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Gastroenterology in developing countries:Issues and advances

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World Journal of Gastroenterology 2009年第23期15卷 2839-2854页

作者： Kate L Mandeville Justus Krabshuis Nimzing Gwamzhi Ladep chris jj mulder Eamonn MM Quigley Shahid A Khan Centre for Infectious Diseases Epidemiology Department of Primary Care and Population Sciences University College London Hampstead Campus Royal Free Hospital London NW3 2PF United Kingdom Highland Data Les Charleix 24390 Tourtoirac Dordogne France Department of Medicine University of Jos and Jos University Teaching Hospital Jos Plateau State P.M.B. 2076 Nigeria Department of Gastroenterology VU University Medical Center Amsterdam 1081 HV Holland World Gastroenterology Organisation and Department of Medicine National University of Ireland Cork University Hospital Clinical Sciences Building Wilton Cork Ireland Department of Hepatology and Gastro-enterology Faculty of Medicine Imperial College London St Mary's Campus London W2 1NY United Kingdom

Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments,lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas: diarrhoeal diseases, hepatitis B, and Helicobacter pylori . Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those setting up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of "cascades" are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries.

关键词：发展中国家胃肠病传染性疾病预防措施

Efficacy of thioguanine treatment in inflammatory bowel disease: A systematic review

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World Journal of Gastroenterology 2016年第40期22卷 9012-9021页

作者： Berrie Meijer chris jj mulder Godefridus J Peters Adriaan A van Bodegraven Nanne KH de Boer Department of Gastroenterology and Hepatology VU University Medical Center Department of Medical Oncology VU University Medical Center Department of Gastroenterology Geriatrics Internal and Intensive Care Medicine (Co-MIK) Zuyderland Medical Center

AIM To critically assess the available literature regarding the efficacy of thioguanine treatment in inflammatory bowel disease(IBD) patients, irrespective of the(hepato-) toxicity *** A systematic literature search of the MEDLINE database using Pub Med was performed using the keywords "thioguanine", "6-TG", "thioguanine", "inflammatory bowel disease", "IBD", "Crohn's disease", "Ulcerative colitis" and "effectiveness" in order to identify relevant articles published in English starting from 2000. Reference lists of the included articles were crosschecked for missing articles. Reviewed manuscripts concerning the effectiveness of thioguanine treatment in IBD were reviewed by the authors and the data were extracted. Data were subsequently analyzed with descriptive statistics. Due to the lack of standardized outcomes, a formal meta-analysis was not *** A total of 11 applicable studies were found that involved the effectiveness of thioguanine therapy in IBD. Eight studies were conducted in a prospectivemanner, in the remaining three studies, data was collected retrospectively. In total, 353 IBD-patients(225 patients with Crohn's disease, 119 with ulcerative colitis and nine with unclassified IBD) with prior azathioprine/mercaptopurine resistance and/or intolerance(n = 321) or de novo thioguanine administration(n = 32) were included for analysis, of which 228(65%) had clinical improvement on thioguanine therapy, based on standard IBD questionnaires, biochemical parameters or global physician assessments. Short-term results were based on 268 treatment years(median follow-up 9 mo, range 3-22 mo) with a median daily dose of 20 mg(range 10-80 mg). Discontinuation, mostly due to adverse events, was reported in 72 patients(20%). CONCLUSION The efficacy of thioguanine therapy in IBD patients intolerant to conventional thiopurine therapy is observed in 65%, with short term adverse events in 20% of patients.

关键词： Thiopurines Thioguanine 煽动性的肠疾病 Crohn’ s 疾病 Ulcerative 大肠炎

Evaluation of Cladribine treatment in refractory celiac disease type Ⅱ

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World Journal of Gastroenterology 2011年第4期17卷 506-513页

作者： Greetje J Tack Wieke HM Verbeek Abdul Al-Toma Dirk J Kuik Marco WJ Schreurs Otto Visser chris jj mulder Department of Gastroenterology and Hepatology VU University Medical Center Department of Gastroenterology and Hepatology St. Antonius Hospital Department of Epidemiology and Biostatistics VU University Medical Center Department of Pathology VU University Medical Center Department of Haematology VU University Medical Center

AIM: To evaluate cladribine [2-chlorodeoxyadenosine (2-CdA)] therapy in refractory celiac disease (RCD) Ⅱ. METHODS: An open-label cohort-study of RCD Ⅱ patients treated with 2-CdA was performed between 2000 and 2010. Survival rate, enteropathy associated T-cell lymphoma (EATL) occurrence, clinical course, and histological and immunological response rates were evaluated. RESULTS: Overall, 32 patients were included with a median follow-up of 31 mo. Eighteen patients responded well to 2-CdA. Patients responsive to 2-CdA had a statistically significant increased survival compared to those who were unresponsive. The overall 3- and 5-year survival was 83% in the responder and 63% and 22% in the non-responder group, respectively. The overall 2-year clinical, histological and immunological response rates were 81%, 47% and 41%, respectively. Progression into EATL was reported in 16%, all of these patients died. CONCLUSION: Treatment of RCD Ⅱ with 2-CdA holds promise, showing excellent clinical and histological response rates, and probably less frequent transition into EATL.

关键词：疾病类型评价治疗腹腔克拉免疫应答 CDA 反应率

Effect of B vitamin supplementation on plasma homocysteine levels in celiac disease

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World Journal of Gastroenterology 2009年第8期15卷 955-960页

作者： Muhammed Hadithi chris jj mulder Frank Stam Joshan Azizi J Bart A Crusius Amado Salvador Pea Coen DA Stehouwer Yvo M Smulders Department of Gastroenterology VUmc University Medical Center Amsterdam PO Box 7057 Amsterdam 1007 MB The Netherlands Department of Internal Medicine VUmc University Medical Center Amsterdam PO Box 7057 Amsterdam 1007 MB The Netherlands Laboratory of Immunogenetics Department of Pathology VUmc University Medical Center Amsterdam PO Box 7057 Amsterdam 1007 MB The Netherlands Department of Internal Medicine Academic Hospital Maastricht P. Debyelaan 25 6229 HX Maastricht The Netherlands

AIM: To investigate the effect of vitamin supplements on homocysteine levels in patients with celiac disease. METHODS: Vitamin B6, folate, vitamin B12, and fasting plasma homocysteine levels were measured in 51 consecutive adults with celiac disease [median (range) age 56 (18-63) years; 40% men, 26 (51%) had villous atrophy, and 25 (49%) used B-vitamin supplements] and 50 healthy control individuals matched for age and sex. Finally, the C677T polymorphism of 5,10-methylene tetrahydrofolate reductase (MTHFR) was evaluated in 46 patients with celiac disease and all control individuals. RESULTS: Patients with celiac disease and using vitamin supplements had higher serum vitamin B6 (P = 0.003),folate (P dered in disease management.

关键词：血浆同型半胱氨酸维生素B6 水平测定腹腔疾病甲基四氢叶酸还原酶维生素B12 MTHFR基因健康对照组

Colonoscopic yield of colorectal neoplasia in daily clinical practice

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World Journal of Gastroenterology 2009年第9期15卷 1085-1092页

作者： Jochim S Terhaar sive Droste Mike E Craanen Rene WM van der Hulst Joep F Bartelsman Dick P Bezemer Kim R Cappendijk Gerrit A Meijer Linde M Morsink Pleun Snel Hans ARE Tuynman Roy LJ van Wanrooy Eric IC Wesdorp chris jj mulder Department of Gastroenterology and Hepatology VU University Medical CentrePO Box 70571007 MBAmsterdamThe Netherlands Gastroenterology and Hepatology Kennemer Gasthuis2000 AKHaarlemThe Netherlands Gastroenterology and Hepatology Academic Medical Centre1100 DDAmsterdamThe Netherlands Epidemiology and Biostatistics VU University Medical Centre1007 MBAmsterdamThe Netherlands Pathology VU University Medical Centre1007 MBAmsterdamThe Netherlands Gastroenterology and Hepatology Slotervaart Hospital1006 BKAmsterdamThe Netherlands Gastroenterology and Hepatology Medical Centre Alkmaar1800 AMAlkmaarThe Netherlands Gastroenterology and Hepatology Sint Lucas Andreas Hospital1061 AEAmsterdamThe Netherlands

AIM:To assess the prevalence and location of ad-vanced neoplasia in patients undergoing colonoscopy,and to compare the yield per ***:In a multicenter colonoscopy survey (n = 18 hospitals) in the Amsterdam area (Northern Holland),data of all colonoscopies performed during a three month period in 2005 were analyzed. The location and the histological features of all colonic neoplasia were recorded. The prevalence and the distribution ofadvanced colorectal neoplasia and differences in yield between indication clusters were evaluated. Advanced neoplasm was defi ned as adenoma > 10 mm in size,with > 25% villous features or with high-grade dyspla-sia or ***:A total of 4623 eligible patients underwent a total colonoscopy. The prevalence of advanced neo-plasia was 13%,with 281 (6%) adenocarcinomas and 342 (7%) advanced adenomas. Sixty-seven percent and 33% of advanced neoplasia were located in the distal and proximal colon,respectively. Of all patients with right-sided advanced neoplasia (n = 228),51% had a normal distal colon,whereas 27% had a syn-chronous distal adenoma. Ten percent of all colono-scopies were performed in asymptomatic patients,7% of whom had advanced neoplasia. In the respective procedure indication clusters,the prevalence of right-sided advanced neoplasia ranged from 11%-57%. CONCLUSION:One out of every 7-8 colonoscopies yielded an advanced colorectal neoplasm. Colonoscopy is warranted for the evaluation of both symptomatic and asymptomatic patients.

关键词：大肠镜临床实践产量结肠镜检查肿瘤位置阿姆斯特丹组织学特征无症状

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World Journal of Gastroenterology 2012年第38期18卷 5397-5403页

作者： Sietze T van Turenhout Leo GM van Rossum Frank A Oort Robert JF Laheij Anne F van Rijn Jochim S Terhaar sive Droste Paul Fockens René WM van der Hulst Anneke A Bouman Jan BMJ Jansen Gerrit A Meijer Evelien Dekker chris jj mulder Department of Gastroenterology and Hepatology VU University Medical Center1081 HV Amsterdam The Netherlands Department of Epidemiology Biostatistics and HTA Radboud University Nijmegen Medical Center6500 HB Nijmegen The Netherlands Department of Gastroenterology and Hepatology Radboud University Nijmegen Medical Center6500 HB Nijmegen The Netherlands Department of Gastroenterology and Hepatology Academic Medical Center1105 AZ Amsterdam The Netherlands Department of Gastroenterology and Hepatology Kennemer Gasthuis 2035 RC Haarlem The Netherlands Clinical Chemistry VU University Medical Center 1081 HV Amsterdam The Netherlands Department of Gastroenterology and Hepatology Radboud University Nijmegen Medical Center 6500 HB Nijmegen The Netherlands Department of Pathology VU University Medical Center 1081 HV Amsterdam The Netherlands Department of Gastroenterology and Hepatology Academic Medical Center 1105 AZ Amsterdam The Netherlands Department of Gastroenterology and Hepatology VU University Medical Center 1081 HV Amsterdam The Netherlands

AIM: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts. METHODS: In this comparative observational study, two prospective cohorts of CRC cases were compared. The first cohort was obtained from 10 322 average risk subjects invited for CRC screening with FIT, of which, only subjects with a positive FIT were referred for colonoscopy. The second cohort was obtained from 3637 subjects scheduled for elective colonoscopy with a positive FIT result. The same FIT and positivity threshold (OC sensor; ≥ 50 ng/mL) was used in both cohorts. Colonoscopy was performed in all referral subjects and in FIT positive screening subjects. All CRC cases were selected from both cohorts. Outcome measurements were mean FIT results and FIT scores per tissue tumor stage (T stage). RESULTS: One hundred and eighteen patients with CRC were included in the present study: 28 cases obtained from the screening cohort (64% male; mean age 65 years, SD 6.5) and 90 cases obtained from the referral cohort (58% male; mean age 69 years, SD 9.8). The mean FIT results found were higher in the referral cohort (829 ± 302 ng/mLvs 613 ± 368 ng/mL,P = 0.02). Tissue tumor stage (T stage) distribution was dif-ferent between both populations [screening population: 13 (46%) T1, eight (29%) T2, six (21%) T3, one (4%) T4 carcinoma; referral population: 12 (13%) T1, 22 (24%) T2, 52 (58%) T3, four (4%) T4 carcinoma], and higher T stage was significantly associated with higher FIT results (P < 0.001). Per tumor stage, no significant difference in mean FIT results was observed (screening vs referral: T1 498 ± 382 ng/mL vs 725 ± 374 ng/mL, P = 0.22; T2 787 ± 303 ng/mL vs 794 ± 341 ng/mL, P = 0.79; T3 563 ± 368 ng/mLvs 870 ± 258 ng/mL,P = 0.13; T4 not available). After correction for T stage in logistic regression analysis, no significant differences in mean FIT results were observed between both types of cohorts (P = 0.10). CONCLUSION

关键词：结直肠癌化学试验筛选 logistic回归分析免疫粪便平均风险类似

Indications for 5-aminosalicylate in inflammatory bowel disease:Is the body of evidence complete?

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World Journal of Gastroenterology 2006年第38期12卷 6115-6123页

作者： Ad A van Bodegraven chris jj mulder Section of Inflammatory Bowel Diseases VU University medical centre Amsterdam The Netherlands Department of Gastroenterology VU University medical centre Amsterdam The Netherlands

Mesalazine is a safe drug, although adverse events may be seen in a minority of patients. This applies also to pregnant women and children. The role of mesalazine in combination therapy to improve efficacy and con- comitant drug pharmacokinetics, or in chemoprevention against inflammatory bowel disease (IBD)-related co- lonic carcinoma has not yet been completely elucidated. Therapeutic success of mesalazine may be optimized by a combination of high dose and low frequency of dos- age to improve compliance. Therefore, due to its supe- rior safety profile and pharmacokinetic characteristics, mesalazine is preferable to sulphasalazine. This paper reviews the literature concerning mechanisms of action, indications and off-label use, pharmacokinetic properties and formulations, therapeutic efficacy, compliance, pae- diatric indications, chemoprevention, and safety issues and adverse event profile of mesalazine treatment versus sulphasalazine. It also highlights these controversies in order to clarify the potential benefits of mesalazines in IBD therapy and evidence for its use.

关键词：肠道炎症结肠疾病治疗病理机制

Double balloon endoscopy associated pancreatitis:A description of six cases

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World Journal of Gastroenterology 2008年第5期14卷 720-724页

作者： Soeresh VA Jarbandhan Stijn JB van Weyenberg Willem M van der Veer Dimitri GN Heine chris jj mulder Maarten AJM Jacobs Small Bowel Unit Department of Gastroenterology VU University Medical Center Amsterdam The Netherlands

AIM:To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database. METHODS:From November 2003 until January 2007, 603 DBE procedures were performed on 412 patients, with data on complications recorded in a database. The setting was a tertiary care center offering DBE. DBE was performed from the antegrade or retrograde route. Out-come measurements included age, gender, medication, indication, DBE-endoscope type, insertion depth, proce-dure duration, findings, interventions, post-procedural abdominal pain, and post-procedural hospitalization. RESULTS:This is the largest single-center study report-ing on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. CONCLUSION:The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.

关键词：内镜检查术小肠并发症肠脓毒病

Anal plugs and retrograde colonic irrigation are helpful in fecal incontinence or constipation

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World Journal of Gastroenterology 2007年第22期13卷 3101-3105页

作者： Marcel Cazemier Richelle JF Felt-Bersma chris jj mulder Department of Gastroenterology and Hepatology VU University Medical Center Postbus 7057 1007 MB Amsterdam The Netherlands

AIM: To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation (RCI) in patients with fecal incontinence or constipation. METHODS: Patients who received treatment with an anal plug or RCI between 1980 and 2005 were investigated with a questionnaire. RESULTS: Of the 201 patients (93 adults, 108 children), 101 (50/) responded. Adults: anal plugs (8), five stopped immediately, one stopped after 20 mo and two used it for 12-15 mo. RCI (40, 28 fecal incontinence, 12 constipation), 63/ are still using it (mean 8.5 years), 88/ was satisfied. Younger adults (< 40 years) were more satisfied with RCI (94 / vs 65/, P = 0.05). Children: anal plugs (7), 5 used it on demand for an average of 2.5 years with satisfactory results, one stopped immediately and one after 5 years. RCI (26 fecal incontinence, 22 constipation), 90/ are still using it (mean time 6.8 years) and felt satisfi ed. Children tend to be more satisfi ed (P = 0.001). Besides age, no predictive factors for success were found. There was no difference in the outcome between patients with fecal incontinence or constipation. CONCLUSION: RCI is more often applied than anal plugs and is helpful in patients with fecal incontinence or constipation, especially for younger patients. Anal plugs can be used incidentally for fecal incontinence, especially in children.

关键词：便秘大小便失禁治疗结肠灌洗肛门塞