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The brain-esophagus axis in subjects with and without obesity assessed by esophageal acid perfusion and functional brain imaging. 通过食道酸灌注和功能性脑成像评估肥胖和非肥胖受试者的脑-食道轴。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.20524/aog.2023.0818
Marcelo Ribeiro, Cassiano Mateus Forcelini, José Carlos Tomiozzo Jr, Ricardo Bernardi Soder, Fernando Fornari

Background: Gastroesophageal reflux disease (GERD) has a complex pathophysiology and a heterogeneous symptom profile. The brain-esophageal axis in GERD has been studied with functional brain imaging during the last decades, but data from obese patients was just recently reported. A comparison of such a group with non-obese subjects is lacking in the literature. This study aimed to evaluate heartburn perception and brain connectivity responses during esophageal acid stimulation in subjects with and without obesity, controlling for the presence of typical reflux symptoms.

Methods: In this cross-sectional study, 25 patients with obesity (body mass index ≥30 kg/m2) and 46 subjects without obesity underwent functional magnetic resonance imaging (fMRI) of the brain with esophageal water and acid perfusion. The fMRI paradigm and connectivity were assessed.

Results: About two-thirds of the participants had reflux symptoms. Heartburn perception during fMRI did not differ between subjects with and without obesity. The presence of reflux symptoms was associated with lower activation in frontal brain regions during acid perfusion compared to water perfusion. Compared to subjects without obesity, patients with obesity presented significantly lower connectivity within the anterior salience network. Corrected clusters included left caudate, left putamen and left anterior cingulate gyrus.

Conclusions: The brain-esophagus axis showed differences between subjects with and without obesity. Even without symptomatic differences following esophageal acid perfusion, patients with reflux symptoms showed less brain activation in frontal areas, while obese individuals presented lower connectivity within the anterior salience network.

背景:胃食管反流病(GERD)具有复杂的病理生理学和异质性的症状特征。在过去的几十年里,GERD的脑-食管轴已经通过功能性脑成像进行了研究,但最近才报道了肥胖患者的数据。文献中缺乏将这一群体与非肥胖受试者进行比较。本研究旨在评估肥胖和非肥胖受试者在食道酸刺激过程中的烧心感知和大脑连接反应,控制典型反流症状的存在。方法:在这项横断面研究中,25名肥胖(体重指数≥30kg/m2)患者和46名非肥胖患者接受了食道水和酸灌注脑功能磁共振成像(fMRI)。对功能磁共振成像的范例和连接性进行了评估。结果:大约三分之二的参与者有反流症状。在功能磁共振成像中,肥胖和不肥胖的受试者对心脏烧伤的感知没有差异。与水灌注相比,在酸灌注期间,反流症状的存在与额叶区域的激活较低有关。与未肥胖的受试者相比,肥胖患者的前突网络连接显著降低。校正的星团包括左尾状核、左壳核和左前扣带回。结论:肥胖和非肥胖受试者的脑食管轴存在差异。即使在食道酸灌注后没有症状差异,有反流症状的患者在额叶区域表现出较少的大脑激活,而肥胖患者在前突网络内表现出较低的连通性。
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引用次数: 0
Endoscopic submucosal dissection for gastric lesions. 胃病变的内镜黏膜下剥离术。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-20 DOI: 10.20524/aog.2023.0823
Raffaele Manta, Angelo Zullo
Raffaele Mantaa, Angelo Zullob Spedali Riuniti Hospital, Livorno; Nuovo Regina Margherita Hospital, Rome, Italy We read with great interest the recently published systematic review by Benites-Goñi et al on the short-term outcomes of endoscopic submucosal dissection for the treatment of superficial gastric neoplasms in non-Asian countries [1]. Regrettably, we noted that our previous study published in 2020, indexed in PubMed with full open access, was not included in the analysis. Our series reported data from as many as 296 patients, with 299 gastric lesions [2], that is almost one third of the total of 933 patients considered in European studies. Therefore, the estimates reported in this systematic review could have been different if the data from our study had also been considered. We would suggest that the authors should carry out a further check of the accuracy in the literature review they performed on October 26, 2022 [1].
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引用次数: 0
Impact and management of COVID-19 in liver transplant candidates and recipients. 新冠肺炎对肝移植候选人和接受者的影响和管理。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.20524/aog.2023.0815
Christina Liava, Konstantinos Ouranos, Anthi Chatziioannou, Irene Kamenidou, Athanasios Kofinas, Stella Vasileiadou, Nikolaos Antoniadis, Georgios Katsanos, Evangelos Akriviadis, Emmanouil Sinakos

The COVID-19 outbreak has had severe consequences for global public health, medical communities, and the socioeconomic status of a considerable number of countries. The emergence of COVID-19 has also significantly impacted the world of liver transplantation (LT). Studies from transplantation centers around the world have shown that LTs during the COVID-19 pandemic have been restricted because of the high risk of serious COVID-19 infection in this population. According to the Centers for Disease Control and Prevention, patients with liver disease are considered at higher risk for severe COVID-19 infection. In March 2020, the American Association for the Study of Liver Diseases recommended that LT should be limited to emergency cases. The COVID-19 treatment guidelines published by the National Institutes of Health are being constantly updated according to new epidemiology trends and treatment regimens. Immunocompromised patients have a higher risk of developing severe disease or death from COVID-19 compared with the general population. In this review, we summarize the available evidence regarding treatment guidelines and considerations for the evaluation and management of LT candidates and recipients in the era of COVID-19. In addition, we present data regarding COVID-19 among LT patients in our local transplantation center.

新冠肺炎疫情对全球公共卫生、医学界和相当多国家的社会经济地位造成了严重后果。新冠肺炎的出现也对肝移植(LT)世界产生了重大影响。来自世界各地移植中心的研究表明,在新冠肺炎大流行期间,LT受到限制,因为这一人群感染严重新冠肺炎的风险很高。根据美国疾病控制与预防中心的说法,肝病患者被认为患严重新冠肺炎的风险更高。2020年3月,美国肝病研究协会建议LT应仅限于急诊病例。美国国立卫生研究院发布的新冠肺炎治疗指南正在根据新的流行病学趋势和治疗方案不断更新。与普通人群相比,免疫受损患者患新冠肺炎重症或死亡的风险更高。在这篇综述中,我们总结了关于新冠肺炎时代LT候选人和接受者的评估和管理的治疗指南和考虑因素的现有证据。此外,我们提供了当地移植中心LT患者中新冠肺炎的数据。
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引用次数: 1
Prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria: alterations in ultrasonographic parameters of both left and right ventricles before and after stress. 不同诊断标准下肝硬化心肌病的患病率:应激前后左心室和右心室超声参数的变化。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-20 DOI: 10.20524/aog.2023.0824
Dimitrios S Karagiannakis, Katerina Stefanaki, George Anastasiadis, Theodoros Voulgaris, Jiannis Vlachogiannakos

Background: We estimated the frequency of cirrhotic cardiomyopathy (CCM) using all of the proposed diagnostic criteria, to describe the whole spectrum of cardiac alterations, and to investigate the role of stress in unmasking latent cases of CCM.

Methods: Ninety consecutive patients were recruited. CCM was evaluated using the Montreal, the American Society of Echocardiography 2009 criteria, and the 2019 modified criteria of the CCM consortium. A dobutamine stress test was also performed.

Results: Left ventricular diastolic dysfunction (LVDD) was identified in 72 (80%), 36 (40%), and 10 (11.1%) patients based on the above criteria, respectively. None of the patients had right ventricular systolic dysfunction, either at rest or after stress. The dobutamine stress test revealed left systolic dysfunction in 4 (4.5%) patients. There was agreement among the 3 criteria that the presence of LVDD was not associated with the severity of liver disease, using Child-Pugh stage. However, patients with Child-B/C had longer QTc intervals (P=0.004), higher levels of brain natriuretic peptide (P=0.016), and greater echocardiographic E/e' ratio (P<0.001) and E/e'(s) (P=0.003), compared to Child-A patients, while a significant correlation was demonstrated between Child-Pugh score and E/e' (P<0.001), or E/e'(s) (P=0.002).

Conclusions: The prevalence of LVDD seems to be lower than previously considered. Right ventricular function seems to remain unimpaired. A dobutamine stress uncovered only a small percentage of patients with left systolic dysfunction. Nevertheless, the aggravation of several sonographic variables during stress, particularly in Child-B/C patients, potentially indicates a higher risk for clinical heart failure during stressful invasive interventions.

背景:我们使用所有提出的诊断标准来估计肝硬化心肌病(CCM)的发生频率,以描述心脏变化的全谱,并研究应激在揭示潜在CCM病例中的作用。方法:连续招募90名患者。CCM使用蒙特利尔、美国超声心动图学会2009年标准和CCM联合会2019年修订标准进行评估。还进行了多巴酚丁胺应激试验。结果:根据上述标准,分别有72例(80%)、36例(40%)和10例(11.1%)患者发现左心室舒张功能障碍(LVDD)。无论是在休息时还是在压力后,没有一名患者出现右心室收缩功能障碍。多巴酚丁胺负荷试验显示4名(4.5%)患者出现左收缩功能障碍。根据Child-Pugh分期,三项标准一致认为LVDD的存在与肝病的严重程度无关。然而,Child-B/C患者的QTc间期较长(P=0.004)、脑钠肽水平较高(P=0.016),以及更高的超声心动图E/E'比率(结论:LVDD的患病率似乎比以前考虑的要低。右心室功能似乎没有受到损害。多巴酚丁胺压力只发现了一小部分左收缩功能障碍的患者。然而,压力期间几个超声变量的加重,特别是儿童B/C患者,可能表明临床上更高的风险压力性侵入性干预期间的心力衰竭。
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引用次数: 0
Barriers to and requirements for a successful transition in inflammatory bowel disease from pediatric to adult care in Greece. 希腊炎症性肠病从儿科护理成功过渡到成人护理的障碍和要求。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.20524/aog.2023.0817
Olga Giouleme, Anastasios Koutsoumourakis, Anastasia Katsoula, Marios Katsaros, Konstantinos Soufleris, Konstantina Vasilaki, Ioannis Xinias

Background: The incidence of pediatric-onset inflammatory bowel disease (IBD) is rising, while the relapsing and often severe nature of IBD, and its impact on emotional and pubertal development and social maturation underline the need for a successful transition from pediatric to adult care.

Methods: A web-based survey was distributed via the Hellenic Group for the Study of IBD, the Hellenic Society of Gastroenterology Department of North Greece, and the Hellenic Society of Pediatric Gastroenterology, Hepatology, and Nutrition.

Results: The questionnaire was answered by 98 individuals (78 adult and 20 pediatric gastroenterologists, out of 357 and 30, respectively). The response rate was 25.3%. A higher response rate was found among pediatric (66.6%) vs. adult gastroenterologists 21.8% (P<0.001). Pediatric gastroenterologists believed that the appropriate age for transition was either 16-17 or 17-18 years, whereas 59% of the adult gastroenterologists chose the age group of 16-17 years. Both adult and pediatric gastroenterologists stated that the most significant initiators for a successful transition process were cognitive maturity and patients' ability to manage their disease independently. The lack of communication and collaboration between pediatric and adult gastroenterologists was the main barrier to the transition process, as identified by adult gastroenterologists (27.7%). In contrast, 43.5% of pediatric gastroenterologists suggested that differences in the follow up of patients with IBD between pediatric and adult clinics were the main restrictions.

Conclusion: These results highlight the need for a transitional education program for pediatric IBD patients, and the importance of improving collaboration among adult and pediatric gastroenterologists.

背景:儿童发作性炎症性肠病(IBD)的发病率正在上升,而IBD的复发性和严重性,以及它对情绪和青春期发育以及社会成熟的影响,突显了从儿童护理成功过渡到成人护理的必要性。方法:通过希腊IBD研究小组、北希腊希腊胃肠病学会和希腊儿童胃肠病、肝病和营养学会进行了一项基于网络的调查。结果:问卷由98人回答(357人和30人中分别有78名成人和20名儿童胃肠病学家)。有效率为25.3%。儿童有效率(66.6%)高于成人胃肠病学家21.8%(P结论:这些结果强调了对儿童IBD患者进行过渡教育计划的必要性,以及改善成人和儿童胃肠病学家之间合作的重要性。
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引用次数: 0
Association between frailty status and complications in patients undergoing surgical excision of malignant esophageal neoplasms. 食管恶性肿瘤手术切除患者虚弱状态与并发症的关系。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.20524/aog.2023.0825
Shane Shahrestani, Sammy Sayed, Tania Nasrollahi, Tasha Nasrollahi, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi

Background: Research within the last decade highlights the patients' frailty status as an important predictor of esophageal cancer outcomes, but the literature evaluating frailty's role in these patients remains limited. We evaluated the role of frailty in patients undergoing resection of malignant esophageal neoplasms.

Methods: We used the Nationwide Readmissions Database from 2016 and 2017 to identify patients who underwent excision of a malignant esophageal neoplasm. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Propensity score matching identified 289 frail patients and 281 non-frail patients. Mann-Whitney U testing was performed and receiver operating characteristic (ROC) curves were created, following the creation of logistic regression models for predicting discharge disposition. The area under the curve (AUC) served as a proxy for model performance.

Results: Frail patients had significantly more nonroutine discharges, longer inpatient lengths of stay, higher costs, more acute infections, posthemorrhagic anemia and deep vein thrombosis, and greater mortality (P<0.05). No significant differences were found between the 2 cohorts with respect to readmission rates, pulmonary embolism or dysphagia. Predictive models for patient discharge disposition demonstrated that frailty status in combination with age resulted in better ROC curves (AUC: 0.652) compared to models using age alone (AUC: 0.601).

Conclusions: Frailty was found to be significantly correlated with higher rates of inpatient medical complications following esophagectomy. The inclusion of patient frailty status in predictive models for discharge disposition resulted in a better predictive capacity compared to those using age alone.

背景:过去十年的研究强调,患者的虚弱状态是食管癌症预后的重要预测因素,但评估虚弱在这些患者中的作用的文献仍然有限。我们评估了虚弱在食管恶性肿瘤切除患者中的作用。方法:我们使用2016年和2017年的全国读者数据库来确定接受食管恶性肿瘤切除的患者。使用约翰斯·霍普金斯调整临床组虚弱定义诊断指标对患者虚弱进行询问。倾向评分匹配确定289名虚弱患者和281名非虚弱患者。在建立用于预测出院处置的逻辑回归模型后,进行了Mann-Whitney U测试,并创建了受试者操作特征(ROC)曲线。曲线下面积(AUC)是模型性能的代表。结果:虚弱患者的非常规出院次数明显增多,住院时间更长,费用更高,急性感染次数更多,出现出血性贫血和深静脉血栓形成,以及更高的死亡率(结论:发现虚弱与食管切除术后住院并发症的发生率较高显著相关。与单独使用年龄的预测模型相比,将患者虚弱状态纳入出院处置的预测模型具有更好的预测能力。
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引用次数: 0
Comparison of viscous budesonide and fluticasone in the treatment of patients with eosinophilic esophagitis: a systematic review and meta-analysis. 粘性布地奈德和氟替卡松治疗嗜酸性食管炎患者的比较:一项系统综述和荟萃分析。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-20 DOI: 10.20524/aog.2023.0822
Laith Numan, Mohamad A Kalot, Tim Brotherton, Ahmad Tarakji, Shadi Hamdeh

Background: Steroids are an important pharmacologic treatment in patients with eosinophilic esophagitis (EoE). Fluticasone and budesonide are the 2 main steroid medications used in EOE treatment, but current United States (US) guidelines do not recommend one agent over the other. In this study, we conducted a meta-analysis to compare important patient outcomes when both agents are used.

Methods: A comprehensive search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was performed from each database's inception to March 29th, 2023. Two independent reviewers systematically identified trials that compared the effect of budesonide vs. fluticasone in the management of EoE. A meta-analysis was performed using a fixed-effects model. The primary outcome was the histologic response (defined as an eosinophil count <15 per high-power field) which reflects the response to treatment.

Results: Three studies met our inclusion criteria and were included in the analysis, with a total of 272 patients. All studies were carried out in the US and 1 was a randomized controlled trial. Our meta-analysis showed no statistically significant difference with the use of budesonide compared to fluticasone in achieving a histologic response (odds ratio 1.29, 95% confidence interval 0.77-2.14; P=0.34; I2=0%).

Conclusion: Our systematic review and meta-analysis indicated no difference between budesonide and fluticasone in achieving a histologic response in patients with EoE.

背景:类固醇是治疗嗜酸性食管炎(EoE)的重要药物。氟替卡松和布地奈德是EOE治疗中使用的两种主要类固醇药物,但目前美国的指南不建议使用一种药物而不是另一种。在这项研究中,我们进行了一项荟萃分析,以比较使用两种药物时的重要患者结果。方法:从数据库成立到2023年3月29日,对MEDLINE、EMBASE、Cochrane对照试验中央登记册、Cochran系统评价数据库和Scopus进行全面检索。两名独立评审员系统地确定了比较布地奈德和氟替卡松治疗EoE效果的试验。使用固定效应模型进行荟萃分析。主要结果是组织学反应(定义为嗜酸性粒细胞计数结果:三项研究符合我们的纳入标准并纳入分析,共272名患者。所有研究均在美国进行,其中一项是随机对照试验。我们的荟萃分析显示,与氟替卡松相比,布地奈德的使用在组织学反应方面没有统计学显著差异(优势比1.29,95%置信区间0.77-2.14;P=0.34;I2=0%)。结论:我们的系统综述和荟萃分析表明,布地奈德和氟替卡松在EoE患者中获得组织学反应方面没有差异。
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引用次数: 0
Radiofrequency ablation for pancreatobiliary disease: an updated review. 射频消融治疗胰胆管疾病:最新综述。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.20524/aog.2023.0828
Andrew Canakis, Reem Z Sharaiha

Endoscopic radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option in cases of malignant biliary obstruction, pancreatic cancer, and other pancreatic cystic neoplasms. Intraductal biliary RFA is safe, effective, and confers a survival advantage over stenting alone, where it should be used an adjunct to biliary stenting. Endoscopic ultrasound-guided RFA can also provide pancreatic cyst resolution in patients who are not ideal operative candidates. The aim of this review is to describe the endoscopic applications and associated outcomes of RFA.

内窥镜射频消融(RFA)已成为恶性胆道梗阻、胰腺癌症和其他胰腺囊性肿瘤的微创治疗选择。导管内胆道RFA是安全、有效的,与单独支架置入相比具有生存优势,应作为胆道支架置入的辅助手段。内镜超声引导下的RFA也可以为不理想的手术候选人提供胰腺囊肿的解决方案。这篇综述的目的是描述RFA的内镜应用和相关结果。
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引用次数: 0
The impact of a multidisciplinary team approach on the management of focal pancreatic lesions: a single tertiary center experience. 多学科团队方法对胰腺局灶性病变管理的影响:单一三级中心经验。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.20524/aog.2023.0827
Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Martina Pezzullo, Patricia Loi, Julie Navez, Jean Closset, Maria Antonietta Bali, Morgane Van Wettere, Nicki D'Haene, Pieter Demetter, Laurine Verset, Christelle Bouchart, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis

Background: Multidisciplinary team (MDT) meetings aim to optimize patient management. We evaluated the impact of MDT discussions on the management and diagnosis of focal pancreatic lesions in a single tertiary center.

Methods: All patients with an initial diagnosis of solid or cystic pancreatic lesion discussed in our institution's MDT meeting on pancreatic diseases between January 1, 2020, and December 31, 2021, were included. The impact of MDT discussion on patient management, defined as a modification of the initially proposed therapeutic plan after MDT discussion, as well as the criteria leading to this modification, were the primary outcomes. Impact on diagnosis was the secondary outcome.

Results: A total of 522 patients were included. Of these, 185 (35.4%) and 337 (64.6%) had an initial diagnosis of cystic or solid lesion, respectively. The most common referral query was regarding the management plan (349/522; 66.9%). Endoscopy was the procedure most often proposed before MDT discussion (109/522; 20.9%). Overall, the MDT discussion led to modification of the management plan in 377/522 patients (72.2%), with a statistically significant difference between cystic and solid lesions (63.2% vs. 77.2%; P<0.001). Management modifications were mainly driven by revision of cross-sectional radiological images. MDT discussion led to modification of the diagnosis in 92/522 patients (17.6%), with a significant difference regarding cystic lesions (35.7% vs. 7.7%; P<0.001).

Conclusion: MDT discussion impacts the management of patients with cystic and solid pancreatic lesions, leading to a modification of the initially proposed management in two-thirds of them, mainly through revision of cross-sectional imaging.

背景:多学科团队会议旨在优化患者管理。我们评估了MDT讨论对单个三级中心胰腺局灶性病变的管理和诊断的影响。方法:纳入2020年1月1日至2021年12月31日期间在我们机构的胰腺疾病MDT会议上讨论的所有最初诊断为胰腺实性或囊性病变的患者。MDT讨论对患者管理的影响,定义为MDT讨论后对最初提出的治疗计划的修改,以及导致该修改的标准,是主要结果。次要结果是对诊断的影响。结果:共纳入522例患者。其中,185例(35.4%)和337例(64.6%)的初步诊断分别为囊性或实体性病变。最常见的转诊询问是关于管理计划(349/522;66.9%)。内窥镜检查是在MDT讨论之前最常提出的程序(109/522;20.9%)。总体而言,MDT讨论导致377/522名患者(72.2%)修改了管理计划,囊性和实体性病变之间存在统计学上的显著差异(63.2%对77.2%;P结论:MDT的讨论影响了囊性和实质性胰腺病变患者的管理,导致三分之二的患者修改了最初提出的管理方法,主要是通过修改横截面成像。
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引用次数: 0
Endoscopic carbon dioxide insufflation tolerance test on the anal sphincter for anorectal hypofunction: a pilot and feasibility study. 肛门括约肌经内镜二氧化碳吹入耐受性试验治疗肛门直肠功能减退:一项初步和可行性研究。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0805
Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Daijiro Shiomi, Kei Ushikubo, Yumi Kishi, Hisaki Kato, Mai Fukuda, Yuki Shibata, Kosuke Kunita, Mary Raina Angeli Fujiyoshi, Yusuke Fujiyoshi, Yohei Nishikawa, Kazuya Sumi, Haruo Ikeda, Manabu Onimaru, Naoyuki Uragami, Noboru Yokoyama, Haruhiro Inoue

Background: Anorectal function deteriorates with age. The diagnostic performance of the endoscopic pressure study integrated system (EPSIS), an endoscopic carbon dioxide (CO2) insufflation stress test of the lower esophageal sphincter has been previously evaluated as a diagnostic tool for gastroesophageal reflux disease. We aimed to evaluate the applicability of EPSIS in improving anorectal function. We hypothesized that EPSIS can be applied to the diagnosis of lower gastrointestinal tract disorders.

Methods: This was a pilot, single-center, retrospective study using prospectively collected data between December 2021 and March 2022. It was designed to evaluate the differences in EPSIS rectal pressure measurements between older (≥80 years) and younger (<80 years) patients. At the end of the screening colonoscopy, the colonoscope was fixed in a retroflex position. When bowel movement was observed, CO2 was insufflated to the point where gas leakage occurred through the anus. The measured maximum pressure was defined as EPSIS-rectal pressure max (EPSIS-RP max) and compared between the groups.

Results: Overall, 30 patients were included and examined. The median ages of the <80 and ≥80 years' groups were 53 (range: 27-79) and 82 (range: 80-94) years, respectively, with corresponding median measured EPSIS-RP max of 18.7 (range: 8.5-30.2) and 9.8 (range: 5.4-22.3) mmHg (P<0.001).

Conclusions: Measurement of maximum rectal pressure illustrates the age-related decline in physiological anorectal function. Future studies should consider a loading test using EPSIS to quantify the decline in anorectal function and use it as a routine tool for screening and adjunctive diagnosis of anorectal hypofunction.

背景:肛门直肠功能随着年龄的增长而恶化。内镜压力研究集成系统(EPSIS)的诊断性能,即食管下括约肌的内镜二氧化碳(CO2)吹入压力测试,先前已被评估为胃食管反流疾病的诊断工具。我们旨在评估EPSIS在改善肛门直肠功能方面的适用性。我们假设EPSIS可以应用于下消化道疾病的诊断。方法:这是一项试点、单中心、回顾性研究,使用了2021年12月至2022年3月期间前瞻性收集的数据。旨在评估老年人(≥80岁)和年轻人(2人被吹入肛门至气体泄漏点)之间EPSIS直肠压力测量的差异。测量的最大压力被定义为EPSIS直肠最大压力(EPSIS-RP-max),并在两组之间进行比较。结果:总共纳入并检查了30名患者。结论的中位年龄:最大直肠压力的测量表明与年龄相关的肛门直肠生理功能下降。未来的研究应该考虑使用EPSIS进行负荷测试,以量化肛门直肠功能的下降,并将其作为筛查和辅助诊断肛门直肠功能低下的常规工具。
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Annals of Gastroenterology
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