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Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor:A case report and review of the literature

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World Journal of Clinical Cases 2021年第4期9卷 838-846页

作者： Yi-Lun Hsieh Wen-Hung Hsu Ching-Chun Lee Chun-Chieh wu deng-chyang wu Jeng-Yih wu Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University HospitalKaohsiung 807Taiwan Division of Colorectal Surgery Department of SurgeryKaohsiung Medical University HospitalKaohsiung 807Taiwan Department of Pathology Kaohsiung Medical University HospitalKaohsiung 807Taiwan

BACKGROUND Gastric gastrointestinal stromal tumor(GIST)is the most common etiology of gastroduodenal *** gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection,the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection(ESD)in Japan in *** SUMMARY An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a ***,she visited a local clinic for help,where abdominal sonography revealed a space-occupying lesion around the liver,so she was referred to our hospital for further *** sonography was repeated,which revealed a mass with an alternating concentric echogenic ***(EGD)was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric *** was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was *** differential diagnoses were suspected,including gastroduodenal intussusception,gastric cancer invasion to the duodenum,or pancreatic cancer with adherence to the gastric antrum and *** computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal *** the impression of gastroduodenal intussusception,ESD was performed at the base of the gastroduodenal intussusception;unfortunately,a gastric perforation was found after complete resection was accomplished,so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid *** gastric tumor was pathologically proved to be a *** the operation,there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the op

关键词： Gastric gastrointestinal stromal tumor Endoscopic submucosal dissection Gastro-duodenal intussusception Elderly Esophagogastroduodenoscopy Gastrointestinal obstruction Case report

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Cigarette smoking and alcohol drinking and esophageal cancer risk in Taiwan Residents women

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World Journal of Gastroenterology 2010年第12期16卷 1518-1521页

作者： I-Chen wu deng-chyang wu Hung-Ju Su Hui-Jen Tsai Chien-Yu Lu Jang-Ming Lee Ming-Tsang wu Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University Hospital Faculty of Medicine College of MedicineKaohsiung Medical University Biomedical Engineering Research Laboratories Industrial Technology Research Institute Division of Hematology and Oncology Department of Internal MedicineKaohsiung Medical University Hospital Department of Surgery National Taiwan University Hospital Department of Family Medicine Kaohsiung Medical University Hospital Graduate Institute of Occupational Safety & Health Kaohsiung Medical University

AIM:To investigate the etiology of esophageal cancer among Taiwan Residents ***:This is a multi-center,hospital-based,case-control *** patients consisted of women who were newly diagnosed and pathology-proven to have esophageal squamous cell carcinoma(ESCC) from three large medical centers(one from Northern and two from Southern Taiwan,respectively)between August 2000 and December *** ESCC patient was matched with 4 healthy women based on age(within 3 years)and hospital of origin,from the Department of Preventive Medicine in each hospital.A total of 51 case patients and 204 controls,all women,were ***:Frequencies of smokers and drinkers among ESCC patients were 19.6%and 21.6%,respectively,which were significantly higher than smokers(4.4%) and drinkers(4.4%)among controls(OR=4.07,95%CI:1.36-12.16,P=0.01;OR=3.55,95%CI:1.03-12.27,P=0.04).Women who drank an amount of alcohol more than 158 g per week had a 20.58-fold greater risk(95%CI:1.72-245.62,P=0.02)of ESCC than those who never drank alcohol after adjusting for other covariates,although the sample size was ***:Cigarette smoking and alcohol drinking,especially heavy drinking,are the major risks for developing ESCC in Taiwan Residents women.

关键词： Esophageal squamous cell carcinoma Taiwan Residents women Cigarette smoking Alcohol drinking

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Hybrid vs sequential therapy for eradication of Helicobacter pylori in Taiwan: a prospective randomized trial

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World Journal of Gastroenterology 2015年第36期21卷 10435-10442页

作者： Kuan-Yang Chen Tsung-Jung Lin Chin-Lin Lin Hsi-Chang Lee Chung-Kwe Wang deng-chyang wu Institute of Clinical Medicine National YangMing University Institute of Neuroscience National Chengchi University Liver Center Department of GastroenterologyRen-Ai BranchTaipei City Hospital Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University Hospital Division of Internal Medicine Kaohsiung Municipal Hsiao-Kang HospitalKaohsiung Medical University Center for Stem Cell Research Kaohsiung Medical University Hospital Department of Medicine Faculty of MedicineCollege of MedicineKaohsiung Medical University Center for Infectious Disease and Cancer Research Kaohsiung Medical University

AIM: To evaluate the efficacy of sequential vs hybrid therapy in patients with Helicobacter pylori(H. pylori) ***: From March 2013 to May 2014,one hundred and seventy-five H. pylori infected patients who had not been treated for H. pylori before wererandomized to receive either sequential therapy(rabeprazole 20 mg and amoxicillin 1 g twice daily for 5 d,followed by rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg twice daily for 5 d) or hybrid therapy(rabeprazole 20 mg and amoxicillin 1 g for 7 d,followed by rabeprazole 20 mg,amoxicillin 1 g,clarithromycin 500 mg and metronidazole 500 mg twice daily for 7 d). H. pylori status was confirmed by positive results of both rapid urease test and histology examination or a positive result of culture. Eradication efficacy was assessed by follow-up endoscopy with rapid urease test and histological examination 8 wk after the end of anti-H. pylori therapy,or 13C-urea breath test at least 4 wk after completion of treatment. The primary outcome was H. pylori eradication by intension-to-treat(ITT) and per-protocol(PP) ***: One hundred and sixty-seven patients(83 patients in the sequential group and 84 patients in the hybrid group) completed the study. The compliance rates were 97.6% and 97.7% for the two groups,respectively. The eradication rate was 78.2% for the sequential group and 92% for the hybrid group by ITT analysis(P = 0.01). The eradication rate was 81.9% for the sequential group and 96.4% for the hybrid group by PP analysis(P = 0.01). Univariate analysis for the clinical and bacterial factors did not identify any risk factors associated with treatment failure. Severe adverse events were observed in 2.3% of patients in the sequential group and 2.4% of those in the hybrid ***: Due to a grade A(> 95%) success rate for H. pylori eradication by PP analysis,similar compliance and adverse events,hybrid therapy seems to be an appropriate eradication regimen in Taiwan.

关键词： Helicobacter pylori Sequential therapy Hybrid ther

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Detection of genotypic clarithromycin-resistant Helicobacter pylori by string tests

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World Journal of Gastroenterology 2014年第12期20卷 3343-3349页

作者： Jeng-Yih wu Sophie S W Wang Yi-Chern Lee Yoshio Yamaoka David Y Graham Chang-Ming Jan Wen-Ming Wang deng-chyang wu Department of Internal Medicine Kaohsiung Municipal Ta-Tung Hospital Department of Medicine Faculty of MedicineCollege of MedicineKaohsiung Medical University Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University Hospital Department of Medicine Veterans Affairs Medical Center and Baylor College of Medicine Division of Internal Medicine Kaohsiung Municipal Hsiao-Kang HospitalKaohsiung Medical University

AIM: To evaluate the utility of the string test to detect genotypic clarithromycin-resistant Helicobacter pylori (H. pylori) by polymerase chain reaction (PCR)-restriction fragment length polymorphism.

关键词： Helicobacter pylori String test Clarithromycin resistance Polymerase chain reaction-restriction fragment length polymorphism

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CYP2C19 polymorphism has no influence on rabeprazole-based hybrid therapy for Helicobacter pylori eradication

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World Journal of Clinical Cases 2018年第12期6卷 514-520页

作者： Tsung-Jung Lin Hsi-Chang Lee Chih-Lin Lin Chung-Kwe Wang Kuan-Yang Chen deng-chyang wu Department of Health care and Social Work Taipei University of Marine Technology Department of Gastroenterology Taipei City Hospital Institute of Clinical Medicine National YangMing University Institute of Neuroscience National Chengchi University Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University Hospital Division of Internal Medicine Kaohsiung Municipal Ta-Tung HospitalKaohsiung Medical University Center for Infectious Disease and Cancer Research Kaohsiung Medical University

AIM To evaluate the impact of cytochrome P450 2C19(CYP2C19) and interleukin-1β(IL-1β) polymorphisms on the efficacy of Helicobacter pylori(H. pylori) eradication by using rabeprazole-based hybrid *** A total of 88 H. pylori-infected patients were recruited to receive 14-d of hybrid therapy from March 2013 to May 2014. Three patients were excluded from analysis because of incomplete compliance. Either a follow-up endoscopy or 13 C-urea test was performed to determine the results of H. pylori eradication therapy. The genotypes of CYP2C19 and IL-1β were analyzed to investigate the impact on treatment effect. RESULTS The total eradication rate of H. pylori was 92.94%(79/85). According to the CYP2C19 genotypes, the rates of H. pylori eradication were 89.19% in extensive metabolizers(EM) and 95.83% in non-EM. The *** eradication rates regarding the IL-1β genotypes were 92.59% in the normal acid secretion group and 93.10% in the low acid secretion group. After multivariable logistic regression analysis, both the genotypes of CYP2C19 and IL-1β had no significant influences on the eradication rates of H. *** The CYP2C19 and IL-1β polymorphisms are not significantly independent factors of *** eradication using rabeprazole-based hybrid therapy.

关键词： Helicobacter pylori Cytochrome P450 2C19 Interleukin-1β Hybrid therapy Rabeprazole

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Diagnosis of Helicobacter pylori infection: Current options and developments

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World Journal of Gastroenterology 2015年第40期21卷 11221-11235页

作者： Yao-Kuang Wang Fu-Chen Kuo Chung-Jung Liu Meng-Chieh wu Hsiang-Yao Shih Sophie SW Wang Jeng-Yih wu Chao-Hung Kuo Yao-Kang Huang deng-chyang wu Department of Internal Medicine Kaohsiung Municipal Hsiao-Kang Hospital Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University Hospital School of Medicine College of MedicineE-Da HospitalI-Shou University Department of Internal Medicine Kaohsiung Municipal Ta-Tung Hospital Cancer for Stem Cell Research Kaohsiung Medical University Center for Infectious Disease and Cancer Research Kaohsiung Medical University Division of Gastroenterology Department of Internal MedicineTen Chan Hospital

Accurate diagnosis of Helicobacter pylori(H. pylori) infection is a crucial part in the effective management of many gastroduodenal diseases. Several invasive and non-invasive diagnostic tests are available for the detection of H. pylori and each test has its usefulness and limitations in different clinical situations. Although none can be considered as a single gold standard in clinical practice,several techniques have been developed to give the more reliable results. Invasive tests are performed via endoscopic biopsy specimens and these tests include histology,culture,rapid urease test as well as molecular methods. Developments of endoscopic equipment also contribute to the real-time diagnosis of H. pylori during endoscopy. Urea breathingtest and stool antigen test are most widely used noninvasive tests,whereas serology is useful in screening and epidemiological studies. Molecular methods have been used in variable specimens other than gastric mucosa. More than detection of H. pylori infection,several tests are introduced into the evaluation of virulence factors and antibiotic sensitivity of H. pylori,as well as screening precancerous lesions and gastric cancer. The aim of this article is to review the current options and novel developments of diagnostic tests and their applications in different clinical conditions or for specific purposes.

关键词： Helicobacter pylori Diagnosis Invasive Noninvasive

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Superior mesenteric artery syndrome in a diabetic patient with acute weight loss

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World Journal of Gastroenterology 2009年第47期15卷 6004-6006页

作者： Meng-Chieh wu I-Chen wu Jeng-Yih wu deng-chyang wu Wen-Ming Wang Division of Gastroenterology Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung 807 Taiwan China Department of Medicine Faculty of Medicine College of Medicine Kaohsiung Medical University Kaohsiung 807 Taiwan China Division of Internal Medicine Kaohsiung Municipal Hsiao-Kang Hospital Kaohsiung 813 Taiwan China

Superior mesenteric artery(SMA)syndrome is an un- common disease resulting compression of the third portion of the duodenum from the superior mesenteric *** disease shares many common manifestations with diabetic gastroparesis,including postprandial fullness,nausea,vomiting,and ***,it is often overlooked in diabetic ***,we report a 41-year-old man with poorly controlled diabetic mellitus who developed SMA syndrome due to rapid weight loss. The diagnosis was confirmed by computed tomography and an upper gastrointestinal *** condition improved after parenteral nutrient,strict sugar control, and gradual weight gain.

关键词： Diabetes mellitus Superior mesenteric artery syndrome Gastroparesis

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A new look at anti-Helicobacter pylori therapy

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World Journal of Gastroenterology 2011年第35期17卷 3971-3975页

作者： Seng-Kee Chuah Feng-Woei Tsay Ping-I Hsu deng-chyang wu Division of Gastroenterology Kaohsiung Chang Gung Memorial HospitalCollege of MedicineChang Gung University833 KaohsiungTaiwan Division of Gastroenterology Department of Internal MedicineKaohsiung Veterans General HospitalNational Yang-Ming University813 KaohsiungTaiwan Department of General Medicine School of MedicineCollege of MedicineTaipei Medical University110 TaipeiTaiwan Department of Internal Medicine Kaohsiung Medical University Hospital807 KaohsiungTaiwan

With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most ***,several treatment regimens have emerged to cure Helicobacter pylori (***) *** first-line *** therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple *** the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue ***,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue *** salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse *** best second-line therapy for patients who fail to eradicate *** with first-line therapies containing clarithromycin,amoxicillin and metronidazole is ***,a levofloxacin-based triple therapy is an accepted rescue *** guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility ***,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate *** infection if antimicrobial sensitivity data are unavailable.

关键词： Bismuth-containing quadruple therapy Concomitant quadruple therapy Hybrid (dual-concomitant) therapy Rescue anti-Helicobacter pylori treatment Sequential therapy

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CYP2C19 polymorphism influences Helicobacter pylori eradication

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World Journal of Gastroenterology 2014年第43期20卷 16029-16036页

作者： Chao-Hung Kuo Chien-Yu Lu Hsiang-Yao Shih Chung-Jung Liu Meng-Chieh wu Huang-Ming Hu Wen-Hung Hsu Fang-Jung Yu deng-chyang wu Fu-Chen Kuo Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University Hospital Department of Medicine Faculty of MedicineCollege of Medicine and Center for Stem Cell ResearchKaohsiung Medical University Department of Internal Medicine Kaohsiung Municipal Hsiao-Kang Hospital Graduate Institute of Public Health Kaohsiung Medical University School of Medicine College of MedicineE-Da HospitalI-Shou University

The known factors that have contributed to the decline of Helicobacter pylori (H. pylori) eradication rate include antibiotic resistance, poor compliance, high gastric acidity, high bacterial load, and cytochrome P450 2C19 (CYP2C19) polymorphism. Proton pump inhibitor (PPI) is important in the eradication regimen. The principal enzyme implicated in the metabolism of PPIs is CYP2C19. The effects of PPI depend on metabolic enzyme, cytochrome P450 enzymes, and CYP2C19 with genetic differences in the activity of this enzyme (the homozygous EM, heterozygous EM (HetEM), and poor metabolizer). The frequency of the CYP2C19 polymorphism is highly varied among different ethnic populations. The CYP2C19 genotype is a cardinal factor of H. pylori eradication in patients taking omeprazole- based or lansoprazole-based triple therapies. In contrast, the CYP2C19 polymorphism has no significant effect on the rabeprazole-based or esomeprazole-based triple therapies. The efficacy of levofloxacin-based rescue triple therapy might be also affected by the CYP2C19 polymorphism, but CYP2C19 genotypes did not show obvious impact on other levofloxacin-based rescue therapies. Choice of different PPIs and/or increasing doses of PPIs should be individualized based on the pharmacogenetics background of each patient and pharmacological profile of each drug. Other possible factors influencing gastric acid secretion (e.g., IL-1β- 511 polymorphism) would be also under consideration.

关键词： Helicobacter pylori CYP2C19 Polymorphism Eradication Rabeprazole Omeprazole Lansoprazole Pantoprazole Esomeprazole

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Impact of cap-assisted colonoscopy during transendoscopic enteral tubing:A randomized controlled trial

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World Journal of Gastroenterology 2020年第39期26卷 6098-6110页

作者： Quan Wen Kang-Jian Liu Bo-Ta Cui Pan Li Xia wu Min Zhong Lu Wei Hua Tu Yu Yuan Da Lin Wen-Hung Hsu deng-chyang wu Hong Yin Fa-Ming Zhang Medical Center for Digestive Diseases The Second Affiliated Hospital of Nanjing Medical UniversityNanjing 210011Jiangsu ProvinceChina Department of Spleen and Stomach Diseases Hubei Provincial Hospital of Traditional Chinese MedicineWuhan 430061Hubei ProvinceChina Department of Gastroenterology The First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhou 510080Guangdong ProvinceChina Division of Gastroenterology Department of Internal MedicineKaohsiung Medical University HospitalKaohsiung 807Taiwan Department of Gastroenterology Zigong Fourth People’s HospitalZigong 643000Sichuan ProvinceChina

BACKGROUND Colonic transendoscopic enteral tubing(TET)requires double cecal intubation,raising a common concern of how to save cecal intubation time and make the tube *** hypothesized that cap-assisted colonoscopy(CC)might reduce the second cecal intubation time and bring potential benefits during the TET *** To investigate if CC can decrease the second cecal intubation time compared with regular colonoscopy(RC).METHODS This prospective multicenter,randomized controlled trial was performed at four ***≥7 years needing colonic TET were recruited from August 2018 to January *** subjects were randomly assigned to two *** primary outcome was the second cecal intubation *** outcomes included success rate,insertion pain score,single clip fixation time,purpose and retention time of TET tube,length of TET tube inserted into the colon,and all procedurerelated(serious)adverse *** A total of 331 subjects were randomized to the RC(n=165)or CC(n=166)*** median time of the second cecal intubation was significantly shorter for CC than RC(2.2 min vs 2.8 min,P<0.001).In patients with constipation,the median time of second cecal intubation in the CC group(n=50)was shorter than that in the RC group(n=43)(2.6 min vs 3.8 min,P=0.004).However,no difference was observed in the CC(n=42)and RC(n=46)groups of ulcerative colitis patients(2.0 min vs 2.5 min,P=0.152).The insertion pain score during the procedure in CC(n=14)was lower than that in RC(n=19)in unsedated colonoscopy(3.8±1.7 vs 5.4±1.9;P=0.015).Multivariate analysis revealed that only CC(odds ratio[OR]:2.250,95%confidence interval[CI]:1.161-4.360;P=0.016)was an independent factor affecting the second cecal intubation time in difficult *** did not affect the colonic TET tube’s retention time and length of the tube inserted into the ***,multivariate analysis found that only endoscopic clip number(OR:2.201,95%CI:1.541-3.143;P<0.001)was an independe

关键词： Transendoscopic enteral tube Endoscopy Colonoscopy Fecal microbiota transplant Washed microbiota transplant Colon

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