Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Gastroesophageal reflux disease (GERD) is widespread in the population and is characterized by the risk of developing Barrett's esophagus and associated adenocarcinoma. Key factors in the progression of the disease are not only the frequency and duration of reflux episodes, but also the resistance of the esophageal mucosa to aggressive reflux molecules. Assessment of the state of tight junction proteins, the rate of their recovery under the influence of various treatment regimens is an urgent task for choosing optimal approaches to curing patients with GERD. The purpose of the study was to evaluate the efficacy and safety of the combination therapy with a proton pump inhibitor (PPI) and a topical mucosal protective agent (MPA) to relieve GERD symptoms and achieve a complete remission of reflux esophagitis faster.

Methods: 60 patients (38 men and 22 women with an average age 41.5 years) with GERD duration of 5 years, took part in an open randomized prospective clinical study. Participants were randomized in a 1:1 ratio to be divided into the main group taking MPA and PPI and a comparison group taking a PPI only. The duration of therapy was 4 weeks. Before the treatment onset and after the end of treatment, the occurrence and severity of GERD symptoms were assessed, an endoscopic examination was performed and biopsy specimens were taken from the edge of the erosive area and the area of unchanged esophageal mucosa. The severity of histological signs of esophagitis, the expression of tight junction proteins and the proliferation marker Ki-67 were assessed.

Results: A more effective relief of GERD symptoms was documented when using combination therapy PPIs and MPAs. A more pronounced reduction in macroscopic changes was found in patients with erosive esophagitis taking PPIs and MPAs. The use of MPAs in addition to PPIs made it possible to achieve the primary and secondary endpoints more often, which suggested a high efficiency of the drug in combination with PPIs in the treatment of erosive esophagitis.

Conclusions: An individualized approach based on the combination therapy of PPIs and MPAs can improve the effectiveness of treatment in achieving clinical, endoscopic and, more importantly, histological remission in a patient with erosive GERD.

Background and aims: Transcatheter arterial embolization (TAE) is recommended for refractory peptic ulcer bleeding. There are 46% of patients showed no detectable contrast extravasation during TAE. Endoscopic clip in bleeding lesion is visible and could be used as a marker in TAE. We aimed to learn whether endoscopic clips marking would ameliorate the prognosis.

Methods: We retrospectively collected data of patents who received TAE because of refractory peptic ulcer bleeding, between 1 January 2016 to 31 December 2022. 188 patients were included and divided into two groups according to clips visibility in angiography. Baseline data about age, gender, bleeding severity, comorbidities, history of antiplatelet or anticoagulation drugs and endoscopic findings were balanced with the inverse probability of treatment weighting method.

Results: There were 59 patients without clips received TAE, and 129 with clips. The in-hospital rebleeding rate after TAE was much higher in patients without clip than with clips (45.8% vs 33.3%). Cox regression analysis indicated that endoscopic clips marking decreased the rebleeding (aHR=0.492, 95%CI: 0.242-1.001, p=0.050). Also, in patient with clips, the empirical TAE rate was higher (64.3% vs 11.9%, p<0.001). No difference in in-hospital all-cause mortality was found (without clips vs with clips 11.9% vs 12.4%). The hospital stay length and embolized vessels types showed no differences between the two groups.

Conclusions: In refractory peptic ulcer bleeding patients, endoscopic clips marking decreased the in-hospital rebleeding rate after TAE, but did not affect the mortality.

Colonic leiomyoma is extremely rare and is endoscopically indistinguishable from gastrointestinal stromal tumor. We present a case of colonic leiomyoma disguised as a pedunculated colonic polyp in a 62-year-old male who underwent surveillance colonoscopy.

Nutritional approach has been intensely investigated in inflammatory bowel disease (IBD) patients, but, despite many sparse reports, at present, there is not a universally accepted specific diet. In fact, nutritional requirements and, therefore, the ideal diet, may vary according to disease type, extension and activity. Among nutritional related issue in IBD, obesity has become a relevant one. In fact, obesity and IBD are both increasing in prevalence in last decades, and more and more IBD patients are overweight or obese. These two conditions present common metabolic pathways, leading to dysbiosis and mucosal barrier dysfunction, but the real clinical relationship and the potential reciprocal relative influences are not clear. In order to control weight, many IBD patients follow different weight loss diets, often without any specialized medical advice. Among those, low carb, intermittent fasting, paleolithic, and low-fat diets are some of the most popular, and plant based and Mediterranean diet, even though they are not just strictly weight loss diets, are followed by many IBD patients even for weight control. All the diets mentioned above have been effectively associated with weight loss, reduction in waist circumference and body mass index. However, there are still conflicting data regarding safety in IBD patients and potential experimental and clinical anti-inflammatory effect. In the present review, we described potential relations between obesity and IBD, and we analysed available evidence on efficacy and safety of weight loss diets in IBD patients, in order to provide a practical guide to physicians.

This study investigates childlessness and infertility in individuals diagnosed with inflammatory bowel disease (IBD). Notably, the research reveals intriguing patterns related to gender and specific IBD subtypes. Among female patients with Crohn's disease (CD), a higher childlessness rate is observed compared to the general Swiss population. This finding prompts questions about CD's impact on reproductive health, including factors such as disease severity and treatment regimens. Conversely, women with ulcerative colitis (UC) exhibit a stable childlessness rate similar to the general population. UC, as a distinct IBD subtype, may have varying effects on fertility, influenced by disease location and duration. Healthcare providers should address reproductive concerns in IBD patients, emphasizing fertility counseling and tailored management strategies. Future research should explore medication effects on fertility outcomes, and longitudinal studies can enhance our understanding of this evolving landscape. In summary, recognizing the unique challenges faced by IBD patients allows clinicians to provide holistic care that integrates disease control and family planning, necessitating collaboration among specialists and patients.

Background and aims: The world healthcare systems are currently challenged by the accumulating burden of colorectal cancer (CRC), and cancer registries represent an important segment for prevention and developing management plans, being useful in providing data regarding incidence, mortality, survival, exposure to carcinogens, lifestyle. Retrospective data from CRC patients in Romania was used to assess survival impact, costs, and cost-effectiveness considering three crucial aspects: pharmacology, chemo-/radio-therapy, and hospitalization for care and management of these patients.

Methods: 423 CRC patients from the Institutional Cancer Registry of the Prof. Dr. Ion Chiricuta Institute of Oncology in Cluj-Napoca, Romania were included in the cost analysis. For the assessment of cost efficiency of the primary treatment strategy, we collected data regarding direct medical costs associated with surgery, radiotherapy and medication, as well as the afferent day or continuous hospitalization, for each patient. For the cost-effectiveness analysis we used the method of estimation of incremental cost-effectiveness ratio.

Results: No compelling differences regarding survival time were observed in different therapeutic options per CRC stage. Substantial differences in cost effectiveness among therapeutic options in the same stage of several thousand Euros in stages I-III, while for stage IV, the ICER was more than 100,000 Euros per life saved.

Conclusions: Systematic evaluation of costs, cost-effectiveness, and survival impact, helps healthcare systems can make informed decisions to improve the management of colorectal cancer patients, optimizing outcomes while minimizing financial burden.

Background and aims: Diarrhoea has a significant health impact and requires accurate diagnostic approaches, despite the limitations of many existing methods. This review examines various molecular techniques aimed at facilitating the rapid diagnosis of diarrhoeal diseases caused by bacterial, viral and parasitic pathogens.

Methods: A comprehensive systematic literature review was conducted using six prestigious databases, including WOS, Scopus, Science Direct, Embase, PubMed and LILACS Plus. This rigorous approach allowed the synthesis of reviews on molecular diagnostic techniques for infectious diarrhoeal diseases.

Results: This research began with a careful systematic literature review of 2,760 scientific papers published in the last ten years (2014-2024), culminating in the inclusion of 18 studies following rigorous screening and eligibility criteria. In particular, multiplex polymerase chain reaction (PCR), isolation of genomic DNA from stool samples and the Luminex xTAG Gastrointestinal Pathogen Assay emerged as the predominant molecular methods. These techniques demonstrated remarkable consistency in sensitivity, specificity and rapid diagnostic capability, particularly in the context of acute infectious diarrhoeal diseases. They also demonstrated the ability to simultaneously detect and identify multiple pathogens, including bacteria, viruses and parasites.

Conclusions: The use of multiplex real-time PCR assays has not only improved the detection rates of enteropathogens, but has also revealed previously unrecognised gaps in the diagnosis of infectious diarrhoea. Our study highlights the importance of using molecular methods for comprehensive diagnosis in terms of sensitivity, specificity and rapid diagnostic capability. This will provide healthcare professionals with timely and accurate diagnostic data, enabling more effective treatment strategies for this public health problem.

Background and aims: The differential diagnosis of benign and malignant deep lymph nodes (LNs) has been a significant challenge up until now. Endoscopic ultrasound (EUS) elastography is a real-time imaging technique evaluated in several studies with diverse results. A meta-analysis was performed to assess the performance of EUS elastography for the differentiation of benign and malignant deep LNs.

Methods: All the eligible studies were searched by PubMed, Medline, Embase, and the Cochrane Library. A meta-analysis was performed to obtain pooled sensitivity, specificity, positive and negative likelihood ratio (LR). The diagnostic odds ratio (DOR) and area under the curve (AUC) were used to examine the accuracy of qualitative and quantitative EUS elastography.

Results: A total of eleven studies including 599 patients and 943 LNs were analyzed. In studies using the qualitative color pattern as the diagnostic standard, the pooled sensitivity, specificity, positive and negative LR were 0.82 [95% confidence interval (CI): 0.77-0.86)], 0.92 (95%CI: 0.89-0.94), 7.83 (95%CI: 3.58-17.09) and 0.22 (95%CI: 0.14-0.34), respectively. In studies using the quantitative value as the diagnostic standard, the pooled sensitivity, specificity, positive and negative LR were 0.80 (95%CI: 0.74-0.86) and 0.87 (95%CI: 0.82-0.92), 5.63 (95%CI: 3.46-9.17) and 0.23 (95%CI: 0.12-0.44), respectively. The summary DOR and the AUC were 48.73 (95%CI: 21.83-108.80) and 0.933 (Q*=0.869) for qualitative EUS elastography, 33.35 (95% CI: 12.81-86.87) and 0.923 (Q*=0.857) for quantitative EUS elastography.

Conclusions: Our meta-analysis shows that both qualitative and quantitative EUS elastography have high accuracy in the detection of malignant deep LNs, which could be used as a valuable complementary method to EUS-FNA for the differentiation of deep LNs in the future.

Background and aims: Bacterial resistance toward the most used antibiotics is increasing in Helicobacter pylori (H. pylori) strains worldwide. The emergence of multidrug resistance significantly affects the efficacy of standard therapy regimens. Therefore, this prospective study has updated the prevalence rates of primary antibiotic resistance in H. pylori strains isolated in routine practice.

Methods: H. pylori isolates obtained from patients consecutively observed in a single center were tested for primary resistance by using the E-test method. The minimum inhibitory concentration (MIC) breakpoints to define resistance to clarithromycin, metronidazole, and levofloxacin were, respectively, greater than 0. 25 mg/L, 8 mg/L, and 1 mg/L, according to updated EUCAST recommendations. The trend of antibiotic prevalence, either single or combined, during 2020-2023 was assessed.

Results: A total of 789 patients meeting inclusion criteria were diagnosed with H. pylori infection, but bacterial strains were overall recovered in 632 (80.1%) cases. At bacterial culture, primary resistance rate was 36.7% for clarithromycin, 32.8% for metronidazole, and 22.1% for levofloxacin, whilst dual clarithromycin-metronidazole resistance rate was detected in 17.4%, and triple resistance in 9%.

Conclusions: Our data found that primary resistance towards both clarithromycin and metronidazole, as well as dual resistance, is substantially stable in Italy whilst the prevalence of levofloxacin resistance seems to be decreasing in our geographic area.