about colonoscopies performed between 2008-2015.</p><p><strong>Methods: </strong>Reimbursement data on colorectal related medical procedures from the Intermutualistic Agency were linked with data on clinical and pathological staging of colorectal cancer and with histologic data of resected polyps available at the Belgian Cancer Registry over a period covering 8 years (2008-2015).</p><p><strong>Results: </strong>298,246 polyps were resected in 294,923 colonoscopies, of which 275,182 were adenomas (92 %) and 13,616 were SSLs (4%). There was a significant but small correlation between the different quality parameters and PCCRC. Post colonoscopy colorectal cancer rate after 3 years was 7.29 %. There were marked geographic differences in Belgium concerning adenoma detection rate, sessile adenoma detection rate and post colonoscopy colorectal cancer.</p><p><strong>Conclusion: </strong>Most resected polyps were adenomas, only a small percentage involved sessile serrated lesions. There was a significant correlation between adenoma detection rate and other quality parameters, and a small but significant correlation between PCCRC and the different quality parameters. The lowest post colonoscopy colorectal cancer rate was reached with an ADR of 31.4 % and a SSL-DR of 1.2 %.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"86 2","pages":"277-285"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10188528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Diverticulitis associated pancreatitis: a report of 2 cases and review of the literature. 憩室炎相关性胰腺炎:附2例报告并文献复习。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-04-01 DOI: 10.51821/86.2.11616
H Colin, D Ndjekembo Shango, B Pilet, F Waignein, P Yengue

Duodenal diverticula are the second most common type of digestive diverticula after those in the colon. They are present in approximately 27% of patients who undergo upper digestive endoscopy. Most of these diverticula, especially those located near the papilla, are asymptomatic. However, in rare cases, they can be associated with obstructive jaundice (Lemmel Syndrome), bacterial infection, pancreatitis, or bleeding. In this report, we present two cases of acute obstructive pancreatitis caused by duodenal diverticulitis. Both patients were managed conservatively, resulting in a positive outcome.

十二指肠憩室是仅次于结肠的第二种最常见的消化憩室。在接受上消化道内窥镜检查的患者中,大约有27%的患者存在这种情况。大多数憩室,尤其是那些位于乳头附近的憩室,是无症状的。然而,在极少数情况下,它们可能与梗阻性黄疸(Lemmel综合征)、细菌感染、胰腺炎或出血有关。本文报告两例由十二指肠憩室炎引起的急性梗阻性胰腺炎。两例患者均采用保守治疗,结果均为阳性。
{"title":"Diverticulitis associated pancreatitis: a report of 2 cases and review of the literature.","authors":"H Colin,&nbsp;D Ndjekembo Shango,&nbsp;B Pilet,&nbsp;F Waignein,&nbsp;P Yengue","doi":"10.51821/86.2.11616","DOIUrl":"https://doi.org/10.51821/86.2.11616","url":null,"abstract":"<p><p>Duodenal diverticula are the second most common type of digestive diverticula after those in the colon. They are present in approximately 27% of patients who undergo upper digestive endoscopy. Most of these diverticula, especially those located near the papilla, are asymptomatic. However, in rare cases, they can be associated with obstructive jaundice (Lemmel Syndrome), bacterial infection, pancreatitis, or bleeding. In this report, we present two cases of acute obstructive pancreatitis caused by duodenal diverticulitis. Both patients were managed conservatively, resulting in a positive outcome.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"86 2","pages":"352-355"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9813076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Irritable bowel syndrome-like symptoms before and after bariatric surgery and association with short-chain fermentable carbohydrates consumption: an observational prospective study. 减肥手术前后肠易激综合征样症状与短链可发酵碳水化合物消耗的关系:一项观察性前瞻性研究
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-04-01 DOI: 10.51821/86.2.11530
P Van Ouytsel, H Piessevaux, A Szalai, P Loi, H Louis
Background and aims Irritable Bowel Syndrome (IBS)-like symptoms are frequent following bariatric surgery. This study aims to evaluate the frequency of IBS symptoms severity before and after bariatric surgery and their association with short-chain fermentable carbohydrates (FODMAPs) consumption. Patients and methods IBS symptoms severity in a cohort of obese patients was evaluated prospectively before, 6 and 12 months after bariatric surgery by validated questionnaires and tools (Irritable Bowel Syndrome Severity Scoring System (IBS SSS), Bristol Stool Scale (BSS), Quality of Life Short- Form-12 (SF-12), Hospital Anxiety and Depression scale (HAD)). FODMAPs consumption and its association with IBS symptom severity was evaluated by using a food frequency questionnaire focused on high-FODMAPs food consumption. Results Fifty-one patients were included (41 female; mean age 41 years (SD: 12)), 84% received a sleeve gastrectomy, and 16% a Roux-en-Y gastric bypass. Symptoms compatible with IBS were observed in 43% of patients before surgery, in 58% of patients at 6 months and 33% at 12 months (NS, p-value=0,197 and 0,414). In a multivariate model, a significant association was found between the IBS SSS score and lactose consumption at 6 months (β = + 58, 1; p = 0.03), and with polyols consumption at 12 months (β = + 112,6; p = 0.01). Conclusions Mild to moderate IBS symptoms are frequent in obese patients before bariatric surgery. A significant association between lactose and polyols consumption and IBS SSS score was observed after bariatric surgery, suggesting a potential link between the severity of IBS symptoms and some specific FODMAPs consumption.
背景和目的:肠易激综合征(IBS)样症状在减肥手术后很常见。本研究旨在评估减肥手术前后IBS症状严重程度的频率及其与短链可发酵碳水化合物(FODMAPs)摄入的关系。患者和方法:通过经验证的问卷和工具(肠易激综合征严重程度评分系统(IBS SSS)、布里斯托尔大便量表(BSS)、短期生活质量12(SF-12)、医院焦虑和抑郁量表(HAD)),在减肥手术前、手术后6个月和12个月前瞻性评估肥胖患者队列中的IBS症状严重程度。FODMAPs的摄入及其与IBS症状严重程度的关系通过使用关注高FODMAPs食物摄入的食物频率问卷进行评估。结果:51名患者(41名女性;平均年龄41岁(SD:12)),84%接受袖状胃切除术,16%接受Roux-en-Y胃旁路术。43%的患者在手术前、58%的患者在6个月时和33%的患者在12个月时观察到与IBS兼容的症状(NS,p值分别为0197和0414)。在一个多变量模型中,发现IBS SSS评分与6个月时的乳糖消耗量(β=+58,1;p=0.03)和12个月时多元醇消耗量(α=+112,6;p=0.01)之间存在显著相关性。结论:肥胖患者在减肥手术前经常出现轻度至中度IBS症状。减肥手术后观察到乳糖和多元醇的摄入与IBS SSS评分之间存在显著关联,这表明IBS症状的严重程度与某些特定FODMAP的摄入之间存在潜在联系。
{"title":"Irritable bowel syndrome-like symptoms before and after bariatric surgery and association with short-chain fermentable carbohydrates consumption: an observational prospective study.","authors":"P Van Ouytsel,&nbsp;H Piessevaux,&nbsp;A Szalai,&nbsp;P Loi,&nbsp;H Louis","doi":"10.51821/86.2.11530","DOIUrl":"10.51821/86.2.11530","url":null,"abstract":"Background and aims Irritable Bowel Syndrome (IBS)-like symptoms are frequent following bariatric surgery. This study aims to evaluate the frequency of IBS symptoms severity before and after bariatric surgery and their association with short-chain fermentable carbohydrates (FODMAPs) consumption. Patients and methods IBS symptoms severity in a cohort of obese patients was evaluated prospectively before, 6 and 12 months after bariatric surgery by validated questionnaires and tools (Irritable Bowel Syndrome Severity Scoring System (IBS SSS), Bristol Stool Scale (BSS), Quality of Life Short- Form-12 (SF-12), Hospital Anxiety and Depression scale (HAD)). FODMAPs consumption and its association with IBS symptom severity was evaluated by using a food frequency questionnaire focused on high-FODMAPs food consumption. Results Fifty-one patients were included (41 female; mean age 41 years (SD: 12)), 84% received a sleeve gastrectomy, and 16% a Roux-en-Y gastric bypass. Symptoms compatible with IBS were observed in 43% of patients before surgery, in 58% of patients at 6 months and 33% at 12 months (NS, p-value=0,197 and 0,414). In a multivariate model, a significant association was found between the IBS SSS score and lactose consumption at 6 months (β = + 58, 1; p = 0.03), and with polyols consumption at 12 months (β = + 112,6; p = 0.01). Conclusions Mild to moderate IBS symptoms are frequent in obese patients before bariatric surgery. A significant association between lactose and polyols consumption and IBS SSS score was observed after bariatric surgery, suggesting a potential link between the severity of IBS symptoms and some specific FODMAPs consumption.","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"86 2","pages":"288-297"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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: 1
Nutritional status in hepatic encephalopathy and transjugular intrahepatic portosystemic shunt - TIPS, and strategies to improve the outcomes. 肝性脑病和经颈静脉肝内门静脉分流术的营养状况及改善预后的策略。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-04-01 DOI: 10.51821/86.2.11430
M Berenguer

Hepatic encephalopathy (HE) is one of the most severe complications following transjugular intrahepatic portosystemic shunt (TIPS). The identification and treatment of risk factors associated with the development of this complication may reduce the incidence and severity of post-TIPS HE. Several studies have demonstrated that the nutritional status plays a major role in the outcome of the cirrhotic population, particularly those who are decompensated. Although scarce, there are also studies highlighting an association between poor nutritional status, sarcopenia, fragile status, and post-TIPS HE. If these data are confirmed, nutritional support could become a means for decreasing this complication, thereby enhancing the use of TIPs in the treatment of refractory ascites or variceal bleeding. In this review, we will discuss the pathogenesis of HE, the data that supports an association with sarcopenia, nutritional status and frailty and the implications that these conditions have on the use of TIPS in clinical practice.

肝性脑病(HE)是经颈静脉肝内门静脉分流术(TIPS)后最严重的并发症之一。识别和治疗与该并发症相关的危险因素可以降低tips后HE的发生率和严重程度。几项研究表明,营养状况在肝硬化人群的预后中起着重要作用,特别是那些失代偿的人。虽然很少,但也有研究强调营养状况不良、肌肉减少症、脆弱状态和术后HE之间的联系。如果这些数据得到证实,营养支持可能成为减少这一并发症的一种手段,从而加强TIPs在治疗难治性腹水或静脉曲张出血中的应用。在这篇综述中,我们将讨论HE的发病机制、支持HE与肌肉减少症、营养状况和虚弱相关的数据,以及这些情况对TIPS在临床应用的影响。
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引用次数: 0
Unexpected outcome of a sigmoid lesion believed to be malignant. 乙状结肠病变被认为是恶性的意外结果。
IF 1.5 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-04-01 DOI: 10.51821/86.2.11927
K Ferdinande, L Harlet, J Decaestecker, D De Wulf
A 69-year-old male with a past medical history of an Olfactory nerve meningioma and left-sided Bell's palsy presented with 6 weeks of lower abdominal pain and weight loss of 4 kg in 6 months. His current medications included acetylsalicylic acid 80 mg once daily, Amlodipine 5 mg once daily and Allopurinol 300 mg once daily. Physical examination was benign without signs of acute abdomen. The abdomen was nondistended and soft but tender to palpation over the left lower quadrant. Laboratory studies showed no acute outliers. The patient was followed up by his pulmonologist because of thoracic lesions which required a PET-CT for further evaluation. This PET-CT revealed a focal zone of oedematous rectosigmoid colon with a strong suspicion of a semi-circular sigmoid neoplasia with continuation to the bladder (Figure 1a). A presumptive diagnosis of a primary colonic malignancy was made. Colonoscopy was performed and visualised a foreign linear object lodged in both walls of the diverticular sigmoid with surrounding inflammation, but otherwise normal mucosa (Figure 1b). No arguments could be made endoscopically to support the diagnosis of an underlying primary colonic malignancy.
69岁男性,既往有嗅觉神经脑膜瘤病史,左侧贝尔氏麻痹,6周下腹疼痛,6个月内体重减轻4kg。他目前的药物包括乙酰水杨酸80毫克每日一次,氨氯地平5毫克每日一次,别嘌呤醇300毫克每日一次。体格检查为良性,无急腹症征象。腹部左下腹未扩张,柔软但触诊触痛。实验室研究显示没有急性异常。由于胸部病变需要PET-CT进一步评估,患者由其肺科医生随访。PET-CT显示局灶性乙状结肠直肠水肿区,强烈怀疑乙状结肠半圆形瘤样病变并延伸至膀胱(图1a)。假定诊断为原发性结肠恶性肿瘤。结肠镜检查显示,乙状结肠憩室两侧壁上有一个外来线状物体,周围有炎症,但其他地方粘膜正常(图1b)。内窥镜下没有证据支持潜在的原发性结肠恶性肿瘤的诊断。
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引用次数: 0
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Acta gastro-enterologica Belgica
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