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Endoscopic ultrasound-guided lumen-apposing metal stent with or without coaxial plastic stent for pancreatic fluid collections: a systematic review and meta-analysis comparing safety and efficacy. 内镜超声引导下腔内金属支架与同轴塑料支架或不与同轴塑料支架治疗胰腺积液:安全性和有效性比较的系统综述和荟萃分析。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-03-01 Epub Date: 2024-02-12 DOI: 10.20524/aog.2024.0858
Harishankar Gopakumar, Vakya Revanur, Rajanikanth Kandula, Srinivas R Puli

Background: Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) are preferred for draining symptomatic large pancreatic fluid collections (PFCs). A concurrent coaxial double-pigtail plastic stent (DPPS) is proposed to reduce adverse events associated with LAMS. We aimed to perform a comparative outcome analysis of LAMS with or without DPPS for PFCs.

Methods: Electronic databases from January 2005 through July 2023 were searched for studies comparing the use of LAMS with or without DPPS for PFCs. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models.

Results: After reviewing 1780 studies, we extracted data from 6 studies comprising 348 patients. The weighted odds of overall technical success, using LAMS plus DPPS compared to LAMS alone, were 0.53 (95% confidence interval [CI] 0.15-1.83), and the odds of clinical success were 1.10 (95%CI 0.59-2.05). The weighted odds of total adverse events with LAMS compared to LAMS plus DPPS were 2.21 (95%CI 1.37-3.59). Analysis of individual adverse events showed that the odds of stent occlusion when LAMS alone was used compared to LAMS plus DPPS was 2.36 (95%CI 1.12-4.98). The odds of bleeding were 1.84 (95%CI 0.77-4.38), and the odds of stent migration 0.95 (95%CI 0.40-2.23).

Conclusions: EUS-guided LAMS placement is the current standard of care for managing symptomatic large PFCs. Concurrent use of coaxial DPPS can mitigate the overall adverse events observed with LAMS, while maintaining similar technical and clinical success.

背景:内镜超声(EUS)引导下的腔内金属支架(LAMS)是引流无症状大胰腺积液(PFC)的首选方法。有人建议同时使用同轴双尾塑料支架(DPPS),以减少与 LAMS 相关的不良事件。我们的目的是对使用或不使用 DPPS 的 LAMS 治疗 PFCs 的结果进行比较分析:我们检索了 2005 年 1 月至 2023 年 7 月期间的电子数据库,比较了使用或不使用 DPPS 的 LAMS 治疗 PFCs 的研究。使用固定(逆方差)和随机效应(DerSimonian-Laird)模型计算汇总比例:在查阅了 1780 项研究后,我们从 6 项研究中提取了 348 名患者的数据。使用 LAMS 加 DPPS 与单独使用 LAMS 相比,总体技术成功的加权几率为 0.53(95% 置信区间 [CI] 0.15-1.83),临床成功的几率为 1.10(95%CI 0.59-2.05)。与LAMS加DPPS相比,LAMS总不良事件的加权几率为2.21(95%CI为1.37-3.59)。对单个不良事件的分析表明,单独使用 LAMS 与 LAMS 加 DPPS 相比,发生支架闭塞的几率为 2.36(95%CI 1.12-4.98)。出血几率为1.84(95%CI 0.77-4.38),支架移位几率为0.95(95%CI 0.40-2.23):结论:在 EUS 引导下置入 LAMS 是目前治疗无症状大 PFC 的标准方法。同时使用同轴 DPPS 可以减轻 LAMS 观察到的总体不良事件,同时保持相似的技术和临床成功率。
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引用次数: 0
APRI score is not predictive of post-surgical outcomes in cholangiocarcinoma patients. APRI 评分不能预测胆管癌患者手术后的预后。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2024.0845
Faaiq N Aslam, Tristan A Loveday, Pedro Luiz Serrano Uson Junior, Mark Truty, Rory Smoot, Tanios Bekaii-Saab, Chee-Chee Stucky, Hani Babiker, Mitesh J Borad

Background: Cholangiocarcinoma is an epithelial malignancy of the intrahepatic or extrahepatic biliary tree, primarily driven by chronic inflammation and fibrosis. Fibrosis has been shown to correlate with malignancy, and the aminotransferase-platelet ratio index (APRI) score, a marker for hepatic fibrosis, has proved useful in prognosticating hepatocellular carcinoma. This study aimed to assess the utility of APRI score in predicting post-surgical outcomes in cholangiocarcinoma patients.

Methods: Clinical data from a total of 152 cholangiocarcinoma patients who underwent surgical resection at the Mayo Clinic were collected. The data were subsequently analyzed to determine if there was a relationship between APRI score and the demographic, laboratory, pathologic and outcome data, including overall survival. To determine the relationship between quantitative and qualitative data and the APRI score, a P-value <0.05 was considered as statistically significant.

Results: No relationship between APRI score and demographic factors was identified. There were correlations between APRI score and alanine transaminase, albumin and bilirubin, but the remaining laboratory parameters showed no correlation. APRI score did not prove to be useful as a prognostic tool, as it did not correlate with tumor pathology features (tumor grade t-test P=0.86, N stage ANOVA P=0.94, vascular invasion t-test P=0.59, and perineural invasion t-test P=0.14), or with post-surgical recurrence (t-test P=0.22) and mortality (t-test P=0.39).

Conclusion: APRI score is not a prognostic tool for post-surgical outcomes in patients with cholangiocarcinoma.

背景:胆管癌是肝内或肝外胆管的上皮性恶性肿瘤,主要由慢性炎症和纤维化引起。纤维化已被证明与恶性程度相关,而转氨酶-血小板比值指数(APRI)评分作为肝纤维化的标志物,已被证明有助于肝细胞癌的预后。本研究旨在评估 APRI 评分在预测胆管癌患者手术后预后方面的实用性:方法:收集了在梅奥诊所接受手术切除的 152 名胆管癌患者的临床数据。随后对数据进行分析,以确定 APRI 评分与人口统计学、实验室、病理学和结果数据(包括总生存期)之间是否存在关系。为了确定定量和定性数据与 APRI 评分之间的关系,结果采用了 P 值:未发现 APRI 评分与人口统计学因素之间存在关系。APRI 评分与丙氨酸转氨酶、白蛋白和胆红素之间存在相关性,但其余实验室参数没有相关性。事实证明,APRI评分并不能作为预后工具,因为它与肿瘤病理特征(肿瘤分级t检验P=0.86,N分期方差分析P=0.94,血管侵犯t检验P=0.59,神经周围侵犯t检验P=0.14)、手术后复发(t检验P=0.22)和死亡率(t检验P=0.39)均无相关性:结论:APRI评分不是胆管癌患者手术后预后的预测工具。
{"title":"APRI score is not predictive of post-surgical outcomes in cholangiocarcinoma patients.","authors":"Faaiq N Aslam, Tristan A Loveday, Pedro Luiz Serrano Uson Junior, Mark Truty, Rory Smoot, Tanios Bekaii-Saab, Chee-Chee Stucky, Hani Babiker, Mitesh J Borad","doi":"10.20524/aog.2024.0845","DOIUrl":"10.20524/aog.2024.0845","url":null,"abstract":"<p><strong>Background: </strong>Cholangiocarcinoma is an epithelial malignancy of the intrahepatic or extrahepatic biliary tree, primarily driven by chronic inflammation and fibrosis. Fibrosis has been shown to correlate with malignancy, and the aminotransferase-platelet ratio index (APRI) score, a marker for hepatic fibrosis, has proved useful in prognosticating hepatocellular carcinoma. This study aimed to assess the utility of APRI score in predicting post-surgical outcomes in cholangiocarcinoma patients.</p><p><strong>Methods: </strong>Clinical data from a total of 152 cholangiocarcinoma patients who underwent surgical resection at the Mayo Clinic were collected. The data were subsequently analyzed to determine if there was a relationship between APRI score and the demographic, laboratory, pathologic and outcome data, including overall survival. To determine the relationship between quantitative and qualitative data and the APRI score, a P-value <0.05 was considered as statistically significant.</p><p><strong>Results: </strong>No relationship between APRI score and demographic factors was identified. There were correlations between APRI score and alanine transaminase, albumin and bilirubin, but the remaining laboratory parameters showed no correlation. APRI score did not prove to be useful as a prognostic tool, as it did not correlate with tumor pathology features (tumor grade <i>t</i>-test P=0.86, N stage ANOVA P=0.94, vascular invasion <i>t</i>-test P=0.59, and perineural invasion <i>t</i>-test P=0.14), or with post-surgical recurrence (<i>t</i>-test P=0.22) and mortality (<i>t</i>-test P=0.39).</p><p><strong>Conclusion: </strong>APRI score is not a prognostic tool for post-surgical outcomes in patients with cholangiocarcinoma.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"95-103"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Polymorphisms in CLEC5A and CLEC7A genes modify risk for inflammatory bowel disease. CLEC5A和CLEC7A基因的多态性会改变患炎症性肠病的风险。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2024.0843
Evangelia Legaki, Tilemachos Koutouratsas, Charalampos Theocharopoulos, Vivian Lagkada, Maria Gazouli

Background: Inflammatory bowel disease (IBD) seems to arise from an interplay between genetic and environmental factors. CLEC5A and CLEC7A genes code for 2 members of the C-type lectin receptor superfamily, which participate in the immune response against various pathogens, mediating inflammatory signaling. CLEC5A polymorphisms have been linked to the risk of Crohn's disease (CD), whereas CLEC7A has been implicated in fungal dysbiosis, chemically induced colitis in mice and undertreated ulcerative colitis (UC) in humans. This study aimed to explore how specific CLEC5A and CLEC7A polymorphisms contribute to the development of CD and UC.

Methods: One hundred twelve CD patients, 94 UC patients and 164 sex- and age- matched healthy individuals were genotyped for the single nucleotide polymorphisms rs2078178 and rs16910631 of the CLEC7A gene, and rs1285933 of the CLEC5A gene.

Results: The CLEC7A rs2078178 AA genotype was more frequent in UC patients compared to healthy individuals, The CLEC7A rs16910631 CT genotype was significantly associated with UC risk compared to healthy individuals, while there was no statistical correlation with CD. The CLEC5A rs1285933 GA genotype was found to be protective against UC and CD, and the AA genotype against CD. Carriers of the rs1285933 A allele appeared to have reduced susceptibility to CD, implying that the presence of the A allele could be protective against CD development.

Conclusions: This is the first study to correlate the CLEC5A rs1285933 polymorphism with the risk for UC. The rs2078178 AA genotype and the CLEC7A rs16910631 CT could be promising biomarkers for UC susceptibility.

背景:炎症性肠病(IBD)似乎是由遗传和环境因素相互作用引起的。CLEC5A和CLEC7A基因编码C型凝集素受体超家族的两个成员,它们参与对各种病原体的免疫反应,介导炎症信号转导。CLEC5A基因的多态性与克罗恩病(CD)的发病风险有关,而CLEC7A基因则与真菌菌群失调、小鼠化学诱导性结肠炎和人类溃疡性结肠炎(UC)治疗不当有关。本研究旨在探讨特定的 CLEC5A 和 CLEC7A 多态性如何导致 CD 和 UC 的发生:对 112 名 CD 患者、94 名 UC 患者和 164 名性别和年龄匹配的健康人进行了 CLEC7A 基因 rs2078178 和 rs16910631 以及 CLEC5A 基因 rs1285933 的单核苷酸多态性基因分型:与健康人相比,CLEC7A rs2078178 AA基因型在UC患者中更常见;与健康人相比,CLEC7A rs16910631 CT基因型与UC风险显著相关,而与CD无统计学相关性。研究发现,CLEC5A rs1285933 GA 基因型对 UC 和 CD 具有保护作用,而 AA 基因型对 CD 具有保护作用。rs1285933 A等位基因携带者似乎对CD的易感性降低,这意味着A等位基因的存在可能对CD的发展具有保护作用:这是首次将 CLEC5A rs1285933 多态性与 UC 风险相关联的研究。rs2078178 AA基因型和CLEC7A rs16910631 CT基因型有可能成为UC易感性的生物标志物。
{"title":"Polymorphisms in <i>CLEC5A</i> and <i>CLEC7A</i> genes modify risk for inflammatory bowel disease.","authors":"Evangelia Legaki, Tilemachos Koutouratsas, Charalampos Theocharopoulos, Vivian Lagkada, Maria Gazouli","doi":"10.20524/aog.2024.0843","DOIUrl":"10.20524/aog.2024.0843","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) seems to arise from an interplay between genetic and environmental factors. <i>CLEC5A</i> and <i>CLEC7A</i> genes code for 2 members of the C-type lectin receptor superfamily, which participate in the immune response against various pathogens, mediating inflammatory signaling. <i>CLEC5A</i> polymorphisms have been linked to the risk of Crohn's disease (CD), whereas <i>CLEC7A</i> has been implicated in fungal dysbiosis, chemically induced colitis in mice and undertreated ulcerative colitis (UC) in humans. This study aimed to explore how specific <i>CLEC5A</i> and <i>CLEC7A</i> polymorphisms contribute to the development of CD and UC.</p><p><strong>Methods: </strong>One hundred twelve CD patients, 94 UC patients and 164 sex- and age- matched healthy individuals were genotyped for the single nucleotide polymorphisms rs2078178 and rs16910631 of the <i>CLEC7A</i> gene, and rs1285933 of the <i>CLEC5A</i> gene.</p><p><strong>Results: </strong>The <i>CLEC7A</i> rs2078178 AA genotype was more frequent in UC patients compared to healthy individuals, The <i>CLEC7A</i> rs16910631 CT genotype was significantly associated with UC risk compared to healthy individuals, while there was no statistical correlation with CD. The <i>CLEC5A</i> rs1285933 GA genotype was found to be protective against UC and CD, and the AA genotype against CD. Carriers of the rs1285933 A allele appeared to have reduced susceptibility to CD, implying that the presence of the A allele could be protective against CD development.</p><p><strong>Conclusions: </strong>This is the first study to correlate the <i>CLEC5A</i> rs1285933 polymorphism with the risk for UC. The rs2078178 AA genotype and the <i>CLEC7A</i> rs16910631 CT could be promising biomarkers for UC susceptibility.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"64-70"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serial rotational thromboelastometry measurements show worsening hypocoagulability in acute-on-chronic liver failure and are associated with the severity of liver disease. 连续旋转血栓弹性测量显示,急性-慢性肝功能衰竭患者的低凝状态不断恶化,并与肝病的严重程度相关。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2024.0847
George Kampelos, Larisa Vasilieva, Theodoros Alexopoulos, Iliana Mani, Emilia Hadziyannis, Stavroula Giannouli, Sofia Manioudaki, Efrosyni Nomikou, Alexandra Alexopoulou

Background: Viscoelastic tests are used to better understand the complex picture of hemostasis in cirrhosis. Limited data exist regarding the clinical relevance of rotational thromboelastometry (ROTEM) in acute-on-chronic liver failure (ACLF) or acute decompensation (AD). We examined the pattern and role of sequential observations of 9 ROTEM components in both ACLF and AD groups.

Method: ROTEM measurements were compared within and between groups at 3 time points: on admission (T1), at 24 h (T2) and 48 h post-admission (T3).

Results: Forty-two consecutive patients (22 ACLF, 20 AD) were included. ROTEM determinants exhibited significant hypocoagulable deterioration in ACLF but not in AD over the 3 time points in clot formation time (CFT)EXTEM (P=0.01), maximum clot firmnessEXTEM (P=0.014), CFTINTEM (P<0.001), and alphaINTEM (P=0.028). The sum of hypocoagulable determinants increased from T1 to T3 in ACLF (P=0.029), but remained stable in AD. Five ROTEM variables showed significant differences towards hypocoagulability in ACLF compared to AD at T3. A "hypocoagulable" profile was associated with more severe liver disease (P<0.001 for model for end-stage liver disease [MELD] or Child-Pugh scores) and higher 30- and 90-day mortality (log-rank P=0.001 and P=0.013, respectively) but no more bleeding episodes or transfusions. Two ROTEM variables displayed strong correlations with MELD at T1 and 7 at T3 (|r coefficient|>0.5).

Conclusions: ROTEM measurements indicated worsening hypocoagulability shortly post-admission compared to baseline in ACLF, but remained stable in AD. The hypocoagulable derangement was mostly correlated with the severity of liver disease and higher short-term mortality, but not more bleeding episodes.

背景:粘弹性测试用于更好地了解肝硬化止血的复杂情况。关于旋转血栓弹性测定法(ROTEM)在急性慢性肝衰竭(ACLF)或急性失代偿期(AD)中的临床意义的数据有限。我们对 ACLF 和 AD 组中 9 个 ROTEM 组份的连续观察模式和作用进行了研究:方法:比较组内和组间在入院时(T1)、入院后 24 小时(T2)和入院后 48 小时(T3)3 个时间点的 ROTEM 测量结果:结果:共纳入 42 名连续患者(22 名 ACLF 患者,20 名 AD 患者)。在凝块形成时间(CFT)EXTEM(P=0.01)、最大凝块坚固度EXTEM(P=0.014)、CFTINTEM(PINTEM(P=0.028)这三个时间点上,ROTEM决定因素在ACLF患者中表现出明显的低凝恶化,而在AD患者中则没有。在 ACLF 中,低凝决定因素的总和从 T1 增加到 T3(P=0.029),但在 AD 中保持稳定。与 AD 相比,ACLF 在 T3 阶段的五个 ROTEM 变量在低凝性方面存在显著差异。低凝 "特征与更严重的肝病有关(P0.5):ROTEM测量结果表明,与基线相比,ACLF患者入院后不久的低凝状态恶化,但AD患者的低凝状态保持稳定。低凝紊乱主要与肝病的严重程度和较高的短期死亡率有关,但与出血次数无关。
{"title":"Serial rotational thromboelastometry measurements show worsening hypocoagulability in acute-on-chronic liver failure and are associated with the severity of liver disease.","authors":"George Kampelos, Larisa Vasilieva, Theodoros Alexopoulos, Iliana Mani, Emilia Hadziyannis, Stavroula Giannouli, Sofia Manioudaki, Efrosyni Nomikou, Alexandra Alexopoulou","doi":"10.20524/aog.2024.0847","DOIUrl":"10.20524/aog.2024.0847","url":null,"abstract":"<p><strong>Background: </strong>Viscoelastic tests are used to better understand the complex picture of hemostasis in cirrhosis. Limited data exist regarding the clinical relevance of rotational thromboelastometry (ROTEM) in acute-on-chronic liver failure (ACLF) or acute decompensation (AD). We examined the pattern and role of sequential observations of 9 ROTEM components in both ACLF and AD groups.</p><p><strong>Method: </strong>ROTEM measurements were compared within and between groups at 3 time points: on admission (T1), at 24 h (T2) and 48 h post-admission (T3).</p><p><strong>Results: </strong>Forty-two consecutive patients (22 ACLF, 20 AD) were included. ROTEM determinants exhibited significant hypocoagulable deterioration in ACLF but not in AD over the 3 time points in clot formation time (CFT)<sub>EXTEM</sub> (P=0.01), maximum clot firmness<sub>EXTEM</sub> (P=0.014), CFT<sub>INTEM</sub> (P<0.001), and alpha<sub>INTEM</sub> (P=0.028). The sum of hypocoagulable determinants increased from T1 to T3 in ACLF (P=0.029), but remained stable in AD. Five ROTEM variables showed significant differences towards hypocoagulability in ACLF compared to AD at T3. A \"hypocoagulable\" profile was associated with more severe liver disease (P<0.001 for model for end-stage liver disease [MELD] or Child-Pugh scores) and higher 30- and 90-day mortality (log-rank P=0.001 and P=0.013, respectively) but no more bleeding episodes or transfusions. Two ROTEM variables displayed strong correlations with MELD at T1 and 7 at T3 (|r coefficient|>0.5).</p><p><strong>Conclusions: </strong>ROTEM measurements indicated worsening hypocoagulability shortly post-admission compared to baseline in ACLF, but remained stable in AD. The hypocoagulable derangement was mostly correlated with the severity of liver disease and higher short-term mortality, but not more bleeding episodes.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"71-80"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic papillary large-balloon dilation with sphincterotomy for difficult common bile duct stones ≤12 mm: a prospective study. 内镜下乳头状大气囊扩张术加括约肌切开术治疗≤12毫米的胆总管疑难结石:一项前瞻性研究。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-23 DOI: 10.20524/aog.2023.0855
Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Gregorios Chlouverakis, Emmanouil Vardas, Gregorios Paspatis

Background: Stone recurrence is a significant complication following endoscopic bile duct clearance. Endoscopic papillary large-balloon dilation (EPLBD) with biliary sphincterotomy (EBS) has shown satisfactory results in preventing recurrence of "large" common bile duct stones (CBDS). However, data on outcomes after EPLBD+EBS for CBDS ≤12 mm remain scarce. The present study prospectively evaluated the mid- and long-term efficacy of EPLBD+EBS for CBDS recurrence among this group of patients.

Methods: Consecutive patients with CBDS ranging from 8-12 mm, treated with EPLBD+EBS from June 2018 through June 2020, were prospectively followed-up for at least 36 months. CBDS recurrence was defined as recurrent stones confirmed by endoscopic retrograde cholangiopancreatography (ERCP) during the follow-up period.

Results: Overall, 72 patients (mean age: 67 years, 52.8% male) were included, of whom 22 (30.5%) had multiple (≥3) CBDS, 23 (31.9%) had a history of cholecystectomy, 13 (18.1%) had a periampullary diverticulum and 22 (30.5%) had a previous EBS. The mean CBD diameter was 11.6±1 mm, while a tapered duct was noted in 7 (9.7%). Post-procedural bleeding and cholangitis occurred in 1 and 2 cases respectively. No cases of perforation and post-ERCP pancreatitis were observed. During a mean follow up of 46.4±6.2 months (range 37-60), no mid-term recurrence was observed, whereas CBDS recurred in 2/72 (2.7%) in the long term.

Conclusions: EPLBD+EBS in patients with CBDS ≤12 mm was associated with a very low rate of mid- and long-term CBDS recurrence. Our results need to be further investigated with randomized controlled trials.

背景:结石复发是内镜胆管清除术后的一个重要并发症。内镜下乳头大气囊扩张术(EPLBD)和胆道括约肌切开术(EBS)在预防 "大 "胆总管结石(CBDS)复发方面取得了令人满意的效果。然而,对于≤12 mm的CBDS,EPLBD+EBS术后的疗效数据仍然很少。本研究前瞻性地评估了 EPLBD+EBS 治疗这类患者 CBDS 复发的中长期疗效:从 2018 年 6 月到 2020 年 6 月,连续接受 EPLBD+EBS 治疗的 8-12 mm CBDS 患者接受了至少 36 个月的前瞻性随访。CBDS复发定义为随访期间经内镜逆行胰胆管造影(ERCP)证实的复发结石:共纳入 72 名患者(平均年龄:67 岁,52.8% 为男性),其中 22 人(30.5%)有多发性 CBDS(≥3),23 人(31.9%)有胆囊切除术史,13 人(18.1%)有胰周憩室,22 人(30.5%)曾有 EBS。CBD 的平均直径为 11.6±1 mm,7 例(9.7%)患者的胆管呈锥形。术后出血和胆管炎的病例分别为 1 例和 2 例。未观察到穿孔和ERCP术后胰腺炎病例。在平均 46.4±6.2 个月(37-60 个月)的随访期间,未观察到中期复发,而 2/72 例(2.7%)CBDS 长期复发:CBDS≤12毫米患者接受EPLBD+EBS治疗后,CBDS中长期复发率非常低。我们的结果需要通过随机对照试验进一步研究。
{"title":"Endoscopic papillary large-balloon dilation with sphincterotomy for difficult common bile duct stones ≤12 mm: a prospective study.","authors":"Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Gregorios Chlouverakis, Emmanouil Vardas, Gregorios Paspatis","doi":"10.20524/aog.2023.0855","DOIUrl":"10.20524/aog.2023.0855","url":null,"abstract":"<p><strong>Background: </strong>Stone recurrence is a significant complication following endoscopic bile duct clearance. Endoscopic papillary large-balloon dilation (EPLBD) with biliary sphincterotomy (EBS) has shown satisfactory results in preventing recurrence of \"large\" common bile duct stones (CBDS). However, data on outcomes after EPLBD+EBS for CBDS ≤12 mm remain scarce. The present study prospectively evaluated the mid- and long-term efficacy of EPLBD+EBS for CBDS recurrence among this group of patients.</p><p><strong>Methods: </strong>Consecutive patients with CBDS ranging from 8-12 mm, treated with EPLBD+EBS from June 2018 through June 2020, were prospectively followed-up for at least 36 months. CBDS recurrence was defined as recurrent stones confirmed by endoscopic retrograde cholangiopancreatography (ERCP) during the follow-up period.</p><p><strong>Results: </strong>Overall, 72 patients (mean age: 67 years, 52.8% male) were included, of whom 22 (30.5%) had multiple (≥3) CBDS, 23 (31.9%) had a history of cholecystectomy, 13 (18.1%) had a periampullary diverticulum and 22 (30.5%) had a previous EBS. The mean CBD diameter was 11.6±1 mm, while a tapered duct was noted in 7 (9.7%). Post-procedural bleeding and cholangitis occurred in 1 and 2 cases respectively. No cases of perforation and post-ERCP pancreatitis were observed. During a mean follow up of 46.4±6.2 months (range 37-60), no mid-term recurrence was observed, whereas CBDS recurred in 2/72 (2.7%) in the long term.</p><p><strong>Conclusions: </strong>EPLBD+EBS in patients with CBDS ≤12 mm was associated with a very low rate of mid- and long-term CBDS recurrence. Our results need to be further investigated with randomized controlled trials.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"89-94"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chronic constipation in Parkinson's disease: clinical features and molecular insights on the intestinal epithelial barrier. 帕金森病患者的慢性便秘:临床特征和对肠道上皮屏障的分子认识。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-23 DOI: 10.20524/aog.2023.0851
Alexandros Ioannou, Anna Costanzini, Fiorella Giancola, Luis Cabanillas, Lisa Lungaro, Francesca Manza, Matteo Guarino, Rosario Arena, Giacomo Caio, Francesco Torresan, Andreas Polydorou, Antonios Vezakis, George Karamanolis, Catia Sternini, Roberto De Giorgio

Background: Chronic constipation (CC) is a severe symptom in Parkinson's disease (PD), with an unclear pathogenesis. Abnormalities of the enteric nervous system (ENS) and/or intestinal epithelial barrier (IEB) may be pathophysiologically relevant in PD patients with CC. We investigated possible molecular changes of the IEB in PD/CCs compared with CCs and controls.

Methods: Twelve PD/CCs (2 female, age range 51-80 years), 20 CCs (15 female, age range 27-78 years), and 23 controls (11 female, age range 32-74 years) were enrolled. Ten PD/CCs and 10 CCs were functionally characterized by anorectal manometry (AM) and transit time (TT). Colon biopsies were obtained and assessed for gene and protein expression, and localization of IEB tight junction markers claudin-4 (CLDN4), occludin-1 (OCCL-1), and zonula occludens-1 (ZO-1) by RT-qPCR, immunoblot and immunofluorescence labeling.

Results: PD/CCs were clustered in 2 functional categories: patients with delayed TT and altered AM (60%), and a second group showing only modifications in AM pattern (40%). Gene expression of CLDN4, OCCL-1 and ZO-1 was higher in PD/CCs than controls (P<0.05). Conversely, PD/CCs showed a trend to decrease (P>0.05) in CLDN4 and OCCL-1 protein levels than controls, whereas ZO-1 protein was comparable. In PD/CCs compared with controls, decreasing tendency of vasoactive intestinal polypeptide mRNA, protein and immunoreactive fiber density were observed, although the difference was not statistically significant.

Conclusion: Transit and anorectal dysfunctions in PD/CCs are associated with difference in ZO-1, OCCL-1 and CLDN4 expression, thus supporting the role of an altered IEB as a contributory mechanism to possible neuronal abnormalities.

背景:慢性便秘(CC)是帕金森病(PD)的一种严重症状,其发病机制尚不清楚。肠神经系统(ENS)和/或肠上皮屏障(IEB)的异常可能与帕金森病伴有慢性便秘的患者的病理生理学相关。我们研究了与CC和对照组相比,PD/CC患者肠上皮屏障可能发生的分子变化:我们招募了 12 名 PD/CC(2 名女性,年龄在 51-80 岁之间)、20 名 CC(15 名女性,年龄在 27-78 岁之间)和 23 名对照组(11 名女性,年龄在 32-74 岁之间)。10 名 PD/CCs 和 10 名 CCs 通过肛门直肠测压(AM)和转运时间(TT)进行功能测试。通过 RT-qPCR、免疫印迹和免疫荧光标记,对结肠活检组织的基因和蛋白质表达以及 IEB 紧密连接标记物 claudin-4 (CLDN4)、occludin-1 (OCCL-1) 和 zonula occludens-1 (ZO-1) 的定位进行评估:结果:PD/CCs被分为两类:一类是TT延迟和AM改变的患者(60%),另一类是仅显示AM模式改变的患者(40%)。PD/CCs中CLDN4、OCCL-1和ZO-1的基因表达高于对照组(P0.05),CLDN4和OCCL-1蛋白水平高于对照组,而ZO-1蛋白水平与对照组相当。与对照组相比,PD/CC 中血管活性肠肽 mRNA、蛋白和免疫活性纤维密度均呈下降趋势,但差异无统计学意义:结论:PD/CCs 的转运和肛门直肠功能障碍与 ZO-1、OCCL-1 和 CLDN4 表达的差异有关,因此支持 IEB 的改变是可能导致神经元异常的机制之一。
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引用次数: 0
Efficacy and adverse effects of insulin versus plasmapheresis in patients with hypertriglyceridemia-3-induced acute pancreatitis: a systematic review and meta-analysis. 高甘油三酯血症-3诱发急性胰腺炎患者使用胰岛素与浆细胞分离疗法的疗效和不良反应:系统综述和荟萃分析。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2023.0849
Shobhit Piplani, Arpit Jain, Kamaldeep Singh, Shreya Gulati, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Gavro Jelic, Rosalba Santana De Roberts, Dushyant Damania, Miroslav Radulovic

Background: Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP.

Methods: Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269.

Results: From this study's analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively).

Conclusions: This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.

背景:高甘油三酯血症是急性胰腺炎(AP)的常见病因。本文献综述比较了胰岛素治疗(无论是否使用肝素)和血浆置换术在降低高甘油三酯血症诱发的急性胰腺炎患者甘油三酯水平方面的有效性和不良反应:排除系统综述、荟萃分析、证据综述、社论、评论、协议、摘要、论文和预印本。使用综述管理器进行荟萃分析。文献检索共获得 2765 篇文章,但只有 5 篇被纳入系统综述和荟萃分析,参与综述的总人数为 269 人:从该研究的分析结果来看,胰岛素±肝素疗法在降低甘油三酯水平方面比浆溶疗法更成功(标准化平均差异-0.37,95% 置信区间[CI] 0.99 至 0.25;P=0.25)。胰岛素和肝素疗法的死亡率低于血浆置换疗法(风险比 [RR] 0.70,95%CI 0.25-1.95)。与胰岛素±肝素疗法相比,血浆置换疗法组的低血压、低血糖和急性肾功能衰竭发生率较低(低血压、低血糖和急性肾功能衰竭的发生率分别为 RR 1.13,95%CI 0.46-2.81;RR 3.90,95%CI 0.45-33.78;RR 0.48,95%CI 0.02-13.98):本研究发现,胰岛素±肝素疗法和血浆置换疗法在降低甘油三酯水平方面的死亡率没有明显差异。值得注意的是,在这两种疗法中最常见的副作用方面也没有发现明显差异,因此表明这两种疗法并无优劣之分。
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引用次数: 0
Long-term aspirin use in patients hospitalized with ischemic colitis. 缺血性结肠炎住院患者长期服用阿司匹林。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2024.0848
Humzah Iqbal, Rakahn Haddadin, Patrick Zhang, Hasib Haidary, Devang Prajapati

Background: Ischemic colitis is a form of mesenteric ischemia that often presents in patients with vascular disease. Long-term aspirin use has been shown to improve the outcomes in patients with cardiovascular or cerebrovascular disease. However, the relationship between aspirin use and ischemic colitis is unclear.

Methods: Patients with a diagnosis of ischemic colitis were identified using the 2020 Nationwide Inpatient Sample. Patients were stratified by long-term aspirin use at the time of hospitalization. Data were collected regarding mortality, bowel perforation, peritonitis, shock, blood transfusion, length of stay in days (LOS), hospital charges, age, sex, race, primary insurance, median income, hospital region, hospital size, and comorbidities. The relationship between aspirin use and outcomes was analyzed using multivariate regression analysis.

Results: A total of 67,685 patients were included. Aspirin users had a mean age of 72.8 years compared to 66.8 years for non-aspirin users. Long-term aspirin use was associated with a lower risk of in-hospital mortality (P<0.001), bowel perforation (P<0.001), peritonitis (P=0.01), shock (P<0.001), and blood transfusion (P<0.001). The mean LOS was 6.1 days in the aspirin group compared to 9.4 days in the non-aspirin group. Ischemic colitis patients taking aspirin had a mean hospitalization charge of $87,123 compared to $161,610 for those not using aspirin.

Conclusions: Our study examined the impact of aspirin use in ischemic colitis patients. Among patients hospitalized with ischemic colitis, we found that long-term aspirin use was associated with a lower risk of in-hospital mortality and adverse events.

背景:缺血性结肠炎是肠系膜缺血的一种形式,通常出现在患有血管疾病的患者身上。长期服用阿司匹林可改善心脑血管疾病患者的预后。然而,阿司匹林的使用与缺血性结肠炎之间的关系尚不清楚:方法:利用 2020 年全国住院患者样本对诊断为缺血性结肠炎的患者进行识别。根据住院时长期服用阿司匹林的情况对患者进行分层。收集的数据包括死亡率、肠穿孔、腹膜炎、休克、输血、住院天数(LOS)、住院费用、年龄、性别、种族、主要保险、收入中位数、医院所在地区、医院规模和合并症。使用多变量回归分析法分析了阿司匹林的使用与结果之间的关系:共纳入 67,685 名患者。阿司匹林使用者的平均年龄为 72.8 岁,而非阿司匹林使用者的平均年龄为 66.8 岁。长期服用阿司匹林与较低的院内死亡风险有关(结论:我们的研究探讨了阿司匹林对急性心肌梗死的影响:我们的研究探讨了阿司匹林对缺血性结肠炎患者的影响。在住院的缺血性结肠炎患者中,我们发现长期服用阿司匹林与较低的院内死亡和不良事件风险有关。
{"title":"Long-term aspirin use in patients hospitalized with ischemic colitis.","authors":"Humzah Iqbal, Rakahn Haddadin, Patrick Zhang, Hasib Haidary, Devang Prajapati","doi":"10.20524/aog.2024.0848","DOIUrl":"10.20524/aog.2024.0848","url":null,"abstract":"<p><strong>Background: </strong>Ischemic colitis is a form of mesenteric ischemia that often presents in patients with vascular disease. Long-term aspirin use has been shown to improve the outcomes in patients with cardiovascular or cerebrovascular disease. However, the relationship between aspirin use and ischemic colitis is unclear.</p><p><strong>Methods: </strong>Patients with a diagnosis of ischemic colitis were identified using the 2020 Nationwide Inpatient Sample. Patients were stratified by long-term aspirin use at the time of hospitalization. Data were collected regarding mortality, bowel perforation, peritonitis, shock, blood transfusion, length of stay in days (LOS), hospital charges, age, sex, race, primary insurance, median income, hospital region, hospital size, and comorbidities. The relationship between aspirin use and outcomes was analyzed using multivariate regression analysis.</p><p><strong>Results: </strong>A total of 67,685 patients were included. Aspirin users had a mean age of 72.8 years compared to 66.8 years for non-aspirin users. Long-term aspirin use was associated with a lower risk of in-hospital mortality (P<0.001), bowel perforation (P<0.001), peritonitis (P=0.01), shock (P<0.001), and blood transfusion (P<0.001). The mean LOS was 6.1 days in the aspirin group compared to 9.4 days in the non-aspirin group. Ischemic colitis patients taking aspirin had a mean hospitalization charge of $87,123 compared to $161,610 for those not using aspirin.</p><p><strong>Conclusions: </strong>Our study examined the impact of aspirin use in ischemic colitis patients. Among patients hospitalized with ischemic colitis, we found that long-term aspirin use was associated with a lower risk of in-hospital mortality and adverse events.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"31-36"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Novel predictors of response to therapy with terlipressin and albumin in hepatorenal syndrome-acute kidney injury. 肝肾综合征-急性肾损伤患者对特利加压素和白蛋白治疗反应的新预测指标。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-23 DOI: 10.20524/aog.2023.0853
Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty

Background: A combination of terlipressin and albumin is the first-line pharmacologic treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI). We assessed the response rates to terlipressin-albumin therapy in patients with HRS-AKI and determined early predictors of treatment response and survival.

Methods: A total of 84 patients with HRS-AKI (International Club of Ascites definition 2015) treated with terlipressin-albumin were included. Predictors of HRS reversal were identified by logistic regression analysis. Survival analysis was performed using the Kaplan-Meier method, and Cox regression models were used to determine independent predictors of mortality.

Results: Complete response to therapy was observed in 54.8%, partial response in 14.3%, and no response in 31% of patients. The factors associated with complete treatment response were the presence of systemic inflammatory response syndrome (SIRS), baseline serum creatinine, a rise in mean arterial pressure by day 3, and a reduction in the renal resistive index (ΔRRI) by day 3 of treatment. Independent predictors of HRS reversal were the presence of SIRS at baseline (P=0.022; odds ratio [OR] 15.74, 95% confidence interval [CI] 1.47-167.82) and ΔRRI ≥5% by day 3 of treatment (P=0.048; OR 6.67, 95%CI 1.021-43.62). Mean transplant-free survival at 6 months was significantly better in treatment responders (148 vs. 90 days, P<0.001). Independent predictors of 6-month mortality were response to treatment (P=0.004) and model for end-stage liver disease-sodium >23 (P=0.018).

Conclusions: SIRS and ΔRRI are simple parameters to predict treatment response in HRS-AKI. Non-responders have higher mortality and should be identified early to expedite liver transplantation.

背景:特利加压素和白蛋白联合疗法是肝肾综合征-急性肾损伤(HRS-AKI)的一线药物治疗方法。我们评估了 HRS-AKI 患者对特利加压素-白蛋白疗法的反应率,并确定了治疗反应和生存的早期预测因素:共纳入84名接受特利加压素-白蛋白治疗的HRS-AKI(国际腹水俱乐部2015年定义)患者。通过逻辑回归分析确定了HRS逆转的预测因素。采用 Kaplan-Meier 法进行生存分析,并使用 Cox 回归模型确定死亡率的独立预测因素:54.8%的患者对治疗有完全反应,14.3%的患者有部分反应,31%的患者无反应。与完全治疗反应相关的因素包括全身炎症反应综合征(SIRS)、基线血清肌酐、治疗第 3 天前平均动脉压升高以及治疗第 3 天前肾脏阻力指数(ΔRRI)降低。HRS逆转的独立预测因素是基线时存在SIRS(P=0.022;比值比[OR]15.74,95%置信区间[CI]1.47-167.82)和治疗第3天时ΔRRI≥5%(P=0.048;比值比6.67,95%置信区间1.021-43.62)。治疗应答者6个月的平均无移植生存期明显更长(148天 vs. 90天,P23(P=0.018)):结论:SIRS和ΔRRI是预测HRS-AKI治疗反应的简单参数。结论:SIRS和ΔRRI是预测HRS-AKI治疗反应的简单参数,无反应者死亡率较高,应及早识别以加快肝移植。
{"title":"Novel predictors of response to therapy with terlipressin and albumin in hepatorenal syndrome-acute kidney injury.","authors":"Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty","doi":"10.20524/aog.2023.0853","DOIUrl":"10.20524/aog.2023.0853","url":null,"abstract":"<p><strong>Background: </strong>A combination of terlipressin and albumin is the first-line pharmacologic treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI). We assessed the response rates to terlipressin-albumin therapy in patients with HRS-AKI and determined early predictors of treatment response and survival.</p><p><strong>Methods: </strong>A total of 84 patients with HRS-AKI (International Club of Ascites definition 2015) treated with terlipressin-albumin were included. Predictors of HRS reversal were identified by logistic regression analysis. Survival analysis was performed using the Kaplan-Meier method, and Cox regression models were used to determine independent predictors of mortality.</p><p><strong>Results: </strong>Complete response to therapy was observed in 54.8%, partial response in 14.3%, and no response in 31% of patients. The factors associated with complete treatment response were the presence of systemic inflammatory response syndrome (SIRS), baseline serum creatinine, a rise in mean arterial pressure by day 3, and a reduction in the renal resistive index (ΔRRI) by day 3 of treatment. Independent predictors of HRS reversal were the presence of SIRS at baseline (P=0.022; odds ratio [OR] 15.74, 95% confidence interval [CI] 1.47-167.82) and ΔRRI ≥5% by day 3 of treatment (P=0.048; OR 6.67, 95%CI 1.021-43.62). Mean transplant-free survival at 6 months was significantly better in treatment responders (148 vs. 90 days, P<0.001). Independent predictors of 6-month mortality were response to treatment (P=0.004) and model for end-stage liver disease-sodium >23 (P=0.018).</p><p><strong>Conclusions: </strong>SIRS and ΔRRI are simple parameters to predict treatment response in HRS-AKI. Non-responders have higher mortality and should be identified early to expedite liver transplantation.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"81-88"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The inflammatory bowel disease care manager: Italian state of the art. 炎症性肠病护理经理:意大利现状。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-23 DOI: 10.20524/aog.2023.0852
Daniele Napolitano, Federica Di Vincenzo, Nicoletta Orgiana, Elisa Schiavoni, Francesco Germini, Daniela Pugliese, Franco Scaldaferri

Background: In the inflammatory bowel disease (IBD) multidisciplinary team, a key figure is the IBD care manager, usually an independent practice nurse, responsible for evidence-based assessment, care planning, treatment evaluation, and provision of practical information, health education, and emotional support to patients. The objective of this study was to evaluate the profile of this figure in Italy.

Methods: A team of experienced nurses created a questionnaire based on the Second N-ECCO declaration, which was administered to nurses who worked in an IBD unit for a period of at least 3 years. A definition of IBD care manager was provided to every participant. The questionnaire consisted of 3 sections: behavioral, knowledge and managerial skills that an IBD care manager should exhibit. Results were studied in relation to the benefits for the patient, organizational advantages, clinical advantages and Italian state of the art.

Results: Fifty-five nurses participated in the study, from 28 Italian centers. In the evaluation of behavioral skills of IBD care managers, "management and support of the pregnant patient" was the lowest scored item, while "patient privacy" obtained higher scores. In the evaluation of knowledge, "knowledge of intimacy and sexuality" obtained the lowest scores, while "knowledge of psychophysical and social impact of the disease" obtained a higher score. In managerial skills "management of pain" obtained the lowest scores.

Conclusion: Our study confirmed that IBD care managers are invaluable nursing figures within the multidisciplinary team that cares for IBD patients, providing benefits to both patients' clinics and management.

背景:在炎症性肠病(IBD)多学科团队中,IBD 护理经理是一个关键人物,通常由独立执业的护士担任,负责循证评估、护理计划、治疗评估,并为患者提供实用信息、健康教育和情感支持。本研究的目的是评估意大利这一角色的概况:一个由经验丰富的护士组成的小组根据第二份 N-ECCO 声明制作了一份调查问卷,并对在 IBD 病区工作至少 3 年的护士进行了问卷调查。每位参与者都获得了 IBD 护理管理者的定义。问卷包括三个部分:IBD 护理管理者应具备的行为、知识和管理技能。研究结果涉及对患者的益处、组织优势、临床优势和意大利的技术水平:来自 28 个意大利中心的 55 名护士参加了研究。在对 IBD 护理管理者行为技能的评估中,"对怀孕患者的管理和支持 "得分最低,而 "患者隐私 "得分较高。在知识评估中,"亲密关系和性知识 "得分最低,而 "疾病对心理生理和社会影响的知识 "得分较高。在管理技能方面,"疼痛管理 "得分最低:我们的研究证实,IBD 护理管理者是护理 IBD 患者的多学科团队中不可或缺的护理人物,对患者的临床和管理都有益处。
{"title":"The inflammatory bowel disease care manager: Italian state of the art.","authors":"Daniele Napolitano, Federica Di Vincenzo, Nicoletta Orgiana, Elisa Schiavoni, Francesco Germini, Daniela Pugliese, Franco Scaldaferri","doi":"10.20524/aog.2023.0852","DOIUrl":"10.20524/aog.2023.0852","url":null,"abstract":"<p><strong>Background: </strong>In the inflammatory bowel disease (IBD) multidisciplinary team, a key figure is the IBD care manager, usually an independent practice nurse, responsible for evidence-based assessment, care planning, treatment evaluation, and provision of practical information, health education, and emotional support to patients. The objective of this study was to evaluate the profile of this figure in Italy.</p><p><strong>Methods: </strong>A team of experienced nurses created a questionnaire based on the Second N-ECCO declaration, which was administered to nurses who worked in an IBD unit for a period of at least 3 years. A definition of IBD care manager was provided to every participant. The questionnaire consisted of 3 sections: behavioral, knowledge and managerial skills that an IBD care manager should exhibit. Results were studied in relation to the benefits for the patient, organizational advantages, clinical advantages and Italian state of the art.</p><p><strong>Results: </strong>Fifty-five nurses participated in the study, from 28 Italian centers. In the evaluation of behavioral skills of IBD care managers, \"management and support of the pregnant patient\" was the lowest scored item, while \"patient privacy\" obtained higher scores. In the evaluation of knowledge, \"knowledge of intimacy and sexuality\" obtained the lowest scores, while \"knowledge of psychophysical and social impact of the disease\" obtained a higher score. In managerial skills \"management of pain\" obtained the lowest scores.</p><p><strong>Conclusion: </strong>Our study confirmed that IBD care managers are invaluable nursing figures within the multidisciplinary team that cares for IBD patients, providing benefits to both patients' clinics and management.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"37-45"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Annals of Gastroenterology
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