Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Chronic atrophic gastritis (CAG) is a known precancerous condition that can lead to the development of gastric cancer (GC). Low serum pepsinogen (PG) I levels have been proposed as a non-invasive marker for chronic atrophic gastritis of the stomach body, but the adequate upper cut-off for diagnosis remains controversial, as values ranging from 30 to 50 mcg/L are currently considered as a "grey zone". We aimed to identify patients with chronic atrophic gastritis (CAG) of the stomach body amongst subjects with PG-I levels ranging between 30 and 50 mcg/L by means of a proton pump inhibitor (PPI) challenge.

Methods: We selected 102 patients with baseline PG-I <60 mcg/L in whom upper gastrointestinal endoscopy with protocol biopsies staged according to OLGA system had been performed. Subsequently, all patients underwent a PPI challenge (consisting of PG-I testing after taking Esomeprazole 40 mg daily for 1 week). This population was divided into 5 groups according to PG-I levels: group A (PG-I< 30 mcg/L); group B (PG-I: 31-35 mcg/L); group C (PG-I: 36-40 mcg/L); group D (PG-I: 41-50 mcg/L); group E (PG-I: 51-60 mcg/L). By using the ROC curve, a cut-off of 30% increase from baseline PG-I was chosen.

Results: A statistically significant relationship between PG-I levels and OLGA staging was found, being 100% in the group of PG-I < 30mcg/L. Based on the value of the cut-off of 30% (calculated by ROC curve) corresponding to the delta increase between PG-I baseline value and after a one-week full dose of PPI, the positive predictive value was 95%, the negative predictive value 86%, the sensitivity 83% and the specificity 96%.

Conclusions: The use of the PPI challenge allows to identify subjects with CAG showing pepsinogen I values ranging between 30 and 50 mcg/L.

Endometriosis is a medical condition where endometrial tissue and glands are found outside the uterine cavity: on ovaries, pelvic peritoneum, rectovaginal septum, bladder, bowel and more. The ectopic tissue is estrogen dependent and cause inflammation and immune response and is responsible for chronic pain, infertility and disability of these patients. Without a specific biomarker and with a wide range of symptoms, the diagnosis is often overlooked or delayed. Abdominal and pelvic pain together with dysmenorrhea, dyspareunia, irregular bleeding, and cyclic alteration of intestinal habits are a challenging combination of symptoms that characterise endometriosis. One of the less recognized yet significant causes of abdominal pain is intestinal endometriosis. Gastroenterologists and gynecologists must solve the intricate puzzle of gynecological, gastrointestinal and nonspecific symptoms that are present in patients with intestinal endometriosis; further managements should be decided by a multidisciplinary team. This review aims to present the pathogenic mechanisms, diagnostic challenges and treatment while highlighting the importance of recognizing intestinal endometriosis as a potential differential diagnosis in patients with gastrointestinal symptoms.

Background and aims: Severe alcoholic hepatitis is characterized by an increased risk of infections. Polymorphisms in immune response-related genes may influence susceptibility to infections in alcoholic hepatitis. This study aimed to investigate the association between two clusters of differentiation 14's (CD14) single nucleotide polymorphisms (SNPs), rs2569190 and rs5744455, and the occurrence of infections in severe alcoholic hepatitis, the response to corticotherapy and the mortality rates at one and three months.

Methods: Patients with severe alcoholic hepatitis were genotyped for CD14 - rs2569190 and rs5744455 SNPs. Genotype and allele frequencies were compared between patients who presented infections and those who did not.

Results: A total of 97 patients with biopsy proven sAH were included in the study, out of which 47 (48.4 %) had an associated infection. rs5744455 SNP was significantly associated with the presence of infection. Patients carrying the rs5744455T variant allele had a lower incidence of infections compared to those with the wild-type allele (32% vs 68%; p=0.002). In contrast, the rs2569190 SNP revealed no significant differences, either in the single genotype analysis (p=0.608) or under a dominant model (p=0.318). Community-acquired infections were primarily urinary tract infections (21.65%), followed by pulmonary infections (4.12%), with Escherichia coli responsible for 41.67% of cases. Healthcare-associated infections were more varied, including urinary tract (7.22%), respiratory (6.19%), digestive (7.21%), cutaneous (3.09%), and blood infections (5.15%). Klebsiella pneumoniae was the most prevalent strain, accounting for 16.67% of these infections.

Conclusions: Our findings highlight a potential protective role of the CD14 rs5744455T variant allele against infections in sAH, suggesting that genetic variability may influence infection susceptibility in this population.

Background and aims: Helicobacter pylori (H. pylori) is a grade I carcinogen, responsible for the development of 89% of non-cardia gastric cancers. All infected patients have an indication for treatment. The ideal first line therapy has not been defined yet. The objective of this study was to evaluate the effectiveness and safety of 14 day bismuth based quadriple and 14 day triple regimens in treatment naive H. pylori infected patients.

Methods: Computer based random allocation of patients was used to assign to either a 14 day triple regimen (group 1, esomeprazole 40 mg BID, amoxicillin 1000 mg BID and clarythromycin 500 mg BID ) or a 14 day bismuth based quadruple regimen (group 2, esomeprazole 40 mg BID, amoxicillin 500 mg QID, metronidazole 400 mg QID and bismuth oxide 120 mg QID).

Results: Altogether 201 patients were included, 101 to group 1 and 100 to group 2. Average age of patients were 75 years of age ( ± 18 years). Twenty five patients were lost to follow up (12.4%), 176 were available for analysis ( 91 patients from group 1 and 85 from group 2). Eradication rate was 94.5% in the first group and 97,6% in the second group (NS). Side effects were reported in 22.8% in the first treatment group and in 24% in the second treatment group (NS). The majority of side effects were mild and did not resulted in any discontinuation of treatment.

Conclusions: Clarithromycin based triple regimen can still be the first line H. pylori regimen in Slovenia. Bismuth based quadruple regimen is to be used in future H. pylori screen and treat programs as the methodology of primary gastric cancer prevention.

Background and aims: Patients with hereditary polyposis syndromes are at high risk of developing small bowel polyps. We aimed to investigate the effectiveness of single balloon enteroscopy (SBE) in detecting and removing such polyps and to compare its diagnostic yield to videocapsule endoscopy (VCE).

Methods: We retrospectively recruited patients undergoing SBE and VCE in our center for familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome (PJS), Cowden syndrome (CS) and juvenile polyposis syndrome (JPS). K Cohen concordance index and sensitivity, specificity, positive/negative predictive value (PPV-NPV) and odds ratio (OR) were calculated.

Results: We recruited 17 patients (9 females, 8 males, age range 29-82), undergoing 35 SBE procedures (7 JPS, 2 LS, 7 PJS, 4 CS, 15 FAP). Small bowel polyps were found in 19 cases (54%), in 6 JPS, 4 PJS, 2 CS and 7 FAP, with size ranging 3 mm-3 cm. The risk of small bowel polyps was not linked to the presence of gastric (OR=1.12, p=1), nor duodenal polyps (OR=0.89, p=1). Compared to VCE, the k index was 0.33±0.16, with sensitivity 79%, specificity 53%, PPV=68%, NPV=67%. Agreement was higher for polyps >1 cm (k=0.53) than for small ones (k =0.35). Thirteen polypectomy sessions were performed in polyps >1 cm, removing median 3 polyps/session (range 1-6). We observed only one early bleeding, treated with clips, and two cases of post-procedural abdominal pain.

Conclusions: Small bowel polyps may be commonly found in the polyposis syndrome. Concordance VCE-SBE is only fair. Polypectomy may be easily performed during SBE, with a low complication rate.

Background and aims: Parkinson's disease (PD) patients frequently experience constipation and non-motor symptoms, significantly affecting their quality of life. Although constipation is common, its causal relationship with mental health issues, such as anxiety and depression, remains underexplored. This study aims to investigate the association between constipation severity, non-motor symptoms, and mental health outcomes in PD patients.

Methods: A total of 97 PD patients from three hospitals in Changshu City were included in this study. Clinical data were collected using assessment tools, including the Non-Motor Symptoms Scale, Patient Assessment of Constipation Quality of Life questionnaire, Hamilton Depression Rating Scale , and Hamilton Anxiety Rating Scale. Mendelian randomization analysis was applied to examine the causal relationships between constipation severity, non-motor symptoms, and mental health outcomes.

Results: A moderate correlation was found between constipation severity and non-motor symptoms, especially in elderly and female patients. However, no significant causal association was identified between constipation and mental health issues such as anxiety, depression, or sleep disorders.

Conclusions: The study underscores the importance of managing constipation in PD patients to improve their non-motor symptoms and quality of life. Despite the observed correlation with non-motor symptoms, further studies are needed to clarify the role of constipation in mental health issues in PD.