Minerva gastroenterologica e dietologica最新文献

英文中文

Endoscopic retrograde cholangiopancreatography related perforations: there is a plenty to discover? 内窥镜逆行胰胆管造影相关穿孔:有很多有待发现?

Minerva gastroenterologica e dietologica

Pub Date : 2020-07-03 DOI: 10.23736/S1121-421X.20.02736-1

T. Khoury, A. Mari, W. Sbeit

引用次数: 0

Irritable Bowel Syndrome and lactose intolerance: the importance of differential diagnosis. A monocentric study. 肠易激综合征和乳糖不耐症:鉴别诊断的重要性。单中心研究。

Minerva gastroenterologica e dietologica

Pub Date : 2020-07-03 DOI: 10.23736/S1121-421X.20.02734-8

R. Catanzaro, Morena Sciuto, Birbal Singh, S. Pathak, F. Marotta

BACKGROUNDNowadays Irritable Bowel Syndrome (IBS) and Lactose Intolerance (LI) are two very frequent diseases. IBS is a functional disorder, while LI is caused by the inability to digest lactose. LI is often incorrectly diagnosed as IBS. The aim of our study is to identify LI patients among IBS patients, so as to set up a correct therapy.METHODSWe enrolled 259 patients with IBS and we compared them to a control group of 108 patients. All patients underwent H2 Breath-Test (HBT) and two questionnaires regarding the symptoms associated with IBS and LI were administered to the intolerant subjects and one questionnaire to IBS patients with no LI.RESULTSAt the HBT, 79.9% (n = 207) of patients with IBS were positive, while in the control group were positive 25.0% (n = 27) of subjects (p < 0.001). The questionnaires showed, after a month of therapy, a marked improvement in LI symptoms subjects. In addition, there was also a prevalence of more severe symptoms among subjects with IBS and LI than those with IBS and no LI.CONCLUSIONSWe can affirm that most patients with initial diagnosis of IBS are, instead, lactose intolerant. This diagnosis allows us to undertake an adequate therapy so as to improve symptoms and quality of life. Therefore it is important to include LI in the pathologies with which IBS enters into differential diagnosis.

背景肠易激综合征(IBS)和乳糖不耐症(LI)是目前常见的两种疾病。IBS是一种功能性疾病，而LI是由无法消化乳糖引起的。LI常被误诊为肠易激综合征。我们研究的目的是在IBS患者中识别LI患者，从而制定正确的治疗方案。方法我们招募了259例IBS患者，并将其与对照组的108例患者进行比较。所有患者均进行H2呼吸测试(HBT)，对不耐受的患者进行两份有关IBS和LI相关症状的问卷调查，对没有LI的IBS患者进行一份问卷调查。结果HBT阳性的IBS患者为79.9% (n = 207)，对照组为25.0% (n = 27) (p < 0.001)。问卷显示，经过一个月的治疗，LI症状明显改善。此外，IBS和LI患者的症状也比IBS和LI患者更严重。结论初步诊断为肠易激综合征的患者多为乳糖不耐症。这种诊断使我们能够采取适当的治疗，以改善症状和生活质量。因此，在肠易激综合征进入鉴别诊断的病理中包括LI是很重要的。

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引用次数: 8

Rheumatic manifestations in inflammatory bowel disease. 炎症性肠病的风湿病表现。

Minerva gastroenterologica e dietologica

Pub Date : 2020-07-03 DOI: 10.23736/S1121-421X.20.02726-9

A. Finucci, M. C. Ditto, S. Parisi, R. Borrelli, M. Priora, C. Realmuto, E. Fusaro

Rheumatic manifestations are the most frequent extra-intestinal manifestations (EIMs) in Inflammatory Bowel Disease (IBD) patients, and they are responsible for a relevant reduction of quality of life. IBD is associated with a variety of musculoskeletal manifestations such as arthritis and non-inflammatory pain as well as with metabolic diseases, such as osteoporosis. Different imaging techniques (primarily ultrasound, magnetic resonance imaging and X-rays) can help the clinician to correctly identify the nature of manifestations and to treat the patient accordingly. Nowadays, in the setting of IBD-related arthritides, different drugs are available and can be effective on both articular and intestinal involvement. Therefore, a multi-disciplinary approach provides an early diagnosis and a better clinical outcome that can only be given from the recognition and consideration of the different EIMs. As for rheumatic manifestations, namely IBDrelated arthritis, an early intervention allows to control disease activity and to prevent structural damage.

风湿病表现是炎症性肠病(IBD)患者中最常见的肠外表现(EIMs)，它们是导致相关生活质量下降的原因。IBD与多种肌肉骨骼表现相关，如关节炎和非炎症性疼痛，以及代谢疾病，如骨质疏松症。不同的成像技术(主要是超声、磁共振成像和x射线)可以帮助临床医生正确识别症状的性质，并相应地治疗患者。如今，在ibd相关关节炎的情况下，有不同的药物可用，并且对关节和肠道受累都有效。因此，多学科的方法提供了早期诊断和更好的临床结果，这只能从不同的EIMs的认识和考虑中得到。对于风湿病表现，即ibd相关关节炎，早期干预可以控制疾病活动并防止结构损伤。

引用次数: 2

Fibromax and inflamatory markers cannot replace liver biopsy in the evaluation of non-alcoholic fatty liver disease. 在评估非酒精性脂肪肝疾病时，纤维蛋白和炎症标志物不能取代肝活检。

Minerva gastroenterologica e dietologica

Pub Date : 2020-07-01 DOI: 10.23736/S1121-421X.20.02746-4

Leonardo L Lardi, R. M. Lul, G. Z. Port, G. Coral, A. Peres, G. Dorneles, Fernanda Branco, S. Fernandes, C. Leães, A. Mattos, C. Buss, C. Tovo

BACKGROUNDTo evaluate the performance of a non-invasive test (Fibromax™) and inflamatory markers (IL-1 beta, IL-6, IL-8, TNF-alpha, MCP-1) in the diagnosis and staging of patients with non-alcoholic fatty liver disease.METHODSPatients older than 18 years with steatosis were prospectively evaluated at a tertiary hospital in southern Brazil. Liver biopsy, Fibromax™ test and inflamatory markers (IL 1 beta, IL-6, IL-8, TNF-alpha, MCP-1) were performed. Measures of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were used, considering liver biopsy as the gold standard.RESULTSSeventy three Fibromax™ tests were analyzed. Steatotest presented a sensitivity of 95.5% and PPV of 97.0% for the diagnosis of steatosis. Nashtest obtained a sensitivity of 83.3%, specificity of 37.5%, PPV of 90.9% and NPV of 23.1% for the diagnosis of non-alcoholic steatohepatitis (NASH). Fibrotest presented a sensitivity of 38.9%, specificity of 92.7%, PPV of 63.6% and NPV of 82.3% to evaluate advanced fibrosis. In the evaluation of patients with grade 2 and 3 steatosis, ROC analyses showed an area under the curve (AUROC) for Steatotest of 0.68 (p=0.015). Nashtest AUROC was 0.59 (p=0.417) for the evaluation of NASH. Fibrotest AUROC was 0.79 (p<0.001) for advanced fibrosis. Kappa coefficient values for Steatotest, Nashtest and Fibrotest were not statistically significant. Thirty seven patients performed also analysis of the inflamatory markers, showing that patients with inflammatory activity grade 2-3 on liver biopsy had significantly higher levels of IL6 (p=0.016) and lower TNF-alpha (p=0,034), but there was no other difference when analysed fibrosis or steatosis.CONCLUSIONSThe Fibromax™ test and the inflamatory markers (IL 1 beta, IL-6, IL-8, TNF-alpha, MCP-1) did not present a satisfactory performance to be considered a good alternative to replace liver biopsy in the evaluation of NAFLD.

目的:评价无创试验(Fibromax™)和炎症标志物(IL-1 β、IL-6、IL-8、tnf - α、MCP-1)在非酒精性脂肪肝患者诊断和分期中的作用。方法对巴西南部一家三级医院的18岁以上脂肪变性患者进行前瞻性评估。进行肝活检、Fibromax™检测和炎症标志物(IL -1 β、IL-6、IL-8、tnf - α、MCP-1)。以肝活检为金标准，采用敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性等指标。结果分析了73例Fibromax™试验。脂肪试验诊断脂肪变性的敏感性为95.5%，PPV为97.0%。NASH测试诊断非酒精性脂肪性肝炎(NASH)的敏感性为83.3%，特异性为37.5%，PPV为90.9%，NPV为23.1%。在评估晚期纤维化时，Fibrotest的敏感性为38.9%，特异性为92.7%，PPV为63.6%，NPV为82.3%。在2级和3级脂肪变性患者的评估中，ROC分析显示，脂肪变性的曲线下面积(AUROC)为0.68 (p=0.015)。NASH评价的Nashtest AUROC为0.59 (p=0.417)。晚期纤维化的纤维试验AUROC为0.79 (p<0.001)。脂肪试验、纳什试验和纤维试验的Kappa系数值均无统计学意义。37名患者也进行了炎症标志物分析，显示肝活检炎症活动等级为2-3级的患者il - 6水平显著升高(p=0.016)， tnf - α水平显著降低(p= 0.034)，但在分析纤维化或脂肪变性时没有其他差异。结论Fibromax™试验和炎症标志物(IL -1 β、IL-6、IL-8、tnf - α、MCP-1)的表现并不令人满意，不能被认为是评估NAFLD的良好替代肝活检方法。

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引用次数: 5

Groove pancreatitis: a case report with a brief review of this diagnostic challenge. 沟状胰腺炎:一个病例报告，简要回顾这一诊断挑战。

Minerva gastroenterologica e dietologica

Pub Date : 2020-07-01 DOI: 10.23736/S1121-421X.20.02721-X

G. Valentini, M. Surace, S. Grosso, A. Vernetto, A. Serra, I. Andria, D. Mazzucco

Groove Pancreatitis is an uncommon and still under-recognized form of recurrent or chronic pancreatitis that involves the space between the pancreatic head, the duodenum and the common bile duct, the so called groove area. Its importance is that it can mimic pancreatic carcinoma, it may coexist with it or even masks it and should be considered in the differential diagnosis of pancreatic masses or duodenal stenosis. Groove Pancreatitis represents a diagnostic challenge because, from a clinical point of view, its manifestations and complications can be numerous and different from each other. Despite modern imaging techniques, even in the most specialized centers, many untrained radiologists and gastroenterologists may encounter difficulty to make the proper diagnosis. In this work, we have described a case Groove Pancreatitis manifesting as flare up of previously diagnosed chronic pancreatitis and we have tried to make a brief revision of literature concerning diagnosis and treatment of the disease.

沟状胰腺炎是一种罕见的复发性或慢性胰腺炎，它累及胰头、十二指肠和胆总管之间的间隙，即所谓的沟状区。它的重要性在于它可以模拟胰腺癌，也可以与胰腺癌共存甚至掩盖胰腺癌，在胰腺肿块或十二指肠狭窄的鉴别诊断中应予以考虑。沟状胰腺炎是一种诊断挑战，因为从临床角度来看，其表现和并发症可能很多，而且彼此不同。尽管有现代的成像技术，即使在最专业的中心，许多未经训练的放射科医生和胃肠病学家也可能难以做出正确的诊断。在这项工作中，我们描述了一例沟状胰腺炎，表现为先前诊断的慢性胰腺炎的突然发作，我们试图对有关该病的诊断和治疗的文献进行简要修订。

引用次数: 1

Inpatients bowel preparation: with team work we can win. 住院病人肠道准备:团队合作，我们才能赢。

Minerva gastroenterologica e dietologica

Pub Date : 2020-07-01 DOI: 10.23736/S1121-421X.20.02725-7

G. Iabichino, L. Eusebi, M. Palamara, C. Luigiano

引用次数: 0

Intestinal perforations after endoscopic retrograde cholangiopancreatography in the United States: a 16-year study using the national inpatient sample. 美国内窥镜逆行胆管造影后肠道穿孔:一项为期16年的研究，使用全国住院患者样本。

Minerva gastroenterologica e dietologica

Pub Date : 2020-06-02 DOI: 10.23736/S1121-421X.20.02718-X

B. Olaiya, D. Adler

BACKGROUNDIntestinal perforation is a rare but feared complication of ERCP. In this study, we identify patient and hospital factors for ERCP related intestinal perforation using a large national database. We also examine the effects of intestinal perforations on hospital outcomes.METHODSData were obtained from the National Inpatient Sample, the largest publicly available inpatient care database in the United States. ICD-9-CM procedure codes for all ERCP procedures conducted between 1998 and 2013. Our primary outcome of interest was the incidence of intestinal perforations after ERCP. Secondary outcomes of interest included hospital length of stay and inpatient mortality.RESULTSA total of 392,336 ERCP procedures were performed over the study period, met our inclusion criteria, and were analyzed. Mean age of sample was 59 years and just over 60% were females. Low volume hospitals accounted for over 85% of ERCPs. Intestinal perforations occurred at a rate of 1.2 per 1000 ERCP procedures. Patient's age was the only patient-related factor significantly associated with perforation. (OR: 1.016; 95% CI 1.009 - 1.025). For hospitals, teaching status was the only hospital related factor associated with intestinal perforation after ERCP (OR: 1.56; 95% CI 1.28 -1.91). Length of stay was much longer in patients with ERCP related perforations and mortality risk was ten times higher in the same cohort.CONCLUSIONSPatients who have ERCP related perforations have longer hospital stays and have a higher mortality risk. Older patients and those who had ERCP in teaching hospitals are at a higher risk of perforation.

背景肠穿孔是ERCP的一种罕见但令人恐惧的并发症。在这项研究中，我们使用一个大型的国家数据库来确定与ERCP相关的肠穿孔的患者和医院因素。我们还研究了肠道穿孔对医院预后的影响。方法数据来自全国住院患者样本，这是美国最大的公开住院护理数据库。ICD-9-CM 1998 - 2013年间所有ERCP手术的程序代码。我们感兴趣的主要结局是ERCP术后肠穿孔的发生率。次要结局包括住院时间和住院死亡率。结果在研究期间共进行了392,336例ERCP手术，符合我们的纳入标准，并进行了分析。样本的平均年龄为59岁，女性略高于60%。小规模医院占ercp的85%以上。肠穿孔发生率为每1000例ERCP手术1.2例。患者的年龄是唯一与穿孔显著相关的患者相关因素。(或:1.016;95% ci 1.009 - 1.025)。医院方面，教学状况是唯一与ERCP术后肠穿孔相关的医院相关因素(OR: 1.56;95% ci 1.28 -1.91)。在同一队列中，ERCP相关穿孔患者的住院时间要长得多，死亡风险高出10倍。结论ERCP相关穿孔患者住院时间较长，死亡风险较高。老年患者和在教学医院接受ERCP的患者有较高的穿孔风险。

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引用次数: 1

Irritable bowel syndrome: diagnosis and management. 肠易激综合征:诊断和管理。

Minerva gastroenterologica e dietologica

Pub Date : 2020-06-01 Epub Date: 2019-12-09 DOI: 10.23736/S1121-421X.19.02640-0

Imke Masuy, Jasper Pannemans, Jan Tack

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders (FGIDs) encountered in clinical practice. In the absence of an accurate biomarker for the disorder, IBS is mainly diagnosed based symptomology using the Rome criteria. Due to the heterogeneity of the disorder, finding the correct treatment option is often challenging. In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients. Issues with dietary changes are the strict elimination of multiple food products and hence difficult compliance to the diet. When lifestyle changes do not lead to adequate symptom relief, patients should be treated according to their predominant bowel habits and most prominent symptoms. Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively, but have little effect on abdominal pain. To treat gastro-intestinal (GI) symptoms, antispasmodics can be attributed. Low doses of neuromodulators can help gain control over GI and central symptoms, but are also prone to more severe side effects, restricting their widespread use. Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists or alternative therapy, including psychotherapy, hypnotherapy, acupuncture or phytomedicines. However, for many of these options, scientific evidence is sparse and high-quality research is often lacking, leading to inconclusive results. In general, all of the available treatment options only provide symptom relief for a subset of patients. This review provides a full overview of the diagnostic process and currently available treatment options for IBS.

肠易激综合征(IBS)是临床上最常见的功能性胃肠疾病(fgid)之一。在缺乏准确的生物标志物的情况下，肠易激综合征的诊断主要基于症状学，使用Rome标准。由于疾病的异质性，找到正确的治疗方案往往是具有挑战性的。一般来说，生活方式和饮食的改变，包括低fodmap的无谷蛋白饮食，是所有患者的一线治疗。饮食变化的问题是严格消除多种食品，因此难以遵守饮食。当生活方式的改变不能使症状得到充分缓解时，应根据患者的主要排便习惯和最突出的症状进行治疗。通便药或促泻药和止泻药分别用于治疗便秘和腹泻，但对腹痛效果甚微。为了治疗胃肠道(GI)症状，可以使用抗痉挛药物。低剂量的神经调节剂可以帮助控制胃肠道和中枢症状，但也容易产生更严重的副作用，限制了它们的广泛使用。难治性IBS症状可以用益生菌、抗生素、组胺受体拮抗剂或替代疗法治疗，包括心理治疗、催眠疗法、针灸或植物药物。然而，对于其中许多选择，科学证据很少，往往缺乏高质量的研究，导致不确定的结果。一般来说，所有可用的治疗方案只能为一小部分患者提供症状缓解。本综述全面概述了肠易激综合征的诊断过程和目前可用的治疗方案。

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引用次数: 8

Another case of spontaneous gastric decompression and resolution of infected walled-off pancreatic necrosis: is it time to change approach? 另一例自发性胃减压和感染性壁性胰腺坏死的解决:是时候改变方法了吗?

Minerva gastroenterologica e dietologica

Pub Date : 2020-06-01 Epub Date: 2020-03-24 DOI: 10.23736/S1121-421X.20.02663-X

Giovanni Valentini, Monica Surace, Dario Mazzucco

引用次数: 1

Predictors of risk of fracture in inflammatory bowel diseases: a prospective study using FRAX score. 炎症性肠病骨折风险的预测因素:一项使用FRAX评分的前瞻性研究

Minerva gastroenterologica e dietologica

Pub Date : 2020-06-01 Epub Date: 2020-03-24 DOI: 10.23736/S1121-421X.20.02672-0

Davide G Ribaldone, Massimo Procopio, Rinaldo Pellicano, Marco Barale, Gabriele Giudici, Mario Morino, Giorgio M Saracco, Marco Astegiano

Background: Despite the well-known risk of osteoporosis and bone fractures among patients with inflammatory bowel diseases, the WHO FRAX tool has been used in a limited number of studies in this specific population. The purpose of this study was to search for predictors of risk of fractures assessed by FRAX score.

Methods: We prospectively calculated FRAX score for hip and major osteoporotic fractures in inflammatory bowel disease patients consecutively recruited.

Results: The mean risk of hip fractures at 10 years, for the 80 recruited patients, resulted 1.4%, while the mean risk of major osteoporotic fractures was 7.8%. The risk of hip fractures was 1.3% among the 30 Crohn's disease patients versus 1.4% (P=0.82) among 50 ulcerative colitis patients. A prolonged use of corticosteroids correlated with a tendency to a greater risk of hip fracture (r=0.38, P=0.08). Patients with normal erythrocyte sedimentation rate (ESR) values had a risk of osteoporotic hip fractures of 0.75%, while those with high ESR values had a risk of 1.86% (P=0.04). Regarding the risk of major bone fractures, patients with normal ESR values had a risk of 5.9%, versus a risk of 18% in those with elevated ESR (P=0.03).

Conclusions: The correlation between increase of inflammatory markers and increased risk of osteoporotic fractures and the lack of difference between Crohn's disease and ulcerative colitis suggest a central role of inflammation over malabsorption in this population.

背景:尽管众所周知炎症性肠病患者存在骨质疏松和骨折的风险，但世卫组织FRAX工具已在这一特定人群的有限数量的研究中使用。本研究的目的是寻找FRAX评分评估骨折风险的预测因素。方法:我们前瞻性地计算了连续招募的炎症性肠病患者髋部和主要骨质疏松性骨折的FRAX评分。结果:80例入选患者10年时髋部骨折的平均风险为1.4%，而主要骨质疏松性骨折的平均风险为7.8%。30名克罗恩病患者髋部骨折的风险为1.3%，而50名溃疡性结肠炎患者髋部骨折的风险为1.4% (P=0.82)。长期使用皮质类固醇与髋部骨折风险增加相关(r=0.38, P=0.08)。红细胞沉降率(ESR)正常的患者发生骨质疏松性髋部骨折的风险为0.75%，而红细胞沉降率高的患者发生骨质疏松性髋部骨折的风险为1.86% (P=0.04)。关于主要骨折的风险，ESR值正常的患者的风险为5.9%，而ESR值升高的患者的风险为18% (P=0.03)。结论:炎症标志物增加与骨质疏松性骨折风险增加之间的相关性，以及克罗恩病和溃疡性结肠炎之间的差异，表明炎症在这一人群中比吸收不良更重要。

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引用次数: 2

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