BMC Gastroenterology最新文献

Introduction: Hypercoagulability contributes to the majority of deaths and organ failure associated with obstructive jaundice (OJ). However, the exact mechanism of the coagulopathy in OJ remains elusive. Our objectives were to demonstrate whether phosphatidylserine (PS) exposure on blood cells (BCs), microparticles (MPs), and endothelial cells (ECs) can account for the hypercoagulability and liver damage in OJ patients.

Methods: We evaluated OJ patients at two time point, which before (Day 0) and 7 days (Day 7) after the endoscopic retrograde cholangiopancreatography procedure (ERCP), and compared with healthy controls. Lactadherin was used to quantify PS exposure on BCs, MPs and ECs. Human umbilical vein endothelial cells (HUVECs) were incubated with serum of OJ patients and the expression of PS were evaluated. Meanwhile, healthy BCs and HUVECs were treated with 0, 25, 50 or 100µM unconjugated bilirubin (UCB) and PS exposure on cells were evaluated. Procoagulant activity was evaluated by purified coagulation complex assays, clotting time, and fibrin turbidity. In addition, we established a cholestatic mouse model by bile duct ligation to determine the potential role of PS in intrahepatic coagulation and liver damage.

Results: Using flow cytometry, we found that OJ patients exhibited elevated levels of PS + BCs and associated MPs compared to the controls. Furthermore, the number of PS + BCs and MPs in patients at Day 0 were significantly higher than in patients at Day 7. Similarly, we observed markedly elevated PS exposure on HUVECs cultured with serum from patients at Day 0 versus serum from patients at Day 7. In vitro assays, PS exposure on BCs and HUVECs progressively increased with the concentration of UCB. Moreover, PS + BCs and MPs contributed to greatly shortened coagulation time and markedly enhanced coagulation factor Xa, thrombin, and fibrin generation. This procoagulant activity could be blocked approximately 80%, by the addition of lactadherin. Moreover, cholestatic mice exhibited significantly increased levels of liver tissue necrosis, fibrin deposition, and thrombophilia compared to sham mice. The enhanced intrahepatic coagulation and liver injury could be reversed by inhibiting PS with lactadherin.

Conclusions: These results highlight the pathogenic activity of PS + cells and MPs in promoting a prothrombotic environment and liver damage in OJ. As such, lactadherin, a PS blockade, may be a viable therapeutic strategy for treating such patients.

Background: Restrictive eating behaviors are common among patients with inflammatory bowel disease (IBD), which may may develop nutritional and/or quality of life impairments into avoidant/restrictive food intake disorder (ARFID). The objective of this study is to estimate the prevalence and characteristics of ARFID in Chinese patients with IBD, and to investigate the current perceptions and dietary behaviors of patients with and without ARFID.

Methods: A cross-sectional study was conducted in gastroenterology clinics of four tertiary hospitals in China. Patients with IBD were asked to complete a structured questionnaire including demographic characteristics, dietary attitudes and behaviors. The diagnosis of ARFID was established using Chinese version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen questionnaire.

Results: A total of 483 patients with IBD completed the questionnaires, and 20.3% met clinical criteria for ARFID. The average score of ARFID was 21.9 (interquartile range = 17.0-26.0). Multivariable binary logistic regression results showed that patients with Crohn's disease (OR = 0.483, 95%CI = 0.280-0.835; p = 0.009), being in an active disease state (OR = 0.220, 95%CI = 0.123-0.392; p < 0.001), holding dietary attitudes regarding symptom control (OR = 2.431, 95%CI = 1.299-4.548; p = 0.005), and reporting a specific dietary history (OR = 27.158, 95%CI = 3.679-200.456; p = 0.001) were significant more likely to suffer from ARFID.

Conclusions: ARFID is a common problem among patients with IBD. The incidence of ARFID is particularly high among patients with Crohn's disease, during relapse, and those who hold restrictive dietary attitudes or have a history of specific diets. Therefore, it is imperative to prioritize routine screening and early identification of ARFID, especially among high-risk populations, in future research and clinical practice.

Trial registration: ChiCTR2100051539, on 26 September 2021.

Background: Considering the role of leukotrienes in inflammatory pathways, and owing to the anti-leukotrienes effect of montelukast, in the present clinical trial, we aimed to assess the effect of montelukast on remission maintenance in patients with ulcerative colitis (UC).

Methods: In the present double-blind randomized controlled clinical trial, 222 volunteer UC patients on high-dose corticosteroid and montelukast were recruited. The patients received 10 mg of montelukast (98 patients) or placebo (124 patients) for 22 weeks. Simultaneously, the prednisolone dose was tapered. The patients were followed up eight more weeks post-interventions. The primary efficacy of the treatment was remaining in remission.

Results: 194 patients completed this study. During the study, relapse occurred in 108 patients, 32 patients in the montelukast group and 76 patients in the placebo group. There were significant differences between groups regarding the relapse-free period (intervention group mean: 27.25 95% CI: 26.17-28.32 weeks and placebo group mean: 20.88; 95% CI: 19.36, 20.40 weeks, P < 0.001). At the end of the intervention period and six weeks' post-intervention, the mean partial Mayo score, and inflammatory biomarkers were significantly lower in the montelukast group compared with the placebo group. The frequency of patients with high fecal calprotectin levels was significantly higher in the placebo group compared with the montelukast Group.

Conclusion: The findings indicated that compared with placebo, montelukast had a significant positive effect on remission maintenance in UC patients who were in the steroid-tapering phase of therapy.

Clinical trial registration number: IRCT20121212011738N3.

Background: The present study is an online survey to determine the quality of life and functional impairment caused by irritable bowel syndrome (IBS) and the healthcare experiences of IBS patients in Norway, which has not been done previously.

Methods: An author-developed, online questionnaire using Microsoft Forms program was applied. The questionnaire comprised 52 questions. The questionnaire was posted from 1 March to 17 April (a 48-day period) on the Norwegian Gastrointestinal Association website and in its magazine and social media posts.

Results: The questionnaire was completed by 2727 patients. Of these patients 327 were excluded because they have not been diagnosed by a medical doctor. IBS reduced the quality of life in 97% of affected patients, including the social life in 90% and the sexual life in 69%. The unemployment rate of IBS patients in Norway 38%, which is 10-fold higher than that of the general population, and 94% of IBS patients reported that IBS impaired their work/study performance. About half of the patients had to discuss their abdominal symptoms with their general practitioner (GP) more than 10 times and wait more than 1 years before being diagnosed. Only 34% and 48% were satisfied with the help they received from their GP and gastroenterologist, respectively. Only 18% and 43% of the IBS patients felt that their GP and gastroenterologist, respectively, were sufficiently knowledgeable about IBS. Only 21% of the IBS patients was satisfied with the treatment they received.

Conclusions: IBS markedly reduces the affected patient's quality of life and their working productivity. IBS patients are generally dissatisfied with the clinical management they receive from GPs and gastroenterologists.

Background: Choledocholithiasis has been reported to be associated with the occurrence of cholangiocarcinoma (CCA); however, the association has not yet been sufficiently demonstrated. This study aimed to evaluate the association between choledocholithiasis (common bile duct stones) and CCA.

Methods: This nationwide retrospective cohort study used the Health Insurance Review and Assessment database of individuals diagnosed with choledocholithiasis between 2008 and 2009 in South Korea. Individuals were stratified by age, and CCA was categorized into extrahepatic CCA (ECA) and intrahepatic CCA (ICA). The standardized incidence ratio (SIR) was calculated to compare CCA incidence between patients with choledocholithiasis and the general population.

Results: The study enrolled 20,808 patients with choledocholithiasis (52.35% men and 47.65% women; male-to-female ratio: 1.09:1). Over a 10-year follow-up period, CCA occurred in 548 (2.64%) patients, comprising 238 (1.14%) ECA cases and 310 (1.48%) ICA cases. The SIR was 25.23 (95% confidence interval [CI]: 21.98-28.85) for ECA and 24.64 (95% CI: 21.87-27.73) for ICA. Statistical significance persisted even after excluding cases within the first 2 years from the index date, with an SIR of 18.63 (95% CI: 16.23-21.28) for ICA and 12.73 (95% CI: 10.50-15.30) for ECA. The SIRs peaked in patients diagnosed with choledocholithiasis at the age of 70-79 years (SIR 16.61, 95% CI: 11.83-22.69) for ECA and 60-69 years (SIR 29.27, 95% CI: 23.53-36.03) for ICA.

Conclusion: Our study demonstrated a significant association between choledocholithiasis and cholangiocarcinoma, particularly those in their 70s for ECA and 60s for ICA. However, causation cannot be established due to the retrospective design.

Background and aims: Past studies have shown a substantial overlap between irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). This study investigated the prevalence of DCPR-revised (DCPR-R) syndromes in patients with IBS alone and those with overlapping IBS-GERD. We also explored the relationship of these syndromes with various psychological scales.

Methods: In total, 341 patients from the Chinese IBS cohort completed the GerdQ scale and a series of psychological questionnaires. Semi-structured interviews were conducted to evaluate DCPR-R, as well as scores on the Psychosocial Index (PSI), Psychosomatic Symptom Scale (PSSS), World Health Organization (WHO)-5 Well-being Index, Euthymia Scale, Patient Health Questionnaire-9, and 7-item Generalized Anxiety Disorder Scale.

Results: Compared with patients with IBS alone, patients with overlapping IBS-GERD had a significantly higher prevalence of DCPR-R syndromes, particularly in areas such as demoralization, persistent somatization, despair-related demoralization, hypochondriasis, disease phobia, anniversary reaction, thanatophobia, and conversion symptoms. Patients with two or more types of DCPR-R syndromes were more likely to exhibit psychological disorders. In patients with IBS alone, the WHO-5 Well-being Index and PSI well-being scores were predictive of two or more DCPR-R syndromes. For patients with overlapping IBS-GERD, the PSSS score was an independent predictor.

Conclusion: This study highlights key differences in psychosomatic factors between patients with IBS alone and those with overlapping IBS-GERD. The DCPR-R syndromes and various psychological scales offer valuable tools for diagnosing and assessing these differences.

Background: Obesity is detrimental to liver health. Weight-adjusted waist circumference (WWI) is a new indicator of obesity that is superior to body mass index (BMI) and waist circumference (WC) in predicting obesity. There are limited studies on the relationship between Metabolic Associated Fatty Liver Disease (MASLD) and WWI. Therefore, this study aimed to investigate the association between WWI, Controlled Attenuation Parameters (CAP), and Liver Stiffness Measurement (LSM), with special attention to gender differences.

Methods: This cross-sectional study included participants from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES). The study used multiple linear regression models, smoothed curves, and threshold effects analyses to describe the relationships between variables. Multiple regression analyses were used to examine the associations between the four obesity indicators and CAP and LSM. Subject work characteristics (ROC) curves were used to assess the predictive value of WWI and other traditional obesity indicators for hepatic steatosis and liver fibrosis, and predictive power was assessed by area under the curve (AUC).

Results: The study involved 6713 participants, including 3072 men (46%) and 3641 women (54%). The results showed that among female participants, higher WWI was associated with hepatic steatosis (OR = 1.71, 95% CI: 1.43, 2.04; P < 0.0001) and hepatic fibrosis (OR = 2.11, 95% CI: 1.58, 2.84; P < 0.0001). Smoothed curve fitting of WWI versus CAP showed a statistically significant positive correlation between WWI in male and female participants There was a statistically significant positive correlation with CAP for both male and female participants. The same significant non-linear relationship was found between WWI and LSM, with no significant difference between males and females. WWI was also a good predictor of hepatic steatosis compared to other obesity indicators and was more pronounced in male participants (AUC = 0.8224). Whereas in the comparison of WWI with LSM, wBMI was a better predictor in female participants (AUC = 0.7751).

Conclusions: Based on this study, WWI was significantly associated with the risk of hepatic steatosis and hepatic fibrosis in women, suggesting the potential of WWI as a screening tool. Due to the cross-sectional design, causality cannot be inferred. Longitudinal studies are needed to validate our findings.

Purpose: To investigate the impact of implementing a pre-hospitalization optimization strategy on the length of stay and hospital costs for patients undergoing gallbladder surgery at a tertiary hospital, this study aims to analyze patient characteristics relevant to pre-hospitalization gallbladder surgery, focusing on age and underlying medical conditions.

Method: The data from patients who underwent the pre-hospitalization optimization strategy were analyzed and compared with that of patients receiving standard hospitalization to determine whether there were statistically significant differences in duration of stay and associated costs.

Results: Under the optimal management strategy for pre-hospitalization, we analyzed the hospitalization of patients with and without underlying diseases, specifically comparing those aged over 65 years to those under 65 years, against a cohort of general hospitalized patients. The results indicated a significant reduction in preoperative preparation time, postoperative recovery time, total hospitalization days, and hospitalization costs (P < 0.05). Notably, pre-hospitalized patients under 65 years exhibited a significant decrease in postoperative recovery time and total hospitalization days compared to general hospitalized patients (P < 0.05), while the difference in preoperative preparation time was not statistically significant (P > 0.05).

Conclusion: The pre-hospitalization optimization strategy management model can significantly reduce the duration of hospital stays and medical costs for gallbladder surgery patients. This model is advocated for all patients, irrespective of whether they are aged 65 or above, or below 65.