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Carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography:A meta-analysis and systematic review

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World Journal of Gastroenterology 2012年第39期18卷 5622-5631页

作者： Yao Cheng Xian-Ze Xiong Si-Jia Wu Jiong Lu Yi-Xin Lin Nan-Sheng Cheng Tai-Xiang Wu Department of Bile Duct Surgery West China Hospital Sichuan University Chengdu 610041 Sichuan Province China Chinese Cochrane Centre Chinese Clinical Trial Registry Chinese Evidence-Based Medicine Centre INCLEN Resource and Training Centre West China Hospital Sichuan University Chengdu 610041 Sichuan Province China

AIM:To assess the safety and efficacy of carbon dioxide (CO2) insufflation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:The Cochrane Library, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Science Citation Index Expanded, Chinese Biomedical Literature Database, and references in relevant publications were searched up to December 2011 to identify randomized controlled trials (RCTs) comparing CO2 insufflation with air insufflation during ERCP. The trials were included in the review irrespec-tive of sample size, publication status, or language. Study selection and data extraction were performed by two independent authors. The meta-analysis was performed using Review Manager 5.1.6. A random-effects model was used to analyze various *** and subgroup analyses were performed if necessary. R ESULTS:Seven double-blind RCTs involving a total of 818 patients were identified that compared CO2 insufflation (n = 404) with air insufflation (n = 401) during ERCP. There were a total of 13 post-random- ization dropouts in four RCTs. Six RCTs had a high risk of bias and one had a low risk of bias. None of the RCTs reported any severe gas-related adverse events in either group. A meta-analysis of 5 RCTs (n = 459) indicated that patients in the CO2 insufflation group had less post-ERCP abdominal pain and distension for at least 1 h compared with patients in the air insuf-flation group. There were no significant differences in mild cardiopulmonary complications [risk ratio (RR) = 0.43, 95% CI:0.07-2.66, P = 0.36], cardiopulmonary (e.g., blood CO2 level) changes [standardized mean difference (SMD) = -0.97, 95% CI: -2.58-0.63, P = 0.23], cost analysis (mean difference = 3.14, 95% CI:-14.57-20.85, P = 0.73), and total procedure time (SMD = -0.05, 95% CI:-0.26-0.17, P = 0.67) between the two groups. C ONCLUSION:CO2 insufflation during ERCP appears to be safe and reduces post-ERCP abdominal pain and discomfort.

关键词： Systematic review Meta-analysis Carbondioxide insufflation Endoscopic retrograde cholangio-pancreatography abdominal pain

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Need for a comprehensive medical approach to the neuroimmuno-gastroenterology of irritable bowel syndrome

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World Journal of Gastroenterology 2011年第23期17卷 2791-2800页

作者： Pejman Katiraei Gilberto Bultron Department of Pediatrics Loma Linda University11175 Campus StreetColeman Pavilion A1121Loma LindaCA 92350United States

Irritable bowel syndrome （IBS） is defined by the Rome ]I[ criteria as symptoms of recurrent abdominal pain or discomfort with the onset of a marked change in bowel habits with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process. As such, many clinicians regard IBS as a central nervous system problem of altered pain perception. Here, we review the recent literature and discuss the evidence that supports an organic based model, which views IBS as a complex, heterogeneous, inter-dependent, and multi-variable inflammatory process along the neuronal-gut axis. We delineate the organic pathophysiology of IBS, demonstrate the role of inflammation in IBS, review the possible differences between adult and pediatric IBS, discuss the merits of a comprehensive treatment model as taught by the Institute of Functional Medicine, and describe the potential for future research for this syndrome.

关键词： Irritable bowel syndrome abdominal pain Inflammation Probiotics Stress

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Gastrointestinal symptoms in a Japanese population:A health diary study

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World Journal of Gastroenterology 2007年第4期13卷 572-578页

作者： Yasuharu Tokuda Osamu Takahashi Sachiko Ohde Masaaki Shakudo Haruo Yanai Takuro Shimbo Shunichi Fukuhara Shigeaki Hinohara Tsuguya Fukui Clinical Practice Evaluation and Research Center St. Luke's Life Science Institute St. Luke's International Hospital Japan Intermedica Co Japan St. Luke's Graduate School of Nursing Japan Research Institute International Medical Center Japan Department of Epidemiology and Healthcare Research Kyoto University Graduate School of Medicine and Public Health Japan Clinical Practice Evaluation and Research Center St. Luke’s Life Science Institute St. Luke’s International Hospital Japan

AIM： To investigate the incidence of gastrointestinal symptoms and the nature of consequent utilization of health care services in a Japanese population. METHODS： Using self-report, we conducted a prospective cohort study of a nationally representative sample of the Japanese population over a one-month period to determine the incidence of gastrointestinal symptoms of all kinds and resultant health care utilization. Both information on visits to physicians and use of complementary and alternative medicine therapies were collected. RESULTS： From a total of 3568 in the recruitment sample, 3477 participants completed a health diary （response rate 97%）. The data of 112 participants with baseline active gastrointestinal diseases were excluded from the analysis, leaving 3365 participants in the study. The incidence of gastrointestinal symptoms was 250 and the mean number of symptomatic episodes was 0.66 in a month. abdominal pain, diarrhea, nausea, constipation and dyspepsia were the most frequent symptoms. Female gender, younger age, and low baseline quality of life were risk factors for developing these symptoms. The participants were more likely to treat themselves, using dietary, complementary or alternative medicines, than to visit physicians, except in the case of vomiting.CONCLUSION： Gastrointestinal symptoms are common in the Japanese population, with an inddence of 25%. abdominal pain, diarrhea, nausea, constipation and dyspepsia are the most frequent symptoms. Risk factors for developing these symptoms include female gender, younger age, and low baseline quality of life.

关键词： Gastrointestinal diseases abdominal pain Diarrhea Nausea Constipation Dyspepsia

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Incidence of gallstone disease in Italy:Results from a multicenter,population-based Italian study (the MICOL project)

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World Journal of Gastroenterology 2008年第34期14卷 5282-5289页

作者： Davide Festi Ada Dormi Simona Capodicasa Tommaso Staniscia Adolfo F Attili Paola Loria Paolo Pazzi Giuseppe Mazzella Claudia Sama Enrico Roda Antonio Colecchia Department of Internal Medicine and Gastroenterology University of Bologna Department of Clinical Medicine and Biotech-nology University of Bologna Department of Medicine and Aging University of Chieti Department of Gastroenterology University "La Sapienza" Department of Internal Medicine University of Modena Department of Internal Medicine S. Anna Hospital

AIM:To evaluate gallstone incidence and risk factors in a large population-based study. METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study. RESULTS: Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identifi ed as risk factors in men while, in females, the only risk factors were increasing age and a high *** age and pain in the right hypocondrium in men and increasing age in females were identifi ed as predictors of gallstones. pain in the epigastrium/ right hypocondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain. CONCLUSION:Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypocondrium and/or epigastrium is confi rmed as the only symptom related to gallstones.

关键词： Gallstone disease Ultrasonography Epidemiology Prevalence Incidence abdominal pain Cholecystectomy Body mass index

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C-reactive protein,procalcitonin,interleukin-6,vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer

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World Journal of Gastroenterology 2004年第8期10卷 1115-1120页

作者： NevinIlhan NecipIlhan MehmetKcksu Yavuz Ilhan Handan Akbulut Department of Biochemistry and Clinical Biochemistry Firat University Firat Medical Centre23119ElazigTurkey Department of General Surgery Firat University Firat Medical Centre23119ElazigTurkey Division of Immunology Firat University Firat Medical Centre23119ElazigTurkey

AIM:The current study was to determine the serum/pLasma levels of VEGF,IL-6,malondialdehyde (MDA),nitric oxide (NO),PCT and CRP in gastric carcinoma and correlation with the stages of the disease and accompanying infection. METHODS:We examined the levels of serum VEGF,IL-6, PCT,CRP and plasma MDA,NO in 42 preoperative gastric cancer patients and 23 healthy *** were infection anamneses that had no definite origin in 19 cancer patients. RESULTS:The VEGF levels (mean±SD; pg/mL) were 478.05±178.29 and 473.85±131.24 in gastric cancer patients with and without infection,respectively,and these values were not significantly different (P>0.05).The levels of VEGF, CRP,PCT,It-6,MDA and NO in cancer patients were significantly higher than those in healthy controls and the levels of CRP,PCT,It-6,MDA and NO were statistically increased in infection group when compared with non- infection group (P<0.001). CONCLUSION:Although serum VEGF concentrations were increased in gastric cancer,this increase might not be related to ***,PCT,IL-6,MDA and NO have obvious drawbacks in the diagnosis of infections in cancer patients. These markers may not help to identify infections in the primary evaluation of cancer patients and hence to avoid unnecessary antibiotic treatments as well as hospitalization. According to the results of this study,IL-6,MDA,NO and especially VEGF can be used as useful parameters to diagnose and grade gastric cancer.

关键词： abdominal pain Aged Biological Markers C-Reactive Protein Calcitonin Female Helicobacter Infections Humans Interleukin-6 Male Malnutrition Malondialdehyde Middle Aged Neoplasm Staging Nitric Oxide Oxidative Stress Protein Precursors Stomach Neoplasms Tumor Markers, Biological Vascular Endothelial Growth Factor A Vomiting Weight Loss

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Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan

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World Journal of Gastroenterology 2008年第9期14卷 1358-1364页

作者： Hatsushi Yamagishi Tomoyuki Koike Shuichi Ohara Shigeyuki Kobayashi Ken Ariizumi Yasuhiko Abe Katsunori Iijima Akira Imatani Yoshifumi Inomata Katsuaki Kato Daisuke Shibuya Shigemitsu Aida Tooru Shimosegawa Division of Gastroenterology Tohoku University Graduate School of MedicineSendai CityJapan Miyagi Cancer Society Sendai CityJapan Department of Gastroenterology Sendai City Hospital Sendai cityJapan Division of Gastroenterology Tohoku University Graduate School of MedicineSendai CityJapan

AIM:To examine the prevalence of gastroesophageal reflux disease (GERD) symptoms in a large unselected general population in Japan. METHODS: In Japan, mature adults are offered regular check-ups for the prevention of gastric cancer. A notice was sent by mail to all inhabitants aged > 40 years. A total of 160 983 Japanese (60 774 male, 100 209 female; mean age 61.9 years) who underwent a stomach check up were enrolled in this study. In addition, from these 160 983 subjects, we randomly selected a total of 82 894 (34 275 male, 48 619 female; mean age 62.4 years) to evaluate the prevalence of abdominal pain. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a 1 mo period. RESULTS: The respective prevalences of the symptoms in males and females were: heartburn, 15.8% vs 20.7%; dysphagia, 5.4% vs 7.8%; and abdominal pain, 6.6% vs 9.6%. Among these symptoms, heartburn was significantly high compared with the other symptoms, and the prevalence of heartburn was significantly more frequent in females than in males in the 60-89-year agegroup. Dysphagia was also significantly more frequent in female patients. CONCLUSION: The prevalence of typical GERD symptoms (heartburn) was high, at about 20% of the Japan population, and the frequency was especially high in females in the 60-89 year age group.

关键词： Gastroesophageal reflux disease Heartburn Dysphagia abdominal pain

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Pathophysiology and prevention of postoperative peritoneal adhesions

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World Journal of Gastroenterology 2011年第41期17卷 4545-4553页

作者： Willy Arung Michel Meurisse Olivier Detry Department of General Surgery Cliniques Universitaires de LubumbashiUniversity of Lubumbashi Department of abdominal Surgery and Transplantation CHU de LiègeUniversity of Liege

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fi brin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peri-toneal adhesions have been investigated. Their role aims in activating fi brinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting col-lagen synthesis or creating a barrier between adjacentwound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional fi ndings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clini-cal studies are still necessary to evaluate the effective-ness of the several proposed prevention strategies of postoperative peritoneal adhesions.

关键词： abdominal surgery Laparoscopy Complica-tion Occlusion abdominal pain

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Clinical outcome of Fitz-Hugh-Curtis syndrome mimicking acute biliary disease

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World Journal of Gastroenterology 2008年第45期14卷 6975-6980页

作者： Seong Yong Woo Jin Il Kim Dae Young Cheung Se Hyun Cho Soo-Heon Park Joon-Yeol Han Jae Kwang Kim Division of Gastroenterology and Hepatology Department of Internal Medicine the Catholic University of Korea

AIM: To analyze the clinical characteristics of patients diagnosed with Fitz-Hugh-Curtis ***: The clinical courses of patients that visited St. Mary's Hospital with abdominal pain from January 2005 to December 2006 and were diagnosed with Fitz-Hugh-Curtis syndrome were ***: Fitz-Hugh-Curtis syndrome was identified in 22 female patients of childbearing age; their mean age was 31.0 ± 8.1 years. Fourteen of these cases presented with pain in the upper right abdomen alone or together with pain in the lower abdomen, and six patients presented with pain only in the lower abdomen. The first impression at the time of visit was acute cholecystitis or cholangitis in 10 patients and acute appendicitis or pelvic inflammatory disease in eight patients. Twenty-one patients were diagnosed by abdominal computer tomograghy (CT), and the results of abdominal sonography were normal for 10 of these patients. Chlamydia trichomatis was isolated from 18 patients. Two patients underwent laparoscopic adhesiotomy and 20 patients were completely cured by antibiotic ***: For women of childbearing age with acute pain in the upper right abdomen alone or together with pain in the lower abdomen, Fitz-Hugh-Curtis syndrome should be considered during differential diagnosis. Moreover, in cases suspected to be Fitz-Hugh-Curtis syndrome, abdominal CT, rather than abdominal sonography, assists in the diagnosis.

关键词： Chlamydia trichomatis abdominal pain Fitz-Hugh-Curtis syndrome

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Improvement of Quality of Nonanesthetic Colonoscopy by Preoperative Administration of Pinaverium Bromide

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Chinese Medical Journal 2017年第6期130卷 631-635页

作者： Xiao-Lin Wang Jian-Ning Zhou Li Ren Xiao-Li Pan Hong-Yu Ren Jun Liu Division of Gastroenterology Liyuan Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430077 China Division of Gastroenterology Wuhan Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Huhei 430022 China Division of Pharmacy Zaoyang First People's Hospital Zaoyang Hubei 441200 China

Background： Nonanesthetic colonoscopy is popular in clinical practice in China. However, intestinal spasms often result in a prolonged examination time, increased operating difficulties, decreased polyp detection rate, and failure to complete the procedure clinically. Therefore, exploring alternative approaches that can reduce the pain in patients during colonoscopy is of utmost importance, and finding the optimal preoperative administration to improve the quality of nonanesthetic colonoscopy is also necessary. This study aimed to investigate the effects of the prophylactic administration of pinaverium bromide before colonoscopy and the effects of pinaverium bromide alone at different time points or combined with scopolamine butylbromide. Methods： A randomized controlled trial was performed on a cohort of 1000 patients who underwent colonoscopy in outpatient clinic of Wuhan Union Hospital. The patients were randomly assigned to the following groups： Group A, given oral pinaverium bromide （100 mg, three times a day） one day before examination combined with intramuscular injection of scopolamine butylbromide （20 mg） 10 min before colonoscopy; Group B0, given pinaverium bromide alone on the day ofcolonoscopy （ 100 mg, three times a day）; Group B1, given pinaverium bromide alone （100 mg, three times a day） one day before colonoscopy; Group B2, given pinaverium bromide alone （100 mg, three times a day） two days before colonoscopy; and Group C, given scopolamine butylbromide alone （20 mg） before colonoscopy. The successful rate of colonoscopy, procedure time, degree of abdominal pain, and polyp detection rate were recorded and compared among all groups. Results： The successful rate of colonoscopy in Group B1 （82.0%） and Group B2 （83.0%） was significantly higher than that in Group B1 （62.0%, all P 〈 0.01 ）. The time to reach the ileocecal region in Group B1 and Group B, were lower than those in Group B0 （all P 〈 0.05）. However, no significant differences were observed in p

关键词： abdominal pain Pinaverium Bromide Routine Colonoscopy

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Agenesis of the dorsal pancreas

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World Journal of Gastroenterology 2009年第3期15卷 376-377页

作者： Wolfgang J Schnedl Claudia Piswanger-Soelkner Sandra J Wallner Robert Krause Rainer W Lipp Practice for General Internal Medicine Hauptstrasse 5A-8940 LiezenAustria Department of Internal Medicine Medical UniversityAuenbruggerplatz 15A-8036 GrazAustria Institute of Pathophysiology Center for Molecular MedicineHeinrichstrasse 31aA-8010 GrazAustria

During the last 100 years in medical literature,there are only 54 reports,including the report of Pasaoglu et al(World J Gastroenterol 2008;14:2915-2916),with clinical descriptions of agenesis of the dorsal pancreas in *** of the dorsal pancreas,a rare congenital pancreatic malformation,is associated with some other medical conditions such as hyperglycemia,abdominal pain,pancreatitis and a few other *** approximately 50% of reported patients with this congenital malformation,hyperglycemia was *** of hyperglycemia and diabetes mellitus in all patients with agenesis of the dorsal pancreas including description of fasting blood glucose,oral glucose tolerance test,glycated hemoglobin and medical treatment would be a future *** autosomal dominant transmission has been suggested in single families,more family studies including imaging technologies with demonstration of the pancreatic duct system are needed for evaluation of this *** this letter to the editor,we aim to increase available information for the better understanding of this rare disease.

关键词： Agenesis of dorsal pancreas Diabetesmellitus Glucose intolerance abdominal pain Pancreatitis

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