1
|
Lin YL, Yao T, Wang YW, Zhou ZX, Hong ZC, Shen Y, Yan Y, Li YC, Lin JF. Potential drug targets for gastroesophageal reflux disease and Barrett's esophagus identified through Mendelian randomization analysis. J Hum Genet 2024; 69:245-253. [PMID: 38429412 DOI: 10.1038/s10038-024-01234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
Gastroesophageal reflux disease (GERD) is a prevalent chronic ailment, and present therapeutic approaches are not always effective. This study aimed to find new drug targets for GERD and Barrett's esophagus (BE). We obtained genetic instruments for GERD, BE, and 2004 plasma proteins from recently published genome-wide association studies (GWAS), and Mendelian randomization (MR) was employed to explore potential drug targets. We further winnowed down MR-prioritized proteins through replication, reverse causality testing, colocalization analysis, phenotype scanning, and Phenome-wide MR. Furthermore, we constructed a protein-protein interaction network, unveiling potential associations among candidate proteins. Simultaneously, we acquired mRNA expression quantitative trait loci (eQTL) data from another GWAS encompassing four different tissues to identify additional drug targets. Meanwhile, we searched drug databases to evaluate these targets. Under Bonferroni correction (P < 4.8 × 10-5), we identified 11 plasma proteins significantly associated with GERD. Among these, 7 are protective proteins (MSP, GPX1, ERBB3, BT3A3, ANTR2, CCM2, and DECR2), while 4 are detrimental proteins (TMEM106B, DUSP13, C1-INH, and LINGO1). Ultimately, C1-INH and DECR2 successfully passed the screening process and exhibited similar directional causal effects on BE. Further analysis of eQTLs highlighted 4 potential drug targets, including EDEM3, PBX3, MEIS1-AS3, and NME7. The search of drug databases further supported our conclusions. Our study indicated that the plasma proteins C1-INH and DECR2, along with 4 genes (EDEM3, PBX3, MEIS1-AS3, and NME7), may represent potential drug targets for GERD and BE, warranting further investigation.
Collapse
Affiliation(s)
- Yun-Lu Lin
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Tao Yao
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Ying-Wei Wang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhi-Xiang Zhou
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Ze-Chao Hong
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yu Shen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yu Yan
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yue-Chun Li
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Jia-Feng Lin
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| |
Collapse
|
2
|
Yang DJ, Chen KL, Lv ZY, Zhou B, Zhou ZG, Li Y. PD-L1 blockade in mitigating severe acute pancreatitis induced pancreatic damage through modulation of immune cell apoptosis. Int Immunopharmacol 2024; 133:112081. [PMID: 38652963 DOI: 10.1016/j.intimp.2024.112081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Acute pancreatitis (AP) is a prevalent gastrointestinal disorder. The immune response plays a crucial role in AP progression. However, the impact of immune regulatory checkpoint PD-L1 on severe acute pancreatitis (SAP) remains uncertain. Hence, this study aimed to examine the influence of PD-L1 on SAP. We assessed PD-L1 expression in neutrophils and monocytes obtained from SAP patients. We induced SAP in C57BL/6J mice, PD-L1 gene-deficient mice, and PD-L1 humanized mice using intraperitoneal injections of cerulein plus lipopolysaccharide. Prior to the initial cerulein injection, a PD-L1 inhibitor was administered. Pancreatic tissues were collected for morphological and immunohistochemical evaluation, and serum levels of amylase, lipase, and cytokines were measured. Flow cytometry analysis was performed using peripheral blood cells. The expression of PD-L1 in neutrophils and monocytes was significantly higher in SAP patients compared to healthy individuals. Likewise, the expression of PD-L1 in inflammatory cells in the peripheral blood of SAP-induced C57BL/6J mice was notably higher than in the control group. In mice with PD-L1 deficiency, SAP model exhibited lower pancreatic pathology scores, amylase, lipase, and cytokine levels compared to wild-type mice. PD-L1 deletion resulted in reduced neutrophil apoptosis, leading to an earlier peak in neutrophil apoptosis. Furthermore, it decreased early monocyte apoptosis and diminished the peak of T lymphocyte apoptosis. Within the SAP model, administration of a PD-L1 inhibitor reduced pancreatic pathology scores, amylase, lipase, and cytokine levels in both C57BL/6J mice and PD-L1 humanized mice. These findings suggest that inhibiting PD-L1 expression can alleviate the severity of SAP.
Collapse
Affiliation(s)
- Du-Jiang Yang
- Institute of Digestive Surgery, West China Hospital, Sichuan University, No. 1 Ke-yuan-si-lu, Chengdu 610093, Sichuan Province, China; Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China
| | - Ke-Ling Chen
- Institute of Digestive Surgery, West China Hospital, Sichuan University, No. 1 Ke-yuan-si-lu, Chengdu 610093, Sichuan Province, China
| | - Zhao-Ying Lv
- Institute of Digestive Surgery, West China Hospital, Sichuan University, No. 1 Ke-yuan-si-lu, Chengdu 610093, Sichuan Province, China
| | - Bin Zhou
- Institute of Digestive Surgery, West China Hospital, Sichuan University, No. 1 Ke-yuan-si-lu, Chengdu 610093, Sichuan Province, China
| | - Zong-Guang Zhou
- Institute of Digestive Surgery, West China Hospital, Sichuan University, No. 1 Ke-yuan-si-lu, Chengdu 610093, Sichuan Province, China
| | - Yuan Li
- Institute of Digestive Surgery, West China Hospital, Sichuan University, No. 1 Ke-yuan-si-lu, Chengdu 610093, Sichuan Province, China.
| |
Collapse
|
3
|
Jukic I, Kokic Males V, Zanic A, Zaja I. Penoscrotal Edema as a Rare Complication of Acute Pancreatitis: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:820. [PMID: 38793003 PMCID: PMC11122820 DOI: 10.3390/medicina60050820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/01/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Scrotal swelling or hydrocele is a rare complication of acute pancreatitis described in the literature. We present a case of penoscrotal swelling caused by the first attack of acute interstitial edematous alcohol-induced pancreatitis in a young male patient. Case report: A 22-year-old man was admitted to the emergency unit due to diarrhea and vomiting since morning which was followed by severe abdominal pain. Urgent abdominal multislice CT scan showed steatosis, pancreatic swelling and acute peripancreatic fluid collection (interstitial edematous pancreatitis). Also, scan showed fluid between small bowel loops and along the anterior renal fascia, while there was minimal amount of fluid in the Douglas space. There was no sign of penoscrotal swelling. On the second day of admission, the patient developed left scrotal swelling and mild pain without erythema. On the fourth day, a control CT scan showed progression to moderately severe pancreatitis (CT severity index 4). Dilated scrotal veins of the pampiniform venous plexus with an increased caliber of the testicular veins were present on both sides, from the scrotum to the level of the inguinal canal. Penoscrotal swelling was significantly reduced on discharge. Conclusions: Penoscrotal swelling is a rare complication or manifestation of acute inflammation of the pancreas. It is important to identify scrotal swelling caused by pancreatitis because in severe cases it can be related to possible infertility in the future.
Collapse
Affiliation(s)
- Ivana Jukic
- Department of Gastroenterology and Hepatology, University Hospital Split, Spinciceva 1, 21000 Split, Croatia; (I.J.); (I.Z.)
- Department of Health Studies, University of Split, 21000 Split, Croatia
| | | | - Antonija Zanic
- Institute of Emergency Medicine of Split—Dalmatia County, 21000 Split, Croatia;
| | - Ivan Zaja
- Department of Gastroenterology and Hepatology, University Hospital Split, Spinciceva 1, 21000 Split, Croatia; (I.J.); (I.Z.)
- Department of Health Studies, University of Split, 21000 Split, Croatia
| |
Collapse
|
4
|
Jing Q, Liu X, Lv Z, Xue D. IL27 and IL1RN are causally associated with acute pancreatitis: a Mendelian randomization study. Aging (Albany NY) 2024; 16:205825. [PMID: 38742942 DOI: 10.18632/aging.205825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The interleukin (IL) plays a role in the development of acute pancreatitis (AP). However, the specific IL in AP has not been fully revealed. Therefore, the association between prospective IL and AP was studied via Mendelian randomization (MR). METHODS The HUGO Gene nomenclature committee (HGNC) database provided 47 interleukin related genes (ILRGs). ILRGs and differentially expressed genes (DEGs) from GSE194331 were overlapped to create differently expressed ILRGs (DE-ILRGs). The integrative epidemiology unit (IEU) open genome-wide association study (GWAS) database provided exposure and outcome datasets. Univariate MR (UVMR) analysis using MR-Egger, IVW, simple mode, and weighted mode was done. UVMR results were verified using sensitivity analysis. Drug prediction, MVMR analysis, and PPI network development were also performed. RESULTS Six DE-ILRGs were obtained. IL27 and IL1RN were substantially causally linked with AP by UVMR analysis (OR = 0.926, P < 0.001 and OR = 1.031, P = 0.023). Our sensitivity analysis showed the dependability of our results. Direct effect of IL27 was suggested by MVMR analysis. In the cytokine receptor binding pathway, IL27 and IL1RN interacted with IL36G and IL1R2. TAE-684, ARQ-680, and 12 other IL1RN and 14 IL27 medications were predicted. CONCLUSIONS IL1RN was identified as a risk factor for acute pancreatitis (AP), but IL27 was found to be a protective factor for AP.
Collapse
Affiliation(s)
- Qingxu Jing
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical, University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Xuxu Liu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical, University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhenyi Lv
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical, University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Dongbo Xue
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical, University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| |
Collapse
|
5
|
Köksal AŞ, Tozlu M, Sezgin O, Oğuz D, Kalkan İH, Altıntaş E, Yaraş S, Bilgiç Y, Yıldırım AE, Barutçu S, Hakim GD, Soytürk M, Bengi G, Özşeker B, Yurci A, Koç DÖ, İrak K, Kasap E, Cindoruk M, Oruç N, Ünal NG, Şen İ, Gökden Y, Saruç M, Ünal H, Eminler AT, Toka B, Basır H, Sağlam O, Ergül B, Gül Ö, Büyüktorun İ, Özel M, Şair Ü, Kösem G, Nedirli F, Tahtacı M, Parlak E. Acute pancreatitis in Turkey: Results of a nationwide multicenter study. Pancreatology 2024; 24:327-334. [PMID: 37880021 DOI: 10.1016/j.pan.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/12/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is the most common gastrointestinal disease requiring hospitalization, with significant mortality and morbidity. We aimed to evaluate the clinical characteristics of AP and physicians' compliance with international guidelines during its management. METHODS All patients with AP who were hospitalized at 17 tertiary centers in Turkey between April and October 2022 were evaluated in a prospective cohort study. Patients with insufficient data, COVID-19 and those aged below 18 years were excluded. The definitions were based on the 2012 revised Atlanta criteria. RESULTS The study included 2144 patients (median age:58, 52 % female). The most common etiologies were biliary (n = 1438, 67.1 %), idiopathic (n = 259, 12 %), hypertriglyceridemia (n = 128, 6 %) and alcohol (n = 90, 4.2 %). Disease severity was mild in 1567 (73.1 %), moderate in 521 (24.3 %), and severe in 58 (2.6 %) patients. Morphology was necrotizing in 4.7 % of the patients. The overall mortality rate was 1.6 %. PASS and BISAP had the highest accuracy in predicting severe pancreatitis on admission (AUC:0.85 and 0.81, respectively). CT was performed in 61 % of the patients, with the majority (90 %) being within 72 h after admission. Prophylactic NSAIDs were not administered in 44 % of the patients with post-ERCP pancreatitis (n = 86). Antibiotics were administered to 53.7 % of the patients, and 38 % of those received them prophylactically. CONCLUSIONS This prospective study provides an extensive report on clinical characteristics, management and outcomes of AP in real-world practice. Mortality remains high in severe cases and physicians' adherence to guidelines during management of the disease needs improvement in some aspects.
Collapse
Affiliation(s)
- Aydın Şeref Köksal
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey.
| | - Mukaddes Tozlu
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey
| | - Orhan Sezgin
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Dilek Oğuz
- Kırıkkale University, School of Medicine, Department of Gastroenterology, Turkey
| | - İsmail Hakkı Kalkan
- TOBB Economy and Technology University, Department of Gastroenterology, Turkey
| | - Engin Altıntaş
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Serkan Yaraş
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Yılmaz Bilgiç
- İnönü University, School of Medicine, Department of Gastroenterology, Turkey
| | | | - Sezgin Barutçu
- Gaziantep University, School of Medicine, Department of Gastroenterology, Turkey
| | - Gözde Derviş Hakim
- Sağlık Bilimleri University, Izmir School of Medicine, Department of Gastroenterology, Turkey
| | - Müjde Soytürk
- Dokuz Eylül University, School of Medicine, Department of Gastroenterology, Turkey
| | - Göksel Bengi
- Dokuz Eylül University, School of Medicine, Department of Gastroenterology, Turkey
| | - Burak Özşeker
- Muğla Sıtkı Koçman University, School of Medicine, Department of Gastroenterology, Turkey
| | - Alper Yurci
- Erciyes University, School of Medicine, Department of Gastroenterology, Turkey
| | - Deniz Öğütmen Koç
- Sağlık Bilimleri University, Gaziosmanpaşa Education and Research Hospital, Department of Gastroenterology, Turkey
| | - Kader İrak
- Sağlık Bilimleri University, Başakşehir Çam and Sakura City Hospital, Department of Gastroenterology, Turkey
| | - Elmas Kasap
- Manisa Celal Bayar University, School of Medicine, Department of Gastroenterology, Turkey
| | - Mehmet Cindoruk
- Ankara Gazi University, School of Medicine, Department of Gastroenterology, Turkey
| | - Nevin Oruç
- Ege University, School of Medicine, Department of Gastroenterology, Turkey
| | - Nalan Gülşen Ünal
- Ege University, School of Medicine, Department of Gastroenterology, Turkey
| | - İlker Şen
- Sağlık Bilimleri University, Şişli Hamidiye Etfal Education and Research Hospital, Department of Gastroenterology, Turkey
| | - Yasemin Gökden
- Sağlık Bilimleri University, Prof. Dr. Cemil Taşçıoğlu City Hosoital, Department of Gastroenterology, Turkey
| | - Murat Saruç
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Gastroenterology, Turkey
| | - Hakan Ünal
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Gastroenterology, Turkey
| | - Ahmet Tarık Eminler
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey
| | - Bilal Toka
- Sakarya University, School of Medicine, Department of Gastroenterology, Turkey
| | - Hakan Basır
- Mersin University, School of Medicine, Department of Gastroenterology, Turkey
| | - Osman Sağlam
- İnönü University, School of Medicine, Department of Gastroenterology, Turkey
| | - Bilal Ergül
- Kırıkkale University, School of Medicine, Department of Gastroenterology, Turkey
| | - Özlem Gül
- Kırıkkale University, School of Medicine, Department of Gastroenterology, Turkey
| | - İlker Büyüktorun
- Dokuz Eylül University, School of Medicine, Department of Gastroenterology, Turkey
| | - Mustafa Özel
- Erciyes University, School of Medicine, Department of Gastroenterology, Turkey
| | - Ümit Şair
- Sağlık Bilimleri University, Gaziosmanpaşa Education and Research Hospital, Department of Internal Medicine, Turkey
| | - Gizem Kösem
- Manisa Celal Bayar University, School of Medicine, Department of Internal Medicine, Turkey
| | - Ferda Nedirli
- Gazi University, School of Medicine, Department of Internal Medicine, Turkey
| | - Mustafa Tahtacı
- Ankara Yıldırım Beyazıt University, Department of Gastroenterology, Turkey
| | - Erkan Parlak
- Hacettepe University, School of Medicine, Department of Gastroenterology, Turkey
| |
Collapse
|
6
|
Xie J, Cai Y, Xu H, Peng Y, McArthur A. Early enteral nutrition support for patients with acute pancreatitis in the inpatient setting: a best practice implementation project. JBI Evid Implement 2024; 22:175-185. [PMID: 38415812 DOI: 10.1097/xeb.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Acute pancreatitis is a major disease that endangers the health and lives of people. Historically, clinical therapy has recommended. that patients with acute pancreatitis remain nil by mouth. As one of the therapies recommended in recent guidelines, early enteral nutrition support reduces the incidence of infectious complications and reduces the risk of severe conditions. However, early enteral nutrition support has not been optimally implemented within clinical practice for acute pancreatitis inpatients. OBJECTIVES This evidence implementation project aimed to increase compliance with best practice recommendations for early enteral nutrition support, while standardizing the enteral nutrition support process and reducing the incidence of delayed enteral nutrition. METHODS The project was guided by the JBI Evidence Implementation Framework, which is grounded in the audit and feedback process, as well as a seven-stage structured approach to identifying and managing barriers to compliance with recommended practices. RESULTS In the baseline audit, compliance rates were low for all evidence-based audit criteria. Four of the eight criteria showed 0% compliance. However, after implementation, all eight criteria achieved a minimum compliance rate of 60%, with Site 2 achieving 90% to 100% compliance. In addition, nurses improved their knowledge and skills in early enteral nutrition support. The incidence of delayed enteral nutrition also fell from 86.2% to 20.7% at both study sites. The implementation strategy included a training program, psychological interventions, and financial and human resource support. CONCLUSION This project not only significantly improved early enteral nutrition support for acute pancreatitis patients, but also increased nurses' knowledge and practice skills, standardized the process of enteral nutrition support, and reduced the incidence of delayed enteral nutrition. SPANISH ABSTRACT http://links.lww.com/IJEBH/A177.
Collapse
Affiliation(s)
- Jieying Xie
- Emergency Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Nanfang Nursing Centre for Evidence-Based Practice: A JBI Centre of Excellence, Guangzhou, China
| | - Yuhan Cai
- Emergency Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huiying Xu
- Nanfang Nursing Centre for Evidence-Based Practice: A JBI Centre of Excellence, Guangzhou, China
| | - Yang Peng
- Gastroenterology Department, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Alexa McArthur
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
7
|
Abel WF, Kesar V, Wasserman RD, Kumar M, Patel V, Yeaton P, Kesar V. Massive infected pancreatic necrosis in an 8-year-old: Endoscopic management. JPGN REPORTS 2024; 5:175-177. [PMID: 38756110 PMCID: PMC11093900 DOI: 10.1002/jpr3.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 05/18/2024]
Abstract
Pancreatitis is a condition much more commonly found in adults, but when diagnosed in the pediatric population, is often due to medications, congenital pathology, and critical illness. This patient had previously undergone treatment with 6-mercaptopurine and presented with pancreatitis that eventually worsened to a walled-off necrotic collection with paracolic extensions reaching the pelvis. Given clinical worsening with development of shock, procedural options for source control were weighed with gastroenterology, pediatric surgery, and interventional radiology, before pancreatic necrosectomy was determined to be the treatment of choice, given the adjacency of the collection to the stomach. A total of three separate endoscopic pancreatic necrosectomy procedures were performed and the patient s clinical status improved greatly, with vast improvement later seen on outpatient imaging. This successful treatment course argues for the efficacy of pancreatic necrosectomy even in very large walled off collections, and most importantly, lead to a positive outcome in this young patient.
Collapse
Affiliation(s)
- William F. Abel
- Virginia Tech Carilion, Department of Internal MedicineRoanokeVirginiaUSA
| | - Varun Kesar
- Virginia Tech Carilion, Department of Internal Medicine, Division of GastroenterologyRoanokeVirginiaUSA
| | - Reid D. Wasserman
- Virginia Tech Carilion, Department of Internal MedicineRoanokeVirginiaUSA
| | - Manoj Kumar
- Tufts Medical Center, Department of Internal Medicine, Division of GastroenterologyBostonMassachusettsUSA
| | - Vishal Patel
- Virginia Tech Carilion, Department of RadiologyRoanokeVirginiaUSA
| | - Paul Yeaton
- Virginia Tech Carilion, Department of Internal Medicine, Division of GastroenterologyRoanokeVirginiaUSA
| | - Vivek Kesar
- Virginia Tech Carilion, Department of Internal Medicine, Division of GastroenterologyRoanokeVirginiaUSA
| |
Collapse
|
8
|
Huang IH, Schol J, Lin G, Chen YJ, Carbone F, Vaes B, Tack J. Epidemiology of functional dyspepsia and gastroparesis as diagnosed in Flemish-Belgian primary care: A registry-based study from the Intego database. Neurogastroenterol Motil 2024; 36:e14778. [PMID: 38462669 DOI: 10.1111/nmo.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Dyspepsia is a prevalent condition in the general population. Besides organic causes, the differential diagnosis of dyspepsia includes functional dyspepsia (FD) and gastroparesis (GP) which share similar pathophysiological mechanisms and clinical presentation. So far, no study investigated the prevalence of FD and GP in a primary care in Belgium. METHODS Data were obtained from Intego, a Flemish-Belgian general practice-based morbidity registration network. From 586,164 patients between 2000 and 2021, we selected patients with ICD-10 code for FD and GP. Patients with organic gastrointestinal diseases were excluded. We determined demographics and comorbidities of FD/GP. For prevalence and incidence calculation, we included those who consulted their general practitioners at least once in the given year. Pair-wise comparison was conducted to access the impact of comorbidities on risk of FD/GP. KEY RESULTS Between 2011 and 2021, the prevalence of FD/GP ranged from 1.03% to 1.21%. The incidence of FD/GP ranged from 109 to 142 per 100,000 adults. In total 5242 cases of FD/GP were identified. These cases shared commonly coexisting diagnoses of gastroesophageal reflux disease (18.8%), irritable bowel syndrome (17.1%), and chronic constipation (18.7%). Patients with somatization/anxiety/depression had significantly higher risk of FD/GP, compared to the control (OR 1.38, 95% CI 1.19-1.61, p < 0.01). CONCLUSIONS AND INFERENCES The prevalence (1.03%-1.21%) and incidence (109-142/100,000) of FD/GP in primary care over last decade appear to conflict with epidemiological research in the general population. The discrepancies suggest a potential lack of awareness of FD and GP among physicians and/or patients in Flemish-Belgium.
Collapse
Affiliation(s)
- I-Hsuan Huang
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jolien Schol
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Guohao Lin
- Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Yaozhu J Chen
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Florencia Carbone
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
| |
Collapse
|
9
|
Wang CW, Lees CR, Ko MS, Sewell JL, Kathpalia P. Implementation and Analysis of a 5-Year Online Esophageal Motility Curriculum for Gastroenterology Fellows. Dig Dis Sci 2024; 69:1661-1668. [PMID: 38507124 DOI: 10.1007/s10620-024-08370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Motility disorders are frequently encountered in gastroenterology (GI) practice, yet a national structured training curriculum for GI fellows in motility disorders is lacking. Since GI fellowships vary considerably in opportunities for specialized esophageal motility (EM) training, novel educational technology may be leveraged to provide standardized EM curriculum to train GI fellows in esophageal manometry. METHODS GI fellows participated in an online EM learning program at a single academic center from 2017 to 2022. Fellows answered case-based questions and were provided with evidence-based, corrective feedback related to core EM learning objectives. The primary outcome was change in knowledge and comfort in interpretation and clinical application of EM studies. RESULTS Sixty-nine fellows actively participated in the online EM curriculum. 65 fellows completed a pre-curriculum test, and 54 fellows completed a post-curriculum test. There was a cumulative improvement between pre-curriculum test and post-curriculum test scores from 70 to 87%, respectively (p < 0.001). Fellows had a mean improvement of 19% in questions as they progressed through the curriculum. Prior to enrolling in the EM course, 26% of fellows felt comfortable in interpreting EM studies compared to 54% of fellows after completion of the program (p < 0.001). CONCLUSION An online, technology-based curriculum was effective in educating GI fellows on core competencies of EM. Fellows demonstrated improvement in proficiency of clinically important EM studies and increased comfort in interpreting EM studies. Further studies are needed to evaluate the use of technology-based learning to widely disseminate a structured training curriculum in EM, particularly in training programs without a motility presence.
Collapse
Affiliation(s)
- Connie W Wang
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Christopher R Lees
- Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Myung S Ko
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Justin L Sewell
- Division of Gastroenterology, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Priya Kathpalia
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
10
|
Nojkov B, Burnett C, Watts L, Yin J, Ali K, Zhao T, Gong S, Miller C, Habrowski M, Chey WD, Chen JDZ. The impact of transcutaneous electrical acustimulation (TEA) on rectal distension-induced pain in patients with irritable bowel syndrome (IBS)-A study to determine the optimal TEA delivery modalities and effects on rectal sensation and autonomic function. Neurogastroenterol Motil 2024:e14799. [PMID: 38671591 DOI: 10.1111/nmo.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/05/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Treatment options for abdominal pain in IBS are inadequate. TEA was reported effective treatment of disorders of gut-brain interaction but its mechanism of action and optimal delivery method for treating pain in IBS are unknown. This study aims to determine the most effective TEA parameter and location to treat abdominal pain in patients with IBS-Constipation and delineate the effect of TEA on rectal sensation and autonomic function. METHODS Nineteen IBS-C patients underwent TEA at acupoints ST36 (leg), PC6 (wrist), or sham-acupoint. Each patient was studied in five randomized sessions on separate days: (1) TEA/ST36-100 Hz; (2) TEA/ST36-25 Hz; (3) TEA/PC6-100 Hz; (4) TEA/PC6-25 Hz; (5) TEA/Sham-25 Hz. In each session, barostat-guided rectal distention (RD) was performed before and after TEA. Patients graded the RD-induced pain and recorded three rectal sensation thresholds. A heart rate variability (HRV) signal was derived from the electrocardiogram for autonomic function assessment. KEY RESULTS Studied patients were predominantly female, young, and Caucasian. Compared with baseline, patients treated with TEA/ST36-100 Hz had significantly decreased pain scores at RD pressure-points 20-50 mmHg (p < 0.04). The average pain reduction was 40%. Post-treatment scores did not change significantly with other TEA modalities except with sham-TEA (lesser degree compared to ST36-100 Hz, p = 0.04). TEA/ST36-100, but not other modalities, increased the rectal sensation threshold (first sensation: p = 0.007; urge to defecate: p < 0.026). TEA/ST36-100 Hz was the only treatment that significantly decreased sympathetic activity and increased parasympathetic activity with and without RD (p < 0.04). CONCLUSIONS & INFERENCES TEA at ST36-100 Hz is superior stimulation point/parameter, compared to TEA at PC-6/sham-TEA, to reduce rectal distension-induced pain in IBS-C patients. This therapeutic effect appears to be mediated through rectal hypersensitivity reduction and autonomic function modulation.
Collapse
Affiliation(s)
- Borko Nojkov
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lydia Watts
- University of Michigan, Ann Arbor, Michigan, USA
| | - Jieyun Yin
- Transtimulation Research Inc., Oklahoma City, Oklahoma, USA
| | - Khawar Ali
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Shiyuan Gong
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | |
Collapse
|
11
|
Bessone V, Roppenecker DB, Adamsen S. Work-Related Musculoskeletal Injury Rates, Risk Factors, and Ergonomics in Different Endoscopic Specialties: A Review. Healthcare (Basel) 2024; 12:885. [PMID: 38727442 PMCID: PMC11083686 DOI: 10.3390/healthcare12090885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Endoscopy-related musculoskeletal injuries (ERIs) are frequent among gastrointestinal, pulmonary, nasal, and urologic endoscopists, impacting the healthcare system. The present review aims to compare the ERI rates, risk factors, and ergonomic recommendations in the different endoscopic fields. A review was conducted using PubMed and Cochrane Library for articles based on surveys and published until 10 January 2024. Demographic, work, and ERI data from 46 publications were included, covering 10,539 responders. The ERI incidence ranged between 14% and 97%, highlighting the need of intervention independent of the specialties. The neck, back, and shoulder were the most frequent ERI locations, while gender, age, years of experience, and procedure volume the most common risk factors. Ergonomic recommendations suggest concentrating on endoscope design changes, especially in gastrointestinal endoscopy, to increase the comfort, adaptability of the equipment in the operating room, and workflow/institutional policy changes. The inclusion of an ergonomic timeout guarantees the correct equipment positioning, the neutralisation of the endoscopist's posture, and an indirect break between procedures. Ergonomic training to increase awareness and best practice should be promoted, also using new technologies. Future research should concentrate on intervention and comparative studies to evaluate to which extent prevention measures and newly designed equipment could reduce ERI incidence.
Collapse
Affiliation(s)
- Veronica Bessone
- Ambu Innovation GmbH, Karl-Drais-Strasse 4B, DE-86159 Augsburg, Germany
| | | | - Sven Adamsen
- Ambu A/S, Baltorpbakken 13, DK-2750 Ballerup, Denmark
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark
| |
Collapse
|
12
|
Podboy A, Casey C, Buerlein RCD, Strand DS, Shami VM, Wang AY. Increased rate of pancreatitis in gender diverse and transgender patients on hormone therapy: a case series study. BMJ Open Gastroenterol 2024; 11:e001312. [PMID: 38653505 PMCID: PMC11043760 DOI: 10.1136/bmjgast-2023-001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND There is limited data on the incidence of gastrointestinal-specific pathology in gender non-conforming (GNC) populations. METHODS Retrospective analysis of pancreatitis incidence rates in transgender and GNC persons exposed and not exposed to gender-affirming hormone therapy (GAHT). RESULTS 7 of the 1333 patients on hormone therapy had an incidence of pancreatitis. 0 of the 615 patients with no history of GAHT use developed pancreatitis. Representing a 6.96 (95% CI 2.76 to 848.78) for the development of pancreatitis in patients with exposure to GAHT therapy. CONCLUSION Clinicians working with GNC individuals should be aware of this possible association.
Collapse
Affiliation(s)
- Alexander Podboy
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Catherine Casey
- Department of Family Medicine, Section of Transgender Services, Charlottesville, Virginia, USA
| | - Ross C D Buerlein
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel S Strand
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Vanessa M Shami
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
13
|
Wade U, Pascual-Figal DA, Rabbani F, Ernst M, Albert A, Janssens I, Dierckxsens Y, Iqtadar S, Khokhar NA, Kanwal A, Khan A. The Possible Synergistic Pharmacological Effect of an Oral Berberine (BBR) and Curcumin (CUR) Complementary Therapy Alleviates Symptoms of Irritable Bowel Syndrome (IBS): Results from a Real-Life, Routine Clinical Practice Settings-Based Study. Nutrients 2024; 16:1204. [PMID: 38674895 PMCID: PMC11053504 DOI: 10.3390/nu16081204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Irritable bowel syndrome (IBS) is a prevalent chronic functional gastrointestinal disorder, characterised by recurrent abdominal discomfort and altered bowel movements. IBS cause a significantly negative impact on quality of life (QoL). Growing pharmacological evidence suggests that berberine (BBR) and curcumin (CUR) may mitigate IBS symptoms through multiple complementary synergistic mechanisms, resulting in the attenuation of intestinal inflammation and regulation of bowel motility and gut functions. In the present observational study conducted under real-life routine clinical practice settings, 146 patients diagnosed with IBS were enrolled by general practitioner clinics and pharmacies in Belgium. For the first time, this study assessed the potential synergistic pharmacological effect of a combined oral BBR/CUR supplement (Enterofytol® PLUS, containing 200 mg BBR and 49 mg CUR) (two tablets daily for 2 months), serving as complementary therapy in the management of IBS. Following the 2-month supplementation, significant improvements were observed in the patients' IBS severity index (IBSSI) (47.5%) and all the primary IBS symptoms, such as abdominal discomfort (47.2%), distension (48.0%), intestinal transit (46.8%), and QoL (48.1%) (all p < 0.0001). The improvement in the patients' IBSSI was independent of age, sex, and IBS sub-types. The patients' weekly maximum stool passage frequency decreased significantly (p < 0.0001), and the stool status normalized (p < 0.0001). The patients' need for concomitant conventional IBS treatment decreased notably: antispasmodics by 64.0% and antidiarrhoeals by 64.6%. Minor adverse effects were reported by a small proportion (7.1%) of patients, mostly gastrointestinal. The majority (93.1%) experienced symptom improvement or resolution, with a high satisfaction rate (82.6%) and willingness to continue the supplementation (79.0%). These findings support the potential synergistic pharmacological role of BBR and CUR in IBS, and their co-supplementation may alleviate IBS symptoms and improve QoL.
Collapse
Affiliation(s)
- Ursula Wade
- Department of Basic and Clinical Neuroscience, Kings College London, London SE5 9RT, UK;
| | - Domingo A. Pascual-Figal
- Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, 30120 Murcia, Spain;
| | - Fazale Rabbani
- Lady Reading Hospital, Peshawar 25000, Pakistan; (F.R.); (A.K.)
| | - Marie Ernst
- Biostatistics and Research Methods Center (B-STAT), CHU of Liège and University of Liège, 4000 Liège, Belgium (A.A.)
| | - Adelin Albert
- Biostatistics and Research Methods Center (B-STAT), CHU of Liège and University of Liège, 4000 Liège, Belgium (A.A.)
| | | | | | - Somia Iqtadar
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan;
| | - Nisar A. Khokhar
- Department of Medicine, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan;
| | - Ayesha Kanwal
- Lady Reading Hospital, Peshawar 25000, Pakistan; (F.R.); (A.K.)
| | - Amjad Khan
- Department of Biochemistry, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK
| |
Collapse
|
14
|
Kamionkowski S, Shibli F, Saleh S, Trujillo S, Mengalle E, El Mokahal A, Thomas C, Song G, Fass R. Clinical value of random esophageal biopsies in patients with dysphagia and normal endoscopy who are treated with a proton pump inhibitor. Dis Esophagus 2024; 37:doad070. [PMID: 38197434 DOI: 10.1093/dote/doad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 01/11/2024]
Abstract
Rome IV recommended esophageal biopsies in patients with dysphagia and normal endoscopy to exclude mucosal disease. Thus far, studies evaluating the utility of this recommendation remain scarce. The aims of this study were to determine the value of random esophageal biopsies in heartburn patients with dysphagia and normal endoscopy and compare the yield of random esophageal biopsies between younger versus older patients. Data were collected from consecutive patients presenting with dysphagia, 18 years and older, who were on proton pump inhibitors and had normal upper endoscopy. Biopsy results of patients with and without heartburn were recorded. Logistic regression analysis was used to compare normal versus abnormal biopsy results in younger and older patients accounting for confounding variables. The number of abnormal biopsies was significantly higher than normal biopsies (68% and 32%, respectively, P = 0.0001). Among abnormal biopsy results, microscopic gastroesophageal reflux disease was significantly more common than all other findings (39%, P = 0.0495). There was no significant difference in biopsy results in patients with and without heartburn as well as younger versus older patients (P = 0.3384, P = 0.1010, and P = 0.8468, respectively). Our study demonstrated that most patients with dysphagia and normal upper endoscopy who are on proton pump inhibitor have some type of histologic mucosal abnormality, which can direct future management. Among abnormal biopsies, microscopic reflux was by far the most common finding in patients with or without a history of heartburn. While this supports the management strategy proposed by Rome IV, age did not drive esophageal biopsy results.
Collapse
Affiliation(s)
- Sara Kamionkowski
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Fahmi Shibli
- Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Sherif Saleh
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Sophie Trujillo
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Erika Mengalle
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ali El Mokahal
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Charles Thomas
- Department of Research and Scholarship, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| |
Collapse
|
15
|
Yang F, Lan Z, Chen H, He R. Causal associations between human gut microbiota and hemorrhoidal disease: A two-sample Mendelian randomization study. Medicine (Baltimore) 2024; 103:e37599. [PMID: 38552035 PMCID: PMC10977532 DOI: 10.1097/md.0000000000037599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
Hemorrhoidal disease (HEM) is a common condition affecting a significant proportion of the population. However, the causal relationship between the gut microbiota and hemorrhoids remains unclear. In this study, we employed a Mendelian randomization (MR) approach to investigate the potential associations between them. In this study, the exposure factor was determined by selecting summary statistics data from a large-scale gut microbiome whole-genome association study conducted by the MiBioGen Consortium, which involved a sample size of 18,340 individuals. The disease outcome data consisted of 218,920 cases of HEM and 725,213 controls of European ancestry obtained from the European Bioinformatics Institute dataset. Two-sample MR analyses were performed to assess the causalities between gut microbiota and hemorrhoids using various methods, including inverse-variance weighting, MR-Egger regression, MR Pleiotropy Residual Sum and Outlier (MR-PRESSO), simple mode, and weighted median. Reverse MR analyses were performed to examine reverse causal association. Our findings suggest phylum Cyanobacteria (OR = 0.947, 95% CI: 0.915-0.980, P = 2.10 × 10 - 3), genus Phascolarctobacterium (OR = 0.960, 95% CI: 0.924-0.997, P = .034) and family FamilyXI (OR = 0.974, 95% CI: 0.952-0.997, P = .027) have potentially protective causal effects on the risk of HEM, while genus Ruminococcaceae_UCG_002 (OR = 1.036, 95% CI: 1.001-1.071, P = .042), family Peptostreptococcaceae (OR = 1.042, 95% CI: 1.004-1.082, P = .029), genus Oscillospira (OR = 1.048, 95% CI: 1.005-1.091, P = .026), family Alcaligenaceae (OR = 1.048, 95% CI: 1.005-1.091, P = .036) and order Burkholderiales (OR = 1.074, 95% CI: 1.020-1.130, P = 6.50 × 10-3) have opposite effect. However, there was a reverse causal relationship between HEM and genus Oscillospira (OR = 1.140, 95% CI: 1.002-1.295, P = .046) This is the first MR study to explore the causalities between specific gut microbiota taxa and hemorrhoidal disease, which may offer valuable insights for future clinical interventions for hemorrhoidal disease.
Collapse
Affiliation(s)
- Fang Yang
- Anorectal Department of Traditional Chinese Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhihua Lan
- Department of Pathology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Huabing Chen
- Anorectal Department of Traditional Chinese Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Rongfang He
- Department of Pathology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| |
Collapse
|
16
|
Duncan MD. An AI-driven risk assessment tool for predicting the severity of illness in acute pancreatitis. Proc AMIA Symp 2024; 37:448-449. [PMID: 38628338 PMCID: PMC11018033 DOI: 10.1080/08998280.2024.2328998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
|
17
|
Zhou W, Liu Q, Wang Z, Yao L, Chen J, Yang X. Analysis of the clinical profile and treatment efficiency of hyperlipidemic acute pancreatitis. Lipids Health Dis 2024; 23:70. [PMID: 38459563 PMCID: PMC10921628 DOI: 10.1186/s12944-024-02057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/23/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The incidence of hyperlipidemic acute pancreatitis (HLAP) has been increasing annually. However, population-based morbidity assessments need to be updated. Early, rapid, and effective lipid-lowering may minimize pancreatic injury and improve clinical prognosis. It is essential to choose the proper treatment. However, treatment options for HLAP are controversial, and there is no uniform treatment protocol. METHODS In this retrospective study, 127 patients with hyperlipidemic severe acute pancreatitis (HL-SAP) were registered from January 2018 to December 2022 at the General Hospital of Ningxia Medical University. Medical and radiological records of hospitalized patients were collected to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Risk factors for HL-SAP were analyzed using multifactorial logistic regression. A propensity score matching method was used to compare the clinical outcomes of standard and plasma exchange therapies. RESULTS In this research, the prevalence of HLAP increased about 1.6 times, and the prevalence of HL-SAP was 50.60%. HL-SAP occurs most often in people between the ages of 30 and 39. Amylase exceeded 110 U/L in 84.3% of patients and 330 U/L in only 47.2%. 83.5% of HL-SAP patients had fatty livers and high body mass index (BMI). A total of 48.0% of patients experienced organ failure, ICU treatment (55.1%), recurrence (33.1%), and death (21.3%). Between the hyperlipidemic group and the biliary group in terms of age, gender, BMI, fatty liver, pleural effusion, abdominal constriction syndrome (ACS), multiple organ dysfunction syndrome (MODS), length of hospital, medical costs, morbidity and mortality, triglyceride, cholesterol, creatinine, blood glucose, D-dimer, amylase, albumin, lactate dehydrogenase, serum phosphorus, serum calcium, oxygenation index, and recurrence rate were statistically significant (P < 0.05). High BMI (P = 0.0038, odds ratio (OR) = 1.336, 95%CI: 0.99-1.804), high C-reactive protein (CRP) (P = 0.022, OR = 1.011, 95%CI: 1.003-1.019), low calcium (P = 0.003, OR = 0.016, 95%CI. 0.001-0.239), low albumin (P = 0.012, OR = 0.045, 95%CI: -0.062-0.192), and high D-dimer (P = 0.041, OR = 0.619, 95%CI: 0.053-2.510) were risk factors for HL-SAP, according to multifactorial logistic regression analysis. Adjusted for propensity score matching (PSM), Serum triglyceride (TG) was significantly lower in both the standard treatment (P < 0.001) and plasma exchange (P < 0.001) groups at 48 h compared with the initial test after the attack. Clearance (83.20% ± 0.0% vs. 84.4% ± 0.0%, P = 0.531), length of hospital stay (19.9 ± 4.9 vs. 19.8 ± 11.1, P = 0.092), and death (26.3% vs. 23.6%, P = 0.791) showed no difference between the two groups. However, the difference in medical costs(P = 0.039)between the two groups was statistically significant. CONCLUSION The incidence of HLAP exhibited a significant increase, remarkable severity, recurrent trend, and mortality. High BMI, high CRP, low calcium, low albumin, and high D-dimer are risk factors for HL-SAP. Compared with standardized treatment, plasma exchange does not improve the prognosis of HL-SAP patients, and standardized treatment is equally effective, safe, and low-cost in early treatment.
Collapse
Affiliation(s)
- Weidong Zhou
- The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Qinfu Liu
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Zhaojun Wang
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Liying Yao
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Jian Chen
- The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, 750004, China
| | - Xiaojun Yang
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, China.
| |
Collapse
|
18
|
Zheng C, Zheng Y, Zheng Z. Therapeutic plasma exchange decreases serum triglyceride level rapidly and reduces early recurrence rate but no advantages in improving outcomes for patients with hyperlipidemic acute pancreatitis: a retrospective propensity score matching analysis based on twenty year's experience. BMC Endocr Disord 2024; 24:32. [PMID: 38443883 PMCID: PMC10916013 DOI: 10.1186/s12902-024-01562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Hyperlipidaemic acute pancreatitis (HLAP) has become the most common cause of acute pancreatitis (AP) not due to gallstones or alcohol (Mosztbacher et al, Pancreatology 20:608-616, 2020; Yin et al, Pancreas 46:504-509, 2017). Therapeutic plasma exchange (TPE) has been reported to be effective in reducing serum TG levels which is important in management of HLAP (World J Clin Cases 9:5794-803, 2021). However, studies on TPE are mostly focusing on cases reports, TPE remains poorly evaluated till date and need to be compared with conservative therapy with a well-designed study. METHODS A retrospectively cohort study on HLAP patients between January 2003 and July 2023 was conducted. Factors correlated with efficacy of TPE were included in a propensity model to balance the confounding factors and minimize selection bias. Patients with and without TPE were matched 1:2 based on the propensity score to generate the compared groups. Lipid profiles were detected on admission and consecutive 7 days. The triglyceride (TG) level decline rates, percentage of patients to reach the target TG levels, early recurrence rate, local complications and mortality were compared between groups. RESULTS A total of 504 HLAP patients were identified. Since TPE was scarcely performed on patients with TG < 11.3 mmol/L, 152 patients with TG level 5.65 to 11.3 mmol/L were excluded while 352 with TG ≧11.3 mmol/L were enrolled. After excluding 25 cases with incomplete data or pregnancy, 327 patients, of whom 109 treated without TPE while 218 treated with TPE, were included in data analysis. One-to-two propensity-score matching generated 78 pairs, 194 patients with well-balanced baseline characteristics. Of 194 patients enrolled after matching done, 78 were treated without while 116 with TPE. In the matched cohort (n = 194), patients treated with TPE had a higher TG decline rate in 48 h than those without TPE (70.00% vs 54.00%, P = 0.001); the early recurrence rates were 8.96% vs 1.83%, p = 0.055. If only SAP patients were analyzed, the early recurrence rates were 14.81% vs 0.00% (p = 0.026) respectively. For patients with CT severity index (CTSI) rechecked within 14 days, early CTSI improment rate were 40.90% vs 31.91%. Local complications checked 6 months after discharge were 44.12% vs 38.30%. Mortality was 1.28% vs 1.72%. No differences were found in early stage CTSI improment rate (P = .589), local complications (P = .451) or motality between two groups. CONCLUSIONS TPE reduces TG levels more quickly in 48 h compared with those with conservative treatment, but no difference in the consecutive days. TPE tends to reduce the early recurrence rate comparing with conventional therapy, but TPE has no advantages in improving CTSI in early stage, and no improvement for outcomes including local complications and mortalty.
Collapse
Affiliation(s)
- Canbin Zheng
- Department of Endocrine and Metabolic Disease, Shantou Central Hospital, Shantou, Guangdong, China
| | - Yongping Zheng
- Department of Gastroenterology, Shantou Central Hospital, 114 Waima Road, Shantou,, 515031, Guangdong, China.
| | - Zihui Zheng
- Department of Anesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| |
Collapse
|
19
|
Piñerúa-Gonsálvez JF, Zambrano-Infantino RDC, Albornoz-Sandoval JC, Tong-Morao PW, León-Hernández MN, Matheus-Alonso BD, Suárez-López F, Flores Y, Higuera SN, Ruiz-Rebollo ML, Sulbaran M. BEHIND THE PROTON PUMP INHIBITOR PRESCRIPTION: AN INTERNATIONAL SURVEY ON PHYSICIAN PRACTICES AND KNOWLEDGE. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23153. [PMID: 38451672 DOI: 10.1590/s0004-2803.24612023-153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/15/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are widely prescribed worldwide, often resulting in their overuse. Consequently, it is essential to identify the likely causes of this overuse to facilitate their appropriate prescription. OBJECTIVE This study aims to assess physician prescribing patterns, their knowledge of PPIs, and factors affecting their knowledge. METHODS An online survey was conducted among Latin American and Spanish physicians, collecting the following data: professional information, patterns of PPI usage, familiarity with published evidence, and the management approach in three hypothetical case-scenarios. Participant knowledge was categorized as sufficient or insufficient based on the results of the case scenarios. Subsequently, subgroup analysis was performed based on physician training level, years in practice, specialty, and time since the last PPI literature review. RESULTS A total of 371 physicians participated in the survey. Thirty-eight percent frequently prescribe PPIs, primarily for prophylactic purposes (57.9%). Eighty percent were unfamiliar with PPI deprescribing strategies, and 54.4% rarely reviewed the ongoing indication of patients taking a PPI. Sixty-four percent demonstrated sufficient knowledge in the case-scenarios. A significant association was observed between specialty type (medical vs surgical: 69.4% vs 46.8%, P<0.001), the timing of the PPI indication literature review (<5 years vs >5 years: 71.4% vs 58.7%, P=0.010), and sufficient knowledge. CONCLUSION While most participants prescribed PPIs regularly and for prophylaxis purposes, the majority were unfamiliar with deprescribing strategies and rarely reviewed ongoing indications. Sufficient knowledge is correlated with recent literature reviews and medical specialty affiliation. BACKGROUND • The study aims to evaluate physician prescribing patterns, assess their knowledge of proton pump inhibitors, and identify factors influencing their knowledge. BACKGROUND • An online survey of Latin American and Spanish physicians assessed proton pump inhibitor usage patterns and case-scenario responses, categorizing knowledge, and conducting subgroup analysis based on training, experience, specialty, and literature review timing. BACKGROUND • Thirty-eight percent of surveyed physicians commonly prescribed proton pump inhibitors, and among them, 80% were unfamiliar with deprescribing strategies, with 54.4% rarely reviewing ongoing indications. BACKGROUND • Sufficient knowledge was correlated with recent literature reviews and medical specialty affiliations.
Collapse
Affiliation(s)
| | | | | | - Pedro Waykin Tong-Morao
- "Francisco Battistini Casalta" School of Health Sciences, Universidad de Oriente, Ciudad Bolívar, Venezuela
| | | | | | - Frank Suárez-López
- Department of Internal Medicine, Hospital Clinic Universitario de Valladolid, Valladolid, Spain
| | - Yormalis Flores
- Department of Neurology, Hospital Clinic Universitario de Caracas, Caracas, Venezuela
| | | | | | - Mariseli Sulbaran
- Department of Gastroenterology, "Dr. Carlos Arvelo" Military Hospital, Caracas, Venezuela
| |
Collapse
|
20
|
Joseph S, Vandruff VN, Amundson JR, Che S, Zimmermann C, Ishii S, Kuchta K, Denham W, Linn J, Hedberg HM, Ujiki MB. Roux-en-Y gastric bypass versus fundoplication for gastroesophageal reflux disease in patients with obesity results in comparable outcomes. Surgery 2024; 175:587-591. [PMID: 38154997 DOI: 10.1016/j.surg.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/11/2023] [Accepted: 10/24/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass and fundoplication are effective treatments for gastroesophageal reflux disease, though the optimal procedure of choice in obesity is unknown. We hypothesize that Roux-en-Y gastric bypass is non-inferior to fundoplication for symptomatic control of gastroesophageal reflux disease in patients with obesity. METHODS We conducted a retrospective review of a prospectively maintained quality database. Patients with a body mass index ≥of 35 who presented for gastroesophageal reflux disease and subsequently underwent Roux-en-Y gastric bypass or fundoplication were included. Perioperative outcomes and pH testing data were reviewed. Patient-reported outcomes included Reflux Symptom Index, Dysphagia, Gastroesophageal Reflux Disease-Health Related Quality of Life, and Short Form-36 scores. Data were analyzed using the Wilcoxon rank sum test. RESULTS Ninety-five patients underwent fundoplication (n = 72, 75.8%) or Roux-en-Y gastric bypass (n = 23, 24.2%) during the study period. All patients saw an improvement in gastroesophageal reflux disease symptoms and overall quality of life. There were no significant differences in postoperative Reflux Symptom Index, Dysphagia, or Short-Form-36 scores. Significant differences in gastroesophageal reflux disease-Health Related Quality of Life scores were seen at preoperative, 1, 2, and 5 years postoperative (P < .05), with better symptom control in the fundoplication group. No significant difference was noted in postoperative DeMeester scores or percent time pH <4. Weight loss was significantly higher in the Roux-en-Y gastric bypass group at all postoperative time points up to 5 years (P < .05). CONCLUSION Roux-en-Y gastric bypass and fundoplication both decrease gastroesophageal reflux disease symptoms. Subjective data shows that patients undergoing Roux-en-Y gastric bypass may complain of worse symptoms compared to patients undergoing fundoplication. Objective data notes no significant difference in postoperative pH testing. Despite previous data, offering fundoplication or Roux-en-Y gastric bypass to patients with a body mass index of ≥35 kg/m2 is appropriate. The choice of surgical approach should be more directed to patient needs and desired goals at the time of the initial clinic visit.
Collapse
Affiliation(s)
- Stephanie Joseph
- Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, MI; Department of Surgery, NorthShore University Health System, Evanston, IL.
| | - Vanessa N Vandruff
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, NorthShore University HealthSystem, University of Chicago Medical Center, Chicago, IL
| | - Julia R Amundson
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, NorthShore University HealthSystem, University of Chicago Medical Center, Chicago, IL
| | - Simon Che
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | | | - Shun Ishii
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Kristine Kuchta
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Woody Denham
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - John Linn
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - H Mason Hedberg
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, IL
| |
Collapse
|
21
|
Bang JY, Wilcox CM, Navaneethan U, Hawes RH, Varadarajulu S. Treatment of walled-off necrosis using lumen-apposing metal stents versus plastic stents: a systematic review and meta-analysis of data from randomized trials. Endoscopy 2024; 56:184-195. [PMID: 37673106 DOI: 10.1055/a-2169-0362] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND Walled-off necrosis (WON) is highly morbid disease most effectively managed by endoscopic drainage with lumen-apposing metal stents (LAMSs) or plastic stents, with or without necrosectomy. This meta-analysis compared the clinical outcomes of patients included in randomized trials treated using LAMSs or plastic stents. METHODS The MEDLINE and EMBASE databases were searched to identify all data collected from randomized trials comparing LAMSs and plastic stents for the treatment of WON. The primary outcome measure was need for endoscopic necrosectomy. RESULTS Three studies comprising 206 patients met inclusion criteria. Except for procedure duration, which was significantly shorter for LAMSs (standardized mean difference [SMD] -1.22, 95%CI -1.64 to -0.79), there was no significant difference in need for necrosectomy (38.5% vs. 41.2%; risk ratio [RR] 1.07, 95%CI 0.79-1.45), number of interventions (SMD -0.09, 95%CI -0.40 to 0.22), treatment success (90.7% vs. 94.5%; RR 0.96, 95%CI 0.87-1.06), recurrence (4.6% vs. 0.6%; RR 3.73, 95%CI 0.42-33.0), readmission (42.6% vs. 50.2%; RR 0.84, 95%CI 0.62-1.14), length of hospitalization (SMD -0.06, 95%CI -0.55 to 0.43), mortality (8.5% vs. 9.8%; RR 0.70, 95%CI 0.30-1.66), new-onset organ failure (10.6% vs. 14.6%; RR 0.72, 95%CI 0.16-3.32), bleeding (11.0% vs. 10.7%; RR 1.09, 95%CI 0.34-3.44), procedural adverse events (23.6% vs. 19.2%; RR 1.38, 95%CI 0.82-2.33), or overall costs (SMD -0.04, 95%CI -0.31 to 0.24) between LAMSs and plastic stents, respectively. CONCLUSIONS Except for procedure duration, there is no significant difference in clinical outcomes for patients with WON treated using LAMSs or plastic stents.
Collapse
Affiliation(s)
- Ji Young Bang
- Digestive Health Institute, Orlando Health, Orlando, United States
| | | | | | | | | |
Collapse
|
22
|
Zaman S, Gorelick F. Acute pancreatitis: pathogenesis and emerging therapies. JOURNAL OF PANCREATOLOGY 2024; 7:10-20. [PMID: 38524855 PMCID: PMC10959536 DOI: 10.1097/jp9.0000000000000168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/25/2023] [Indexed: 03/26/2024] Open
Abstract
Acute pancreatitis is a severe inflammatory disorder with limited treatment options. Improved understanding of disease mechanisms has led to new and potential therapies. Here we summarize what we view as some of the most promising new therapies for treating acute pancreatitis, emphasizing the rationale of specific treatments based on disease mechanisms. Targeted pharmacologic interventions are highlighted. We explore potential treatment benefits and risks concerning reducing acute injury, minimizing complications, and improving long-term outcomes. Mechanisms associated with acute pancreatitis initiation, perpetuation, and reconstitution are highlighted, along with potential therapeutic targets and how these relate to new treatments.
Collapse
Affiliation(s)
- Saif Zaman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06511
| | - Fred Gorelick
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06511
- Veteran’s Administration Healthcare System, West Haven, CT 06516
- Department of Cell Biology, Yale School of Medicine, New Haven, CT 06511
| |
Collapse
|
23
|
Sun Y, Zhang W, Gu J, Xia L, Cao Y, Zhu X, Wen H, Ouyang S, Liu R, Li J, Jiang Z, Cheng D, Lv Y, Han X, Qiu W, Cai K, Song E, Cao Q, Li L. Magnetically driven capsules with multimodal response and multifunctionality for biomedical applications. Nat Commun 2024; 15:1839. [PMID: 38424039 PMCID: PMC10904804 DOI: 10.1038/s41467-024-46046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Untethered capsules hold clinical potential for the diagnosis and treatment of gastrointestinal diseases. Although considerable progress has been achieved recently in this field, the constraints imposed by the narrow spatial structure of the capsule and complex gastrointestinal tract environment cause many open-ended problems, such as poor active motion and limited medical functions. In this work, we describe the development of small-scale magnetically driven capsules with a distinct magnetic soft valve made of dual-layer ferromagnetic soft composite films. A core technological advancement achieved is the flexible opening and closing of the magnetic soft valve by using the competitive interactions between magnetic gradient force and magnetic torque, laying the foundation for the functional integration of both drug release and sampling. Meanwhile, we propose a magnetic actuation strategy based on multi-frequency response control and demonstrate that it can achieve effective decoupled regulation of the capsule's global motion and local responses. Finally, through a comprehensive approach encompassing ideal models, animal ex vivo models, and in vivo assessment, we demonstrate the versatility of the developed magnetic capsules and their multiple potential applications in the biomedical field, such as targeted drug delivery and sampling, selective dual-drug release, and light/thermal-assisted therapy.
Collapse
Affiliation(s)
- Yuxuan Sun
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Wang Zhang
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Junnan Gu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Liangyu Xia
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yinghao Cao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xinhui Zhu
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Hao Wen
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Shaowei Ouyang
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Ruiqi Liu
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Jialong Li
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Zhenxing Jiang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Denglong Cheng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yiliang Lv
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xiaotao Han
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Wu Qiu
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Enmin Song
- School of Computer and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Quanliang Cao
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China.
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China.
| | - Liang Li
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan, 430074, China.
- State Key Laboratory of Advanced Electromagnetic Technology, Huazhong University of Science and Technology, Wuhan, 430074, China.
| |
Collapse
|
24
|
Kiziloluk S, Yildirim M, Bingol H, Alatas B. Multi-feature fusion and dandelion optimizer based model for automatically diagnosing the gastrointestinal diseases. PeerJ Comput Sci 2024; 10:e1919. [PMID: 38435605 PMCID: PMC10909187 DOI: 10.7717/peerj-cs.1919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
It is a known fact that gastrointestinal diseases are extremely common among the public. The most common of these diseases are gastritis, reflux, and dyspepsia. Since the symptoms of these diseases are similar, diagnosis can often be confused. Therefore, it is of great importance to make these diagnoses faster and more accurate by using computer-aided systems. Therefore, in this article, a new artificial intelligence-based hybrid method was developed to classify images with high accuracy of anatomical landmarks that cause gastrointestinal diseases, pathological findings and polyps removed during endoscopy, which usually cause cancer. In the proposed method, firstly trained InceptionV3 and MobileNetV2 architectures are used and feature extraction is performed with these two architectures. Then, the features obtained from InceptionV3 and MobileNetV2 architectures are merged. Thanks to this merging process, different features belonging to the same images were brought together. However, these features contain irrelevant and redundant features that may have a negative impact on classification performance. Therefore, Dandelion Optimizer (DO), one of the most recent metaheuristic optimization algorithms, was used as a feature selector to select the appropriate features to improve the classification performance and support vector machine (SVM) was used as a classifier. In the experimental study, the proposed method was also compared with different convolutional neural network (CNN) models and it was found that the proposed method achieved better results. The accuracy value obtained in the proposed model is 93.88%.
Collapse
Affiliation(s)
- Soner Kiziloluk
- Computer Engineering, Malatya Turgut Ozal University, Malatya, Turkey
| | - Muhammed Yildirim
- Computer Engineering, Malatya Turgut Ozal University, Malatya, Turkey
| | - Harun Bingol
- Software Engineering, Malatya Turgut Ozal University, Malatya, Turkey
| | - Bilal Alatas
- Software Engineering, Firat (Euphrates) University, Elazig, Turkey
| |
Collapse
|
25
|
Virk MS, Virk MA, He Y, Tufail T, Gul M, Qayum A, Rehman A, Rashid A, Ekumah JN, Han X, Wang J, Ren X. The Anti-Inflammatory and Curative Exponent of Probiotics: A Comprehensive and Authentic Ingredient for the Sustained Functioning of Major Human Organs. Nutrients 2024; 16:546. [PMID: 38398870 PMCID: PMC10893534 DOI: 10.3390/nu16040546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Several billion microorganisms reside in the gastrointestinal lumen, including viruses, bacteria, fungi, and yeast. Among them, probiotics were primarily used to cure digestive disorders such as intestinal infections and diarrhea; however, with a paradigm shift towards alleviating health through food, their importance is large. Moreover, recent studies have changed the perspective that probiotics prevent numerous ailments in the major organs. Probiotics primarily produce biologically active compounds targeting discommodious pathogens. This review demonstrates the implications of using probiotics from different genres to prevent and alleviate ailments in the primary human organs. The findings reveal that probiotics immediately activate anti-inflammatory mechanisms by producing anti-inflammatory cytokines such as interleukin (IL)-4, IL-10, IL-11, and IL-13, and hindering pro-inflammatory cytokines such as IL-1, IL-6, and TNF-α by involving regulatory T cells (Tregs) and T helper cells (Th cells). Several strains of Lactobacillus plantarum, Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus reuteri, Bifidobacterium longum, and Bifidobacterium breve have been listed among the probiotics that are excellent in alleviating various simple to complex ailments. Therefore, the importance of probiotics necessitates robust research to unveil the implications of probiotics, including the potency of strains, the optimal dosages, the combination of probiotics, their habitat in the host, the host response, and other pertinent factors.
Collapse
Affiliation(s)
- Muhammad Safiullah Virk
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | | | - Yufeng He
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Tabussam Tufail
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
- University Institute of Diet and Nutritional Sciences, The University of Lahore, Lahore 54000, Pakistan
| | - Mehak Gul
- Department of Internal Medicine, Sheikh Zayed Hospital, Lahore 54000, Pakistan
| | - Abdul Qayum
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Abdur Rehman
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Arif Rashid
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - John-Nelson Ekumah
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Xu Han
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Junxia Wang
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
| | - Xiaofeng Ren
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China; (M.S.V.)
- Institute of Food Physical Processing, Jiangsu University, Zhenjiang 212013, China
| |
Collapse
|
26
|
Yu X, Wang M, Kong Q. Viral pancreatitis: research advances and mechanisms. Front Microbiol 2024; 14:1326837. [PMID: 38420214 PMCID: PMC10901110 DOI: 10.3389/fmicb.2023.1326837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/20/2023] [Indexed: 03/02/2024] Open
Abstract
Acute pancreatitis is caused by trypsinogen activation in acinar cells caused by various injury forms (gallstone, high triglycerides, alcohol, etc.). Viral pancreatitis is a clinically rare disease type, which is easily neglected by clinicians and causes serious adverse consequences. Viral pancreatitis involves the entry of viruses into pancreatic cells, triggering inflammation, immune response activation, and enzymatic autodigestion, leading to tissue damage and potential complications. At present, there are few available reports on viral pancreatitis, most of which are case reports. This review brings attention to clinicians by describing the incidence of viral pancreatitis to enhance clinical understanding and patient care.
Collapse
Affiliation(s)
- Xianqiang Yu
- Medical School, Qingdao University, Qingdao, China
| | - Minchao Wang
- Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, China
| | - Qingming Kong
- School of Basic Medicine and Forensics, Key Laboratory of Bio-tech Vaccine of Zhejiang Province, Engineering Research Center of Novel Vaccine of Zhejiang Province, Hangzhou Medical College, Hangzhou, China
- Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang province, School of Laboratory Medicine and Bioengineering, Hangzhou Medical College, Hangzhou, China
| |
Collapse
|
27
|
Yin H, Gao X, Yang H, Xu Z, Wang X, Wang X, Gao Y, Shi Z, Chen X, Cao L, Zhang C, Wang Z, Hu H, Xiao W. Total alditols from Cistanche deserticola attenuate functional constipation by regulating bile acid metabolism. JOURNAL OF ETHNOPHARMACOLOGY 2024; 320:117420. [PMID: 37967778 DOI: 10.1016/j.jep.2023.117420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
HEADINGS ETHNOPHARMACOLOGICAL RELEVANCE Functional constipation (FC), characterized by chronic constipation, significantly impacts physiological function and induces psychological stress in patients. However, current clinical treatment options for FC are currently limited. Cistanche deserticola, a traditional Chinese medicine that promotes intestinal moisture and bowel relaxation, contains cistanche total alditol extract (CTAE) as its primary active extract. However, the production of CTAE, its overall efficacy, and potential mechanisms for treating FC have yet to been investigated. AIM OF THE STUDY This study aimed to reveal the overall efficacy and potential mechanism of action of CTAE in rats with FC using a combination of stable preparation, pharmacodynamics, non-targeted metabolomics, bile acid metabolomics, and western blotting. MATERIALS AND METHODS Fourteen batches of CTAE underwent quality testing. A rat model of FC was developed using diphenoxylate tablets. The comprehensive pharmacodynamic effects of CTAE on FC were evaluated using fecal characteristics (wet weight, dry weight, and water content), intestinal transmission (colonic EMG amplitude, colonic EMG frequency, propulsion length, and propulsion rate), serum and colon biochemical indicators, distribution of interstitial cells of Cajal (ICC), and pathological examination. Non-targeted metabolomics was performed to assess the changes in endogenous metabolite profiles induced by CTAE. Bile acid metabolomics and western blotting analyses were employed to validate the potential mechanisms of action of CTAE. RESULTS CTAE, with a total content of betaine, mannitol, D-fructose, glucose, and sucrose of (75.67 ± 3.73) %, significantly enhanced intestinal transit, regulated neurotransmitters, increased the expression of c-kit in ICC, and alleviated intestinal inflammation in rats with FC. Non-targeted metabolomics revealed that CTAE significantly alleviated FC-induced metabolic disorders, mainly the biosynthesis of primary bile acids. Targeted metabolomic analysis confirmed that CTAE regulated FC-induced bile acid disorders. Western-blotting results confirmed that CTAE increased the expression of CYP8B1, FGF15, TGR5, and FXR, thereby modulating bile acid synthesis and enterohepatic circulation. CONCLUSION CTAE demonstrates significant therapeutic effects on FC, primarily through the regulation of bile acid synthesis and enterohepatic circulation. These findings provide a promising foundation for the development and clinical application of novel CATE-based drugs.
Collapse
Affiliation(s)
- Hongmei Yin
- Nanjing University of Chinese Medicine, Nanjing, 210023, China; National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Xia Gao
- Nanjing University of Chinese Medicine, Nanjing, 210023, China; National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Hao Yang
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 200120, China
| | - Zhongkun Xu
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Xuening Wang
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Xuesong Wang
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Yunjia Gao
- School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Ziyi Shi
- School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Xialin Chen
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Liang Cao
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Chenfeng Zhang
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Zhenzhong Wang
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Hanfei Hu
- National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China
| | - Wei Xiao
- Nanjing University of Chinese Medicine, Nanjing, 210023, China; National Key Laboratory on Technologies for Chinese Medicine Pharmaceutical Process Control and Intelligent Manufacture, Jiangsu Kanion Pharmaceutical Co., Ltd. Lianyungang, 222001, China; Jiangsu Kanion Modern Chinese Medicine Institute, Nanjing, 211100, China; Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 200120, China.
| |
Collapse
|
28
|
Kneiseler G, Dechêne A. [Gastrointestinal bleeding in old age]. Z Gerontol Geriatr 2024; 57:59-70. [PMID: 38108897 DOI: 10.1007/s00391-023-02258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 12/19/2023]
Abstract
Gastrointestinal bleeding is a frequent symptom, with increasing age as a risk factor. Upper, middle and lower gastrointestinal bleeding are differentiated depending on the location, whereby only upper and lower gastrointestinal bleeding are elucidated in this article. The symptomatology varies depending on the localization of the bleeding. German and international clinical guidelines currently exist for the preclinical and clinical management of gastrointestinal bleeding. The main focus of the article is on pre-endoscopic management of upper gastrointestinal nonvariceal and variceal bleeding, including the risk stratification, transfusion and coagulation management as well as the initial pharmacological treatment. In addition, current developments in endoscopic and interventional treatment of gastrointestinal bleeding are highlighted.
Collapse
Affiliation(s)
- Guntje Kneiseler
- Medizinische Klinik 6 (Schwerpunkte Gastroenterologie, Hepatologie, Endokrinologie und Ernährungsmedizin) am Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - Alexander Dechêne
- Medizinische Klinik 6 (Schwerpunkte Gastroenterologie, Hepatologie, Endokrinologie und Ernährungsmedizin) am Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| |
Collapse
|
29
|
Wangrattanapranee P, Jensen DM, Khrucharoen U, Jensen ME. Patient Outcomes of Definitive Diverticular Hemorrhage After Colonoscopic, Medical, Surgical, or Embolization Treatment. Dig Dis Sci 2024; 69:538-551. [PMID: 38091175 DOI: 10.1007/s10620-023-08199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/15/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND There are few reports of clinical outcomes or the natural history of definitive diverticular hemorrhage (DDH). AIMS To describe 1-year clinical outcomes of patients with documented DDH treated with colonoscopic hemostasis, angioembolization, surgery, or medical treatment. METHODS DDH was diagnosed when active bleeding or other stigmata of hemorrhage were found in a colonic diverticulum during urgent colonoscopy or extravasation on angiography or red blood cell (RBC) scanning. This was a retrospective analysis of prospectively collected data of DDH patients from two referral centers between 1993 and 2022. Outcomes were compared for the four treatment groups. The Kaplan-Meier analysis was for time-to-first diverticular rebleed. RESULTS 162 patients with DDH were stratified based on their final treatment before discharge-104 colonoscopic hemostasis, 24 medical treatment alone, 19 colon surgery, and 15 angioembolization. There were no differences in baseline characteristics, except for a higher Glasgow-Blatchford score in the angioembolization group vs. the colonoscopic group. Post-treatment, the colonoscopic hemostasis group had the lowest rate of RBC transfusions and fewer hospital and ICU days compared to surgical and embolization groups. The medical group had significantly higher rates of rebleeding and reintervention. The surgical group had the highest postoperative complications. CONCLUSIONS Medically treated DDH patients had significantly higher 1-year rebleed and reintervention rates than the three other treatments. Those with colonoscopic hemostasis had significantly better clinical outcomes during the index hospitalization. Surgery and embolization are recommended as salvage therapies in case of failure of colonoscopic and medical treatments.
Collapse
Affiliation(s)
- Peerapol Wangrattanapranee
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Dennis M Jensen
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
- Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- VA Hemostasis GI Research Unit, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA.
| | - Usah Khrucharoen
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- VA Hemostasis GI Research Unit, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA
| | - Mary Ellen Jensen
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- VA Hemostasis GI Research Unit, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA
| |
Collapse
|
30
|
Lippenberger F, Ziegelmayer S, Berlet M, Feussner H, Makowski M, Neumann PA, Graf M, Kaissis G, Wilhelm D, Braren R, Reischl S. Development of an image-based Random Forest classifier for prediction of surgery duration of laparoscopic sigmoid resections. Int J Colorectal Dis 2024; 39:21. [PMID: 38273097 PMCID: PMC10811180 DOI: 10.1007/s00384-024-04593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE Sigmoid diverticulitis is a disease with a high socioeconomic burden, accounting for a high number of left-sided colonic resections worldwide. Modern surgical scheduling relies on accurate prediction of operation times to enhance patient care and optimize healthcare resources. This study aims to develop a predictive model for surgery duration in laparoscopic sigmoid resections, based on preoperative CT biometric and demographic patient data. METHODS This retrospective single-center cohort study included 85 patients who underwent laparoscopic sigmoid resection for diverticular disease. Potentially relevant procedure-specific anatomical parameters recommended by a surgical expert were measured in preoperative CT imaging. After random split into training and test set (75% / 25%) multiclass logistic regression was performed and a Random Forest classifier was trained on CT imaging parameters, patient age, and sex in the training cohort to predict categorized surgery duration. The models were evaluated in the test cohort using established performance metrics including receiver operating characteristics area under the curve (AUROC). RESULTS The Random Forest model achieved a good average AUROC of 0.78. It allowed a very good prediction of long (AUROC = 0.89; specificity 0.71; sensitivity 1.0) and short (AUROC = 0.81; specificity 0.77; sensitivity 0.56) procedures. It clearly outperformed the multiclass logistic regression model (AUROC: average = 0.33; short = 0.31; long = 0.22). CONCLUSION A Random Forest classifier trained on demographic and CT imaging biometric patient data could predict procedure duration outliers of laparoscopic sigmoid resections. Pending validation in a multicenter study, this approach could potentially improve procedure scheduling in visceral surgery and be scaled to other procedures.
Collapse
Affiliation(s)
- Florian Lippenberger
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ziegelmayer
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian Berlet
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philipp-Alexander Neumann
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Graf
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute for Artificial Intelligence in Medicine and Healthcare, School of Medicine and Faculty of Informatics, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK, Partner Site Munich) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Stefan Reischl
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| |
Collapse
|
31
|
Tarján D, Szalai E, Lipp M, Verbói M, Kói T, Erőss B, Teutsch B, Faluhelyi N, Hegyi P, Mikó A. Persistently High Procalcitonin and C-Reactive Protein Are Good Predictors of Infection in Acute Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:1273. [PMID: 38279274 PMCID: PMC10816999 DOI: 10.3390/ijms25021273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
Infected necrotizing pancreatitis (INP) is associated with an increased risk of organ failure and mortality. Its early recognition and timely initiation of antibiotic therapy can save patients' lives. We systematically searched three databases on 27 October 2022. In the eligible studies, the presence of infection in necrotizing pancreatitis was confirmed via a reference test, which involved either the identification of gas within the necrotic collection through computed tomography imaging or the examination of collected samples, which yielded positive results in Gram staining or culture. Laboratory biomarkers compared between sterile necrotizing pancreatitis and INP were used as the index test, and our outcome measures included sensitivity, specificity, the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Within the first 72 hours (h) after admission, the AUC of C-reactive protein (CRP) was 0.69 (confidence interval (CI): 0.62-0.76), for procalcitonin (PCT), it was 0.69 (CI: 0.60-0.78), and for white blood cell count, it was 0.61 (CI: 0.47-0.75). After the first 72 h, the pooled AUC of CRP showed an elevated level of 0.88 (CI: 0.75-1.00), and for PCT, it was 0.86 (CI: 0.60-1.11). The predictive value of CRP and PCT for infection is poor within 72 h after hospital admission but seems good after the first 72 h. Based on these results, infection is likely in case of persistently high CRP and PCT, and antibiotic initiation may be recommended.
Collapse
Affiliation(s)
- Dorottya Tarján
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Eszter Szalai
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Mónika Lipp
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
| | - Máté Verbói
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Bálint Erőss
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Department of Radiology, Medical Imaging Centre, Semmelweis University, 1085 Budapest, Hungary
| | - Nándor Faluhelyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Division of Medical Imaging, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, 6725 Szeged, Hungary
| | - Alexandra Mikó
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (D.T.); (E.S.); (M.L.); (T.K.); (B.E.); (B.T.); (N.F.); (A.M.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, 6725 Szeged, Hungary
- Department for Medical Genetics, Medical School, University of Pécs, 7624 Pécs, Hungary
| |
Collapse
|
32
|
Peabody JW, Cruz JD, Ganesan D, Paculdo D, Critchley-Thorne RJ, Wani S, Shaheen NJ. A Randomized Controlled Study on Clinical Adherence to Evidence-Based Guidelines in the Management of Simulated Patients With Barrett's Esophagus and the Clinical Utility of a Tissue Systems Pathology Test: Results From Q-TAB. Clin Transl Gastroenterol 2024; 15:e00644. [PMID: 37767993 PMCID: PMC10810603 DOI: 10.14309/ctg.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma. Physicians infrequently adhere to guidelines for managing BE, leading to either reduced detection of dysplasia or inappropriate re-evaluation. METHODS We conducted a three-arm randomized controlled trial with 2 intervention arms to determine the impact of a tissue systems pathology (TSP-9) test on the adherence to evidence-based guidelines for simulated patients with BE. Intervention 1 received TSP-9 results, and intervention 2 had the option to order TSP-9 results. We collected data from 259 practicing gastroenterologists and gastrointestinal surgeons who evaluated and made management decisions for 3 types of simulated patients with BE: nondysplastic BE, indefinite for dysplasia, and low-grade dysplasia. RESULTS Intervention 1 was significantly more likely to correctly assess risk of progression to high-grade dysplasia/esophageal adenocarcinoma and offer treatment in accordance with US society guidelines compared with the control group (+6.9%, 95% confidence interval +1.4% to +12.3%). There was no significant difference in ordering guideline-recommended endoscopic eradication therapy. However, for cases requiring annual endoscopic surveillance, we found significant improvement in adherence for intervention 1, with a difference-in-difference of +18.5% ( P = 0.019). Intervention 2 ordered the TSP-9 test in 21.9% of their cases. Those who ordered the test performed similarly to intervention 1; those who did not, performed similarly to the control group. DISCUSSION The TSP-9 test optimized adherence to clinical guidelines for surveillance and treatment of both patients with BE at high and low risk of disease progression. Use of the TSP-9 test can enable physicians to make risk-aligned management decisions, leading to improved patient health outcomes.
Collapse
Affiliation(s)
- John W. Peabody
- QURE Healthcare, San Francisco, California, USA
- University of California, San Francisco, California, USA
- University of California, Los Angeles, California, USA
| | | | | | | | | | - Sachin Wani
- University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Nicholas J. Shaheen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
33
|
Potter D, Valera P. Health Is Power, and Health Is Wealth: Understanding the Motivators and Barriers of African American/Black Male Immigrants With Gastrointestinal Conditions. Am J Mens Health 2024; 18:15579883241227333. [PMID: 38311894 PMCID: PMC10846062 DOI: 10.1177/15579883241227333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 02/06/2024] Open
Abstract
The digestive health of African American/Black male immigrants in the United States has not been previously studied. Much of what is known about gastrointestinal (GI) concerns in this population is based on studies conducted on the overall Black American population. The purpose of this narrative study was to understand how African American/Black male immigrants with GI concerns navigated their GI condition. Fifteen African American/Black male immigrants from various cities in the United States participated in two remote focus groups to discover what motivates them to take control of their illness. Narrative analysis was used to analyze the qualitative data. Most men, 47% (n = 7), did not have health insurance, and 67% (n = 10) reported their income was less than US$52,000. The themes identified were: (1) lack of knowledge of GI, (2) denial of initial diagnosis, (3) self-discipline, (4) positive provider interactions, (5) health as a priority, and (6) advice to other African American/Black male immigrants experiencing GI. A strengths-based approach is necessary for describing the health-seeking behaviors among African American/Black male immigrants.
Collapse
Affiliation(s)
- Daina Potter
- School of Public Health, Rutgers University, Newark, NJ, USA
| | - Pamela Valera
- School of Public Health, Rutgers University, Newark, NJ, USA
| |
Collapse
|
34
|
Orock A, Johnson A, Mohammadi E, Greenwood-Van Meerveld B. Environmental enrichment reverses stress-induced changes in the brain-gut axis to ameliorate chronic visceral and somatic hypersensitivity. Neurobiol Stress 2024; 28:100590. [PMID: 38075024 PMCID: PMC10698671 DOI: 10.1016/j.ynstr.2023.100590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction Behavioral therapies, including cognitive behavioral therapy, hypnotherapy and stress management activities, have emerged as effective treatments for irritable bowel syndrome (IBS), a female predominant disorder of the brain-gut axis. IBS, affecting over 10% of the global population, typically presents with abnormal bowel habits and abdominal pain due to visceral hypersensitivity. While the mechanisms underlying how behavioral therapies treat IBS are still elusive, we had previously shown that chronic stress alters gene expression in brain regions critical for stress processing and nociception. We found that exposure to an enriched environment (EE), the rodent analogue of behavioral therapies, prior to and during the stressor was sufficient to prevent stress-induced changes in glucocorticoid receptor (GR) expression in the central nucleus of the amygdala (CeA) and hippocampus. Pre-exposure to EE also inhibited stress-induced increased colonic permeability and was able to block the induction of stress-induced visceral and somatic hypersensitivity. However, it remains unknown if EE can reverse chronic viscerosomatic hypersensitivity that persists following exposure to stress. We hypothesized that EE after chronic stress would be sufficient to reverse stress-induced changes in i) GR expression in the CeA and hippocampus, ii) ameliorate stress-induced colonic hyperpermeability and iii) restore normal visceral and somatic sensitivity in male and female rats. Methods Male and female rats were exposed to daily water avoidance stress (WAS). After confirming the rats had developed visceral hypersensitivity, 50% of the animals were housed in EE for 2 weeks while the other 50% remained in standard housing (SH). At the end of this period, we assessed visceral and somatic sensitivity. We also collected colon tissue to measure colonic permeability. Micro-punches of tissue from the CeA and hippocampus were isolated to measure GR expression. Control animals not exposed to WAS were kept in SH for the duration of the study (n = 8 per group). Results In both male and female rats, EE reversed stress-induced visceral (p < 0.001) and somatic (p < 0.01) hypersensitivity when compared to WAS animals housed in SH to levels comparable to control animals. EE exposure also reversed changes in GR expression in both the hippocampus (p < 0.01) and CeA (p < 0.01), normalizing GR expression to control levels. EE exposure ameliorated stress-induced colonic hyperpermeability in both male (p < 0.01) and female (p < 0.01) rats compared to WAS rats in SH. Conclusion Our findings suggest that behavioral therapies are viable therapeutic options for IBS as they can counter the stress-induced pathophysiology underlying IBS symptoms including visceral hypersensitivity, increased colonic permeability and altered gene expression.
Collapse
Affiliation(s)
- A. Orock
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - A.C. Johnson
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Health Care System, Oklahoma City, OK, USA
| | - E. Mohammadi
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - B. Greenwood-Van Meerveld
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterans Affairs Health Care System, Oklahoma City, OK, USA
| |
Collapse
|
35
|
Zhang R, Zhao G, Yan Z, Xuan H, Chen Y. The effective dose of remimazolam in adult gastroscopy. Indian J Pharmacol 2024; 56:10-15. [PMID: 38454583 PMCID: PMC11001170 DOI: 10.4103/ijp.ijp_425_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/24/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES The objectives of this study were to explore the median effective dose (ED50) and the dose required for successful anesthesia in 95% of the patients (ED95) of remimazolam for intravenous anesthesia in adult outpatients undergoing gastroscopy. METHODS This pilot study was conducted in patients scheduled to undergo painless gastroscopy at the authors' hospital between March 15, 2022 and March 25, 2022. The ED of remimazolam was determined using the modified Dixon sequential method, using an initial induction dose of 0.2 mg/kg. With successful or failed anesthesia, the remimazolam dose was decreased or increased by 0.05 mg/kg for the next patient, respectively. RESULTS Twenty-two patients (43.6 ± 10.5 years of age) were enrolled. During gastroscopy, the remimazolam induction dose was 19.93 ± 2.96 mg (0.2-0.45 mg/kg). Eighteen patients could complete anesthesia with remimazolam alone, and four patients needed propofol to complete anesthesia. The induction time after the injection of remimazolam was 20.8 ± 8.4 s, the gastroscopy time was 5.1 ± 1.3 min, and the anesthesia recovery time was 17.5 ± 5.6 min. The ED50 and the ED95 of remimazolam were 0.362 mg/kg (95% confidence interval [CI]: 0.313-0.455 mg/kg) and 0.464 mg/kg (95% CI: 0.403-2.242 mg/kg), respectively. The vital signs of all patients remained within the predefined acceptable limits. No patients required antagonist rescue. CONCLUSION The ED50 and ED95 of remimazolam for adult gastroscopy were 0.362 mg/kg and 0.464 mg/kg, respectively. Additional anesthetics might be required during gastroscopy in some patients. TRIAL REGISTRATION The trial was registered. The number is ChiCTR2200057446.
Collapse
Affiliation(s)
- Rongyan Zhang
- Department of Anesthesiology, Zhuji Central Hospital, Zhuji, Zhejiang, China
| | - Gang Zhao
- Department of Anesthesiology, Zhuji People’s Hospital, Zhuji, Zhejiang, China
| | - Zhangjun Yan
- Department of Anesthesiology, Zhuji People’s Hospital, Zhuji, Zhejiang, China
| | - Hongmei Xuan
- Department of Anesthesiology, Zhuji People’s Hospital, Zhuji, Zhejiang, China
| | - Yan Chen
- Department of Anesthesiology, Zhuji People’s Hospital, Zhuji, Zhejiang, China
| |
Collapse
|
36
|
Holzer CS, Pukaluk A, Viertler C, Regitnig P, Caulk AW, Eschbach M, Contini EM, Holzapfel GA. Biomechanical characterization of the passive porcine stomach. Acta Biomater 2024; 173:167-183. [PMID: 37984627 DOI: 10.1016/j.actbio.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
The complex mechanics of the gastric wall facilitates the main digestive tasks of the stomach. However, the interplay between the mechanical properties of the stomach, its microstructure, and its vital functions is not yet fully understood. Importantly, the pig animal model is widely used in biomedical research for preliminary or ethically prohibited studies of the human digestion system. Therefore, this study aims to thoroughly characterize the mechanical behavior and microstructure of the porcine stomach. For this purpose, multiple quasi-static mechanical tests were carried out with three different loading modes, i.e., planar biaxial extension, radial compression, and simple shear. Stress-relaxation tests complemented the quasi-static experiments to evaluate the deformation and strain-dependent viscoelastic properties. Each experiment was conducted on specimens of the complete stomach wall and two separate layers, mucosa and muscularis, from each of the three gastric regions, i.e., fundus, body, and antrum. The significant preconditioning effects and the considerable regional and layer-specific differences in the tissue response were analyzed. Furthermore, the mechanical experiments were complemented with histology to examine the influence of the microstructural composition on the macrostructural mechanical response and vice versa. Importantly, the shear tests showed lower stresses in the complete wall compared to the single layers which the loose network of submucosal collagen might explain. Also, the stratum arrangement of the muscularis might explain mechanical anisotropy during tensile tests. This study shows that gastric tissue is characterized by a highly heterogeneous microstructure with regional variations in layer composition reflecting not only functional differences but also diverse mechanical behavior. STATEMENT OF SIGNIFICANCE: Unfortunately, only few experimental data on gastric tissue are available for an adequate material parameter and model estimation. The present study therefore combines layer- and region-specific stomach wall mechanics obtained under multiple loading conditions with histological insights into the heterogeneous microstructure. On the one hand, the extensive data sets of this study expand our understanding of the interplay between gastric mechanics, motility and functionality, which could help to identify and treat associated pathologies. On the other hand, such data sets are of high relevance for the constitutive modeling of stomach tissue, and its application in the field of medical engineering, e.g., in the development of surgical staplers and the improvement of bariatric surgical interventions.
Collapse
Affiliation(s)
| | - Anna Pukaluk
- Institute of Biomechanics, Graz University of Technology, Austria
| | - Christian Viertler
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Austria
| | | | | | | | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Austria; Department of Structural Engineering, NTNU, Trondheim, Norway.
| |
Collapse
|
37
|
Zamani M, Alizadeh-Tabari S. Anxiety and depression prevalence in digestive cancers: a systematic review and meta-analysis. BMJ Support Palliat Care 2023; 13:e235-e243. [PMID: 34417285 DOI: 10.1136/bmjspcare-2021-003275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancers of the digestive system can be associated with disturbing and disabling symptoms, which can contribute to a negative psychological pressure on patients. AIM To investigate the reported prevalence of symptoms of anxiety and depression in patients with major digestive cancers, including oesophageal, gastric, colorectal, pancreatic or hepatic cancers. METHODS We searched Embase, PubMed, Scopus and Web of Science for articles published from inception to December 2020. We included studies reporting the prevalence of anxiety or depression symptoms using validated questionnaires in adult patients (≥18 years). RESULTS In total, 51 eligible papers were finally included. Overall, the pooled prevalence of anxiety symptoms was 20.4% (95% CI 17% to 23.8%). The estimate in patients with gastrointestinal (GI) cancers was 19.1% and in patients with hepatic cancer was 29.1%. Among GI cancers, the highest pooled prevalence of anxiety symptoms related to oesophageal cancer (20.6%), while the lowest pooled prevalence pertained to gastric cancer (18.7%). Regarding depression symptoms, the overall pooled prevalence was 30.2% (95% CI 24.3% to 36.1%). The estimate in patients with GI cancers was 31% and in patients with hepatic cancer was 21.5%. Among GI cancers, the highest pooled prevalence of depression symptoms related to oesophageal cancer (45.2%), while the lowest pooled prevalence pertained to colorectal cancer (22.9%). CONCLUSION A considerable prevalence of anxiety and depression symptoms is observed in patients with digestive cancers. Screening and preventive measures with early management of these psychological problems by clinicians could possibly improve outcomes for these patients. PROSPERO REGISTRATION NUMBER CRD42020210079.
Collapse
Affiliation(s)
- Mohammad Zamani
- Digestive Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Babol University of Medical Science, Babol, Iran
| | | |
Collapse
|
38
|
Kelley JK, Kelly K, Reed C, Winkler N, Parker J, Ogilvie J. Does Hispanic ethnicity play a role in outcomes for diverticular surgery in the USA? BMJ Open Gastroenterol 2023; 10:e001215. [PMID: 38050373 PMCID: PMC10693875 DOI: 10.1136/bmjgast-2023-001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE The aim of this study is to investigate whether origins of ethnicity affect the outcomes of surgery for diverticulitis in the USA. DESIGN The American College of Surgeons National Surgical Quality Improvement Programme database from 2008 to 2017 was used to identify patients undergoing colectomy for diverticulitis. Patient demographics, comorbidities, procedural details and outcomes were captured and compared by ethnicity status. RESULTS A total of 375 311 surgeries for diverticulitis were included in the final analysis. The average age of patients undergoing surgery for diverticulitis remained consistent over the time frame of the study (62 years), although the percentage of younger patients (age 18-39 years) rose slightly from 7.8% in 2008 to 8.6% in 2017. The percentage of surgical patients with Hispanic ethnicity increased from 3.7% in 2008 to 6.6% of patients in 2017. Hispanic patients were younger than their non-Hispanic counterparts (57 years vs 62 years, p<0.01) at time of surgery. There were statistically significant differences in the proportion of laparoscopic cases (51% vs 49%, p<0.01), elective cases (62% vs 66%, p<0.01) and the unadjusted rate of postoperative mortality (2.8% vs 3.4%, p<0.01) between Hispanic patients compared with non-Hispanic patients, respectively. Multivariable logistic regression models did not identify Hispanic ethnicity as a significant predictor for increased morbidity (p=0.13) or mortality (p=0.80). CONCLUSION Despite a significant younger population undergoing surgery for diverticulitis, Hispanic ethnicity was not associated with increased rates of emergent surgery, open surgery or postoperative complications compared with a similar non-Hispanic population.
Collapse
Affiliation(s)
- Jesse K Kelley
- Graduate Medical Education, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
- General Surgery, Corewell Health West Michigan, Grand Rapids, Michigan, USA
| | - Kathrine Kelly
- Graduate Medical Education, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
- General Surgery, Corewell Health West Michigan, Grand Rapids, Michigan, USA
| | - Charles Reed
- Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Nathan Winkler
- Graduate Medical Education, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
- General Surgery, Corewell Health West Michigan, Grand Rapids, Michigan, USA
| | - Jessica Parker
- Scholarly Activity and Scientific Support, Corewell Health West Michigan, Grand Rapids, Michigan, USA
| | - James Ogilvie
- Graduate Medical Education, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
- General Surgery, Division of Colorectal Surgery, Corewell Health West Michigan, Grand Rapids, Michigan, USA
| |
Collapse
|
39
|
Tomanguillo J, Searls L, Annie FH, Kemper S, Drabish K, Naravadi V. A Nationwide Analysis of Fluid Resuscitation Outcomes in Patients With Acute Pancreatitis. Cureus 2023; 15:e50182. [PMID: 38192944 PMCID: PMC10771961 DOI: 10.7759/cureus.50182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Traditionally, fluid resuscitation has been the foundation of effective acute pancreatitis (AP) treatment. Experts advocate for aggressive intravenous fluid (IVF) resuscitation, especially within the first 24 hours. Research suggests limited efficacy of this approach; in fact, some studies show there may be a risk of increased complications. The aim of this study was to assess outcomes of aggressive IVF resuscitation in patients with AP. METHODS We queried the TriNetX Research Network (Cambridge, Massachusetts, United States) for patients admitted between January 1, 2010, and December 31, 2020, with a diagnosis of AP and who had received IVF on admission for at least 24 hours. We compared two cohorts; cohort 1 consisted of patients receiving aggressive IVF resuscitation (>3 ml/kg/hr), and cohort 2 was comprised of patients receiving non-aggressive (≤1.5 ml/kg/hr) IVF resuscitation. We compared mortality during index hospitalization, hospital length of stay (HLS), mechanical ventilation rates, acute kidney injury (AKI), and severe sepsis between the cohorts with propensity scoring matched (PSM) pairs of patients. A sub-analysis of patients with severe AP was performed. RESULTS After comparing the two well-matched PSM cohorts (3,680/3,680), we found no significant differences in mortality, HLS, mechanical ventilation rates, AKI, or severe sepsis. We found similar results after conducting the sub-analysis of patients with severe pancreatitis. CONCLUSIONS We found no significant differences in mortality and HLS when comparing rates of IVF resuscitation.
Collapse
Affiliation(s)
- Julton Tomanguillo
- Internal Medicine, Charleston Area Medical Center (CAMC) Institute for Academic Medicine, Charleston, USA
| | - Lauren Searls
- Internal Medicine, Charleston Area Medical Center (CAMC) Institute for Academic Medicine, Charleston, USA
| | - Frank H Annie
- Cardiology, Charleston Area Medical Center (CAMC) Institute for Academic Medicine, Charleston, USA
| | - Suzanne Kemper
- Outcomes Research, Charleston Area Medical Center (CAMC) Health Education and Research Institute, Charleston, USA
| | - Kerry Drabish
- Research, Charleston Area Medical Center (CAMC) Institute for Academic Medicine, Charleston, USA
| | - Vishnu Naravadi
- Gastroenterology, Charleston Area Medical Center (CAMC) Institute for Academic Medicine, Charleston, USA
| |
Collapse
|
40
|
M M, Sandhu MS, Gupta P, Samanta J, Sharma V, Kumar V, Mandavdhare H, Dutta U, Kochhar R. Impact of contrast-enhanced versus non-contrast computed tomography on acute kidney injury in acute necrotizing pancreatitis: A randomized controlled trial. Indian J Gastroenterol 2023; 42:808-817. [PMID: 37578599 DOI: 10.1007/s12664-023-01415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The data evaluating contrast-induced-acute kidney injury (AKI) in patients with acute pancreatitis is scarce. This study aimed to compare the frequency of AKI in patients with acute necrotizing pancreatitis undergoing non-contrast computed tomography (NCCT) with those undergoing contrast-enhanced computed tomography (CECT) during hospitalization. METHODS This prospective randomized controlled trial (CTRI/2019/12/022206) screened consecutive patients with acute pancreatitis for eligibility and randomly allocated patients with acute necrotizing pancreatitis (based on CECT in the first week of illness) and normal renal functions to receive either NCCT or CECT during hospitalization. The incidence of development of new AKI and clinical outcomes was compared between the two groups. Post-hoc analysis was done to adjust for disease severity. RESULTS As many as 105 patients completed the study as per protocol (NCCT = 45 and CECT = 60). AKI occurred in 36 (34.3%) patients, nine (20%) in the NCCT and 27 (45%) in the CECT group. Contrast induced-AKI occurred in 11 (18.3%) patients, while 25 had AKI secondary to acute pancreatitis. The relative risk (RR) of AKI in the CECT group was 2.25 (95% CI 1.17-4.30, p = .0142). The frequency of intensive care unit (ICU) admission (RR = 2.1, 95% CI 1.34-3.27, p = .0001) and need for drainage of collections (RR = 1.39, 95% CI 1.1-1.7, p = .005) was significantly higher and the length of hospitalization (p = .001) and ICU admission (p = 0.001) were significantly longer in the CECT group. However, when adjusted for the severity of acute pancreatitis, there was no difference in AKI and clinical outcomes between the NCCT and CECT groups. The duration of AKI was significantly longer and the need for dialysis was significantly higher in patients who had AKI secondary to acute pancreatitis compared to those with contrast induced-AKI (p = .003). CONCLUSION CECT is not significantly associated with AKI in acute necrotizing pancreatitis.
Collapse
Affiliation(s)
- Manoj M
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Harshal Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| |
Collapse
|
41
|
Rustgi SD, McKinley M, McBay B, Zylberberg HM, Gomez SL, Hur C, Kastrinos F, Gupta S, Kim MK, Itzkowitz SH, Shah SC. Epidemiology of Gastric Malignancies 2000-2018 According to Histology: A Population-Based Analysis of Incidence and Temporal Trends. Clin Gastroenterol Hepatol 2023; 21:3285-3295.e8. [PMID: 36792000 PMCID: PMC10809276 DOI: 10.1016/j.cgh.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND & AIMS Gastric cancer (GC) remains a leading cause of cancer and cancer-related mortality. Recent reports suggest noncardia GC is increasing in certain U.S. POPULATIONS However, whether these trends are driven by gastric adenocarcinoma (GA) or other histologies, including neuroendocrine tumors (NETs), lymphoma, or gastrointestinal stromal tumors (GISTs), is unclear. METHODS We analyzed the Surveillance, Epidemiology and End Results-18 cancer registry (2000-2018) to determine age-standardized incidence rates (ASIR) and annual percentage change (APC) trends for histologically-confirmed GCs, stratified by anatomic location (noncardia vs cardia), age group (20-49 vs 50+ years), sex, race, and ethnicity. Joinpoint regression modeling estimated the statistical significance of trend comparisons. RESULTS Of 74,520 individuals with noncardia GC, most (66.2%) were GA, with the next largest categories being non-mucosa-associated lymphoid tissue (non-MALT) lymphomas (6.9%), GIST (6.7%), NET (6.4%), and MALT lymphoma (5.6%). Noncardia GA ASIR was significantly higher than other histologies and demonstrated the greatest differences by race and ethnicity. APCs for GA and MALT, both Helicobacter pylori-associated cancers, declined significantly over time, which was driven primarily by trends among individuals ≥50 years-old. NET and GIST APCs significantly increased irrespective of age group, with the highest APCs observed among non-Hispanic white individuals. Cardia GC was rarer than noncardia GC and comprised primarily by GA (87.9%). Cardia GC incidence fell during the study period, which was primarily driven by decline in cardia GA. CONCLUSIONS GA was the most common histology. On the basis of our findings, the rise in noncardia GC among certain U.S. populations appears predominantly driven by NET and GIST, not GA. Further studies are needed to clarify underlying etiologies for these findings.
Collapse
Affiliation(s)
- Sheila D Rustgi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Meg McKinley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Brandon McBay
- Department of Public Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Haley M Zylberberg
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Scarlett L Gomez
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Chin Hur
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Samir Gupta
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California
| | - Michelle Kang Kim
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven H Itzkowitz
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shailja C Shah
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California.
| |
Collapse
|
42
|
O'Connor HJ. Forty years of Helicobacter pylori infection and changes in findings at esophagogastroduodenoscopy. Helicobacter 2023; 28:e13026. [PMID: 37818739 DOI: 10.1111/hel.13026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND It is 40 years since the discovery of Helicobacter pylori infection. Over that time major changes have occurred in esophagogastroduodenoscopy (EGD) findings. The aim of this review is to describe these changes, and the important role H. pylori infection has played in their evolution. METHODS References were identified through searches of PubMed using the search terms-endoscopy time trends, peptic ulcer disease, gastroesophageal reflux disease, upper gastrointestinal cancer, gastric polyps, H. pylori, eosinophilic gastrointestinal disorders, and celiac disease, from 1970 through December 2021. RESULTS The prevalence of H. pylori infection has fallen and consequently, H. pylori-positive peptic ulcer disease has become rare. Gastroesophageal reflux disease is now the commonest disorder diagnosed at EGD, and Barrett's esophagus has increased in parallel. Cancer of the distal stomach has fallen while esophageal adenocarcinoma and reflux-related cardia cancer have risen. Gastric polyps have changed from hyperplastic and adenomas to sporadic fundic gland polyps. Antimicrobial resistance has made H. pylori infection more difficult to eradicate. Eosinophilic gastrointestinal disorders, particularly eosinophilic esophagitis, have emerged as important new allergic disorders. Celiac disease has changed and increased. CONCLUSIONS EGD findings appear to have changed from features suggesting a H. pylori-positive "phenotype" 40 years ago to a H. pylori-negative "phenotype" today. These changes have major implications for the management of gastrointestinal disorders.
Collapse
Affiliation(s)
- Humphrey J O'Connor
- Trinity Academic Gastroenterology Group, Trinity Centre for Health Sciences, The University of Dublin, Tallaght University Hospital, Dublin, Ireland
| |
Collapse
|
43
|
Feuerwerker S, Kambli R, Grinberg D, Malhotra A, An G. Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience. Surg Open Sci 2023; 16:94-97. [PMID: 37808421 PMCID: PMC10551647 DOI: 10.1016/j.sopen.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023] Open
Abstract
Background Acute cholecystitis in patients on anti-thrombotic therapy (ATT) presents a clinical dilemma at the intersection between conflicting guidelines, specifically between timing of early operative management (OM) versus time-to-reversal of certain ATT agents. With growing recognition that nonoperative management (NOM) is associated with considerable morbidity, and evidence in the literature that early OM in patients on ATT is safe, we reviewed our own practice to examine how we addressed these conflicting guidelines. Materials and methods We performed a retrospective review of patients with acute cholecystitis between December 2017 and March 2022. Patients were classified as ATT or non-ATT; ATT patients were subdivided into anticoagulation (AC) and antiplatelet (AP) groups. Rates of OM were compared. Results 502 patients with acute cholecystitis were identified, 464 non-ATT and 38 ATT. 30 ATT patients were on AC, 7 on AP, and 1 on both. Non-ATT patients were significantly more likely to receive OM at index presentation compared to those on ATT: 89.9 % vs 63.2 % (p < 0.05). Subgroup analysis of the ATT group showed AP patients were significantly less likely to receive OM compared to those on AC, 12.5 % vs 77 % (p < 0.05). Conclusions At our institution, patients on ATT were significantly less likely to undergo OM for acute cholecystitis compared with non-ATT patients. Those on AC received OM significantly more than patients on AP. Further study is needed to better define the management of this growing population so that acute cholecystitis guidelines might address this issue in the future.
Collapse
Affiliation(s)
- Solomon Feuerwerker
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Ruja Kambli
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Diana Grinberg
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Ajai Malhotra
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Gary An
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| |
Collapse
|
44
|
Li ZZ, Guan LJ, Ouyang R, Chen ZX, Ouyang GQ, Jiang HX. Global, regional, and national burden of gallbladder and biliary diseases from 1990 to 2019. World J Gastrointest Surg 2023; 15:2564-2578. [PMID: 38111771 PMCID: PMC10725539 DOI: 10.4240/wjgs.v15.i11.2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gallbladder and biliary diseases (GABDs) are a major public health issue. AIM To analysis the cause-specific incidence, prevalence, and years lived with disability (YLDs) and its temporal trends of GABDs at the global, regional, and national level. Data on GABD were available from the Global Burden of Disease study 2019. METHODS The estimated annual percentage change (EAPC) was used to quantify temporal trend in GABD age-standardized incidence rates (ASIRs), age-standardized prevalence rate (ASPR), and age-standardized YLD rate (ASYR) by region, sex. We analyzed the relationship between the GABD burden and country development level using the human development index (HDI). RESULTS In 2019, the incident cases of GABD were 52003772, with an ASIR of 63432/100000 population. Globally, the number of incident cases and ASIR of GABD increased 97% and 58.9% between 1990 and 2019. Although, the ASPR and ASYR decreased from 1990 to 2019, the number of prevalent and YLDs cases increased. The highest ASIR was observed in Italy, and the highest ASPR and ASYR was observed in United Kingdom. The highest burden of GABD was found in low-SDI region, and the burden in female was significantly higher than males. A generally negative correlation (ρ = -0.24, P < 0.05) of GABD with the EAPC and human development index (HDI) (in 2021) were observed for ASIR. What's more, no correlation in ASPR (ρ = -0.06, P = 0.39) and ASYR (ρ = -0.07, P = 0.36) of GABD with the EAPC and HDI (in 2021) were observed, respectively. CONCLUSION GABD remain a major global public health challenge; however, the burden of GABD varies geographically. Globally, the number of incident cases and ASIR of GABD increased between 1990 and 2019. The results of our study provide insight into the global disease burden of GABD and may assist policymakers in formulating effective policies to mitigate modifiable risk factors.
Collapse
Affiliation(s)
- Zhong-Zhuan Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Lin-Jing Guan
- Department of Abdomen Ultrasound, Nanning Sixth People’s Hospital, Nanning 530002, Guangxi Zhuang Autonomous Region, China
| | - Rong Ouyang
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Xin Chen
- Department of Gastroenterology, Liuzhou Workers’ Hospital (The Fourth Affiliated Hospital of Guangxi Medical University), Liuzhou 545007, Guangxi Zhuang Autonomous Region, China
| | - Guo-Qing Ouyang
- Department of General Surgery, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China
| | - Hai-Xing Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
45
|
Wang N, Han F, Pan J, Yao G, Wang Y, Xu S, Xiao W, Ding Y, Xu C. Serum Cys C predicts acute kidney injury in patients with acute pancreatitis: A retrospective study. Arab J Gastroenterol 2023; 24:238-244. [PMID: 37989670 DOI: 10.1016/j.ajg.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/23/2023] [Accepted: 09/05/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND STUDY AIMS We investigated the value of the serum cystatin C level as a potential predictor of acute kidney injury (AKI) in patients with acute pancreatitis (AP). PATIENTS AND METHODS We retrospectively examined patients diagnosed with AP between January 2013 and December 2018. Patients were categorized into two groups based on their serum cystatin C levels after admission: the normal (n-Cys C group) and high serum cystatin C levels groups (h-Cys C group). Patients in the h-Cys C group demonstrated serum cystatin C levels ≥1.05 mg/L. Demographic parameters, laboratory data, and AP severity were compared between the two groups. Receiver operating curve (ROC) analysis was used to evaluate the efficacy of serum cystatin C in predicting persistent AKI. RESULTS A total of 379 patients with AP were enrolled: 319 in the n-Cys C group and 60 in the h-Cys C group. Serum cystatin C levels were significantly higher in patients with severe acute pancreatitis (SAP) compared to moderate acute pancreatitis (MAP) (P< 0.05). The h-Cys C group had a higher BISAP score (P < 0.001). Incidences of organ failure and SAP were significantly higher in the h-Cys C group (P < 0.05). ROC analysis indicated that a serum cystatin C cutoff point of 1.055 mg/L optimally predicted persistent AKI (AUC = 0.711). For internal validation, we selected 545 AP patients, treated at our center from 2019 to 2022, including 54 AKI patients. ROC analysis in this validation group yielded a sensitivity of 100% and specificity of 90.9% (AUC = 0.916, 95% CI: 0.894-0.937). CONCLUSION Elevated serum cystatin C levels are sensitive indicators of adverse AKI prognosis in AP patients. The cystatin C level at admission can reflect a patient's initial renal function status.
Collapse
Affiliation(s)
- Ningzhi Wang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China; Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Fei Han
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Jiajia Pan
- Intensive Care Unit, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Guanghuai Yao
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Yao Wang
- Department of Nephrology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Songxin Xu
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Weiming Xiao
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Yanbing Ding
- Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Jiangsu, China.
| | - Chunfang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
| |
Collapse
|
46
|
Rutala WA, Weber DJ. Disinfection, sterilization and antisepsis: Principles, practices, current issues, new research and new technologies. Am J Infect Control 2023; 51:A1-A2. [PMID: 37890938 DOI: 10.1016/j.ajic.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 10/29/2023]
Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Hospitals, Chapel Hill, NC
| |
Collapse
|
47
|
Kee Jang D, Kyu Lee J, Yung Jung C, Ho Kim K, Ra Kang H, Sun Lee Y, Hwa Yoon J, Ro Joo K, Kyu Chae M, Hyeon Baek Y, Seo BK, Hyub Lee S, Lim C. Electroacupuncture for abdominal pain relief in patients with acute pancreatitis: A three-arm randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:537-542. [PMID: 37973472 DOI: 10.1016/j.joim.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Electroacupuncture (EA) may reduce the severity of acute pancreatitis (AP) and provide additional pain relief in patients with chronic pancreatitis. However, the ability of EA to relieve pain in patients with AP has not been well documented. OBJECTIVE This study was undertaken to compare the pain-relieving effects of EA and conventional treatment in patients with AP. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS This study was conducted using a randomized, controlled, three-arm, parallel-group and multi-center design. Patients diagnosed with AP were randomly and equally assigned to EA1, EA2 or control groups. All participants received conventional standard-of-care therapy for AP. Local EA alone was administered in EA1, and local plus distal EA was given in EA2. Local EA included two abdominal acupoints, while distal EA included twelve peripheral acupoints. EA groups underwent one session of EA daily for 4 days (days 1-4), or until pain was resolved or discharged. MAIN OUTCOME MEASURES The primary outcome measure was the change in the visual analogue scale (VAS; 0-100) pain score between baseline and day 5. RESULTS Eighty-nine participants were randomized into EA1, EA2 and control groups, and 88 (EA1, 30; EA2, 29; control, 29) were included in the full-analysis set. VAS score change (median [interquartile range]) on day 5 was (12.3 ± 22.5) in the EA1 group, (10.3 ± 21.5) in the EA2 group, and (8.9 ± 15.2) in the control group. There were not significant differences in the change in VAS score among treatments (P = 0.983). However, time to food intake was significantly shorter in the EA group (EA1 + EA2) than in the control group (median 2.0 days vs 3.0 days), with a hazard ratio of 0.581 (P = 0.022; 95% CI, 0.366-0.924). No significant adverse events occurred. CONCLUSION EA treatment did not significantly reduce pain after 4 days of treatment in patients with AP-associated abdominal pain but significantly reduced time to first food intake. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03173222. Please cite this article as: Jang DK, Lee JK, Jung CY, Kim KH, Kang HR, Lee YS, Yoon JH, Joo KR, Chae MK, Baek YH, Seo BK, Lee SH, Lim C. Electroacupuncture for abdominal pain relief in patients with acute pancreatitis: A three-arm randomized controlled trial. J Integr Med. 2023; 21(6): 537-542.
Collapse
Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea.
| | - Chan Yung Jung
- Department of Acupuncture and Moxibustion, Dongguk University Ilsan Oriental Hospital, College of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Kyung Ho Kim
- Department of Acupuncture and Moxibustion, Dongguk University Ilsan Oriental Hospital, College of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Ha Ra Kang
- Department of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Yeon Sun Lee
- Department of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Jong Hwa Yoon
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Dongguk University, Gyeongju 38067, Republic of Korea
| | - Kwang Ro Joo
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Min Kyu Chae
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Yong Hyeon Baek
- Department of Acupuncture and Moxibustion, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture and Moxibustion, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chiyeon Lim
- Department of Biostatistics, College of Medicine, Dongguk University, Goyang 10326, Republic of Korea
| |
Collapse
|
48
|
Zhang KY, Siddiqi I, Saad M, Balabanis T, Dehghan MS, Nasr A, Tolj V, Habtezion A, Park K, Abu-El-Haija M, Sellers ZM. Temporal Analysis of Inflammatory Bowel Disease and Pancreatitis Co-Occurrence in Children and Adults in the United States. Clin Transl Gastroenterol 2023; 14:e00628. [PMID: 37556391 PMCID: PMC10684167 DOI: 10.14309/ctg.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Pancreatitis in inflammatory bowel disease has been attributed to peripancreatic intestinal disease and/or drug-induced pancreatic toxicity. We used large cohort analyses to define inflammatory bowel disease and pancreatitis temporal co-occurrence with a detailed descriptive analysis to gain greater insight into the pathophysiological relationship between these 2 diseases. METHODS Truven Health MarketScan private insurance claims from 141,017,841 patients (younger than 65 years) and 7,457,709 patients from 4 academic hospitals were analyzed. We calculated the prevalence of Crohn's disease or ulcerative colitis (UC) with acute pancreatitis or chronic pancreatitis (CP) and performed temporal and descriptive analyses. RESULTS Of 516,724 patients with inflammatory bowel disease, 12,109 individuals (2.3%) had pancreatitis. Acute pancreatitis (AP) was 2-6x more prevalent than CP. In adults, AP occurred equally among Crohn's disease and UC (1.8%-2.2% vs 1.6%-2.1%, respectively), whereas in children, AP was more frequent in UC (2.3%-3.4% vs 1.5%-1.8%, respectively). The highest proportion of pancreatitis (21.7%-44.7%) was at/near the time of inflammatory bowel disease diagnosis. Of them, 22.1%-39.3% were on steroids during pancreatitis. Individuals with CP or recurrent pancreatitis hospitalizations had increased risk of a future inflammatory bowel disease diagnosis (odds ratio = 1.52 or 1.72, respectively). DISCUSSION Pancreatitis in inflammatory bowel disease may not simply be a drug adverse event but may also involve local and/or systemic processes that negatively affect the pancreas. Our analysis of pancreatitis before, during, and after inflammatory bowel disease diagnosis suggests a bidirectional pathophysiologic relationship between inflammatory bowel disease and pancreatitis, with potentially more complexity than previously appreciated.
Collapse
Affiliation(s)
- Ke-You Zhang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Ismaeel Siddiqi
- Department of Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michelle Saad
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Tatiana Balabanis
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Melody S. Dehghan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Alexander Nasr
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Vania Tolj
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Aida Habtezion
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
| | - K.T. Park
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Zachary M. Sellers
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, California, USA
| |
Collapse
|
49
|
Profit DD. Describing and Predicting Preprocedural Anxiety in Patients Scheduled for Advanced Gastrointestinal Endoscopy During the COVID-19 Pandemic. Gastroenterol Nurs 2023; 46:475-488. [PMID: 37639614 DOI: 10.1097/sga.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/26/2023] [Indexed: 08/31/2023] Open
Abstract
Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently, with little attention given to a patient's preprocedural anxiety issues. Compounding this concern, in 2020 the COVID-19 pandemic resulted in the delay of many endoscopy cases. It is unknown how this affected the anxiety of patients preparing for advanced endoscopy procedures. Patients with higher anxiety require higher doses of anesthetic medications, and experience increased pain and decreased satisfaction. The purpose of this study was to describe the biological, psychological, and social attributes of patients and identify whether social support, COVID-19-related anxiety, delay of procedure, patient's physical status, and procedural indication category were predictors of state anxiety levels in patients undergoing advanced gastrointestinal endoscopy during the COVID-19 pandemic. The research study was a cross-sectional descriptive design with 90 patients. Patients were classified into low state and high state anxiety groups. Fifty-eight percent of patients had high state anxiety scores. Using logistic regression, social support was identified as a predictor of preprocedural anxiety (odds ratio [OR] = 0.318 [95% confidence interval, CI = 0.170, 0.597, p < .001]) as less social support was associated with higher anxiety. It is imperative that strategies to maximize social support are reinforced.
Collapse
Affiliation(s)
- Dawn Donahue Profit
- Dawn Donahue Profit, PhD, RN, is Staff Development Specialist, Nursing Staff Development, UK HealthCare, Lexington, Kentucky
| |
Collapse
|
50
|
Rutala WA, Weber DJ. Reprocessing semicritical items: An overview and an update on the shift from HLD to sterilization for endoscopes. Am J Infect Control 2023; 51:A96-A106. [PMID: 37890958 DOI: 10.1016/j.ajic.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (e.g., gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. METHODS Analyze the methods used to reprocess semicritical medical devices and identify methods and new technologies to reduce the risk of infection. RESULTS The reprocessing methods for semicritical medical devices is described as well as a shift from high-level disinfection to sterilization for lumened endoscopes. CONCLUSIONS Strict adherence to current guidelines and transition to sterilization for endoscopes is required as more outbreaks have been linked to inadequately disinfected endoscopes and other semicritical items than any other reusable medical devices.
Collapse
Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Department of Infection Prevention, Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
| |
Collapse
|