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Systematic review: Safety of balloon assisted enteroscopy in Crohn's disease

World Journal of gastroenterology 2016年第40期22卷 8999-9011页

作者： Ahilan Arulanandan Parambir S Dulai Siddharth Singh William J Sandborn Denise Kalmaz division of gastro-enterology University of California San Diego

AIM To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy(BAE) in Crohn's disease(CD). METHODS Systematic review(PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy(DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease *** Per procedure perforation rate of diagnostic BAE in CD was 0.15%(95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications(0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12%(95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications(0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74%(95%CI: 0.85-3.55). Eighty-six percentof therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients. CONCLUSION Diagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

关键词： Crohn’s disease Balloon Enteroscopy Safety Perforation stricture

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Update on the endoscopic treatments for achalasia

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World Journal of gastroenterology 2016年第39期22卷 8670-8683页

作者： Dushant S Uppal Andrew Y Wang division of gastro-enterology and Hepatology University of Virginia Health System

Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. Highresolution manometry allows for definitive diagnosis and classification of achalasia, with type Ⅱ being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation(PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy(POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient's clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.

关键词： Per oral endoscopic myotomy Dilation Achalasia Treatment Endoscopy Myotomy Per oral

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Direct-acting antiviral agents against hepatitis C virus and lipid metabolism

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World Journal of gastroenterology 2017年第31期23卷 5645-5649页

作者： tatsuo kanda mitsuhiko moriyama division of gastro-enterology and hepatology department of medicine nihon university school of medicine

Hepatitis C virus (HCV) infection induces steatosis and is accompanied by multiple metabolic alterations including hyperuricemia, reversible hypocholesterolemia and insulin resistance. Total cholesterol, low-density lipoprotein-cholesterol and triglyceride levels are increased by peginterferon and ribavirin combination therapy when a sustained virologic response (SVR) is achieved in patients with HCV. steatosis is significantly more common in patients with HCV genotype 3 but interferon-free regimens are not always effective for treating HCV genotype 3 infections. HCV infection increases fatty acid synthase levels, resulting in the accumulation of fatty acids in hepatocytes. Of note, low-density lipoprotein receptor, scavenger receptor class B type I and Niemann-Pick C1-like 1 proteins are candidate receptors that may be involved in HCV. They are also required for the uptake of cholesterol from the external environment of hepatocytes. Among HCV-infected patients with or without human immunodeficiency virus infection, changes in serum lipid profiles are observed during interferon-free treatment and after the achievement of an SVR. It is evident that HCV affects cholesterol metabolism during interferon-free regimens. Although higher SVR rates were achieved with interferon-free treatment of HCV, special attention must also be paid to unexpected adverse events based on host metabolic changes including hyperlipidemia.

关键词： Cholesterol Hepatitis C virus Interferon-free Lipid metabolism

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Feasibility of initial endoscopic common bile duct stone removal in patients with acute cholangitis

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World Journal of Clinical Cases 2017年第7期5卷 280-285页

作者： Akira Yamamiya Katsuya Kitamura Yu Ishii Yuta Mitsui Tomohiro Nomoto Hitoshi Yoshida division of gastro- enterology Department of MedicineShowa University School of Medicine

AIM To investigate the feasibility of initial endoscopic common bile duct(CBD) stone removal in patients with acute cholangitis(AC).METHODS A single-center,retrospective study was conducted between April 2013 and December 2014 and was approved by the Medical Ethics Committee at our *** informed consent was obtained from each patient prior to the *** cohort comprised 31 AC patients with CBD stones who underwent endoscopic biliary drainage(EBD) for na?ve papilla within 48 h after AC *** retrospectively divided the participants into two groups: 19 patients with initial endoscopic CBD stone removal(initial group) and 12 patients with delayed endoscopic CBD stone removal(delayed group).We evaluated the feasibility of initial endoscopic CBD stone removal in patients with *** We observed no significant differences between the groups regarding patient *** to the assessments based on the Tokyo Guidelines,the AC severity of patients with initial endoscopic CBD stone removal was mild to *** use of antithrombotic agents before EBD was less frequent in the initial group than in the delayed group(11% vs 58%,respectively; P = 0.004).All the patients underwent successful endoscopic CBD stone removaland adverse events did not differ significantly between the *** number of endoscopic retrograde cholangiopancreatography procedures was significantly lower in the initial group than in the delayed group [median(interquartile range) 1(1-1) vs 2(2-2),respectively; P 1].The length of hospital stay was significantly shorter for the initial group than for the delayed group [10(9-15) vs 17(14-20),respectively; P = 0.010].CONCLUSION Initial endoscopic CBD stone removal in patients with AC may be feasible when AC severity and the use of antithrombotic agents are carefully considered.

关键词： Acute cholangitis Common bile duct stone Feasibility Initial endoscopic common bile stone removal Endoscopic retrograde cholangiopancreatography

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Inflammatory bowel disease and cancer: The role of inflammation, immunosuppression, and cancer treatment

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World Journal of gastroenterology 2016年第20期22卷 4794-4801页

作者： Jordan E Axelrad Simon Lichtiger Vijay Yajnik Department of Medicine Division of Digestive and Liver Diseases Columbia University Medical Center Department of Medicine Division of Gastro-enterology The Massachusetts General Hospital

In patients with inflammatory bowel disease(IBD), chronic inflammation is a major risk factor for the development of gastrointestinal malignancies. The pathogenesis of colitis-associated cancer is distinct from sporadic colorectal carcinoma and the critical molecular mechanisms underlying this process have yet to be elucidated. Patients with IBD have also been shown to be at increased risk of developing extra-intestinal malignancies. Medical therapies that diminish the mucosal inflammatory response represent the foundation of treatment in IBD, and recent evidence supports their introduction earlier in the disease course. However, therapies that alter the immune system, often used for long durations, may also promote carcinogenesis. As the population of patients with IBD grows older, with longer duration of chronic inflammation and longer exposure to immunosuppression, there is an increasing risk of cancer development. Many of these patients will require cancer treatment, including chemotherapy, radiation, hormonal therapy, and surgery. Many patients will require further treatment for their IBD. This review seeks to explore the characteristics and risks of cancer in patients with IBD, and to evaluate the limited data on patients with IBD and cancer, including management of IBD after a diagnosis of cancer, the effects of cancer treatment on IBD, and the effect of IBD and medications for IBD on cancer outcomes.

关键词： Inflammatory bowel disease Cancer Antitumor necrosis factor Immunosuppression Chemotherapy Radiation

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Hepatitis delta virus:Making the point from virus isolation up to 2014

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World Journal of Hepatology 2015年第22期7卷 2389-2395页

作者： Raffaella Romeo Riccardo Perbellini 1st division of gastro-enterology IRCCS Fondazione Cà Granda Ospedale Maggiore PoliclinicoUniversity of Milan

Chronic infection with hepatitis delta virus(HDV) has lately regained clinical importance because of the recent evidence of increasing prevalence in several European countries,due to immigration from highly endemic areas. HDV requires the mandatory presence ofhepatitis B virus(HBV) for propagation to hepatocytes. It is transmitted by the same routes of HBV and it can be acquired either by co-infection(simultaneous transmission of the two viruses) or super-infection(acquisition of HDV by an already chronic carrier of HBV). As a consequence,every HBV carrier is potentially at risk for HDV superinfection. Since the clinical course of superinfection can be severe,early diagnosis of HDV infection is necessary.

关键词： Hepatitis delta virus Epidemiology Natural history

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Traditional Chinese herbal extracts inducing autophagy as a novel approach in therapy of nonalcoholic fatty liver disease

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World Journal of gastroenterology 2017年第11期23卷 1964-1973页

作者： Cong Liu Jia-Zhi Liao Pei-Yuan Li division of gastro-enterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

Non-alcoholic fatty liver disease(NAFLD) is one of the leading causes of chronic liver diseases around the world due to the modern sedentary and food-abundant lifestyle, which is characterized by excessive fat accumulation in the liver related with causes other than alcohol abuse. It is widely acknowledged that insulin resistance, dysfunctional lipid metabolism, endoplasmic reticulum stress, oxidative stress, inflammation, and apoptosis/necrosis may all contribute to NAFLD. Autophagy is a protective self-digestion of intracellular organelles, including lipid droplets(lipophagy), in response to stress to maintain homeostasis. Lipophagy is another pathway for lipid degradation besides lipolysis. It is reported that impaired autophagy also contributes to NAFLD. Some studies have suggested that the histological characteristics of NAFLD(steatosis, lobular inflammation, and peri-sinusoid fibrosis) might be improved by treatment with traditional Chinese herbal extracts, while autophagy may be induced. This review will provide insights into the characteristics of autophagy in NAFLD and the related role/mechanisms of autophagy induced by traditional Chinese herbal extracts such as resveratrol, Lycium barbarum polysaccharides, dioscin, bergamot polyphenol fraction, capsaicin, and garlic-derived S-allylmercaptocysteine, which may inhibit the progression of NAFLD. Regulation of autophagy/lipophagy with traditional Chinese herbal extracts may be a novel approach for treating NAFLD, and the molecular mechanisms should be elucidated further in the near future.

关键词： Traditional Chinese herbal extracts Nonalcoholic fatty liver disease Autophagy

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Pyrroloquinoline quinone:a potential neuroprotective compound for neurodegenerative diseases targeting metabolism

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Neural Regeneration Research 2025年第1期20卷 41-53页

作者： Alessio Canovai Pete A.Williams Department of Biology University of PisaPisaItaly Department of Clinical Neuroscience Division of Eye and VisionSt.Erik Eye HospitalKarolinska InstitutetStockholmSweden

Pyrroloquinoline quinone is a quinone described as a cofactor for many bacterial dehydrogenases and is reported to exert an effect on metabolism in mammalian cells/*** quinone is present in the diet being available in foodstuffs,conferring the potential of this compound to be supplemented by dietary *** quinone’s nutritional role in mammalian health is supported by the extensive deficits in reproduction,growth,and immunity resulting from the dietary absence of pyrroloquinoline quinone,and as such,pyrroloquinoline quinone has been considered as a“new vitamin.”Although the classification of pyrroloquinoline quinone as a vitamin needs to be properly established,the wide range of benefits for health provided has been reported in many *** this respect,pyrroloquinoline quinone seems to be particularly involved in regulating cell signaling pathways that promote metabolic and mitochondrial processes in many experimental contexts,thus dictating the rationale to consider pyrroloquinoline quinone as a vital compound for mammalian *** the regulation of different metabolic mechanisms,pyrroloquinoline quinone may improve clinical deficits where dysfunctional metabolism and mitochondrial activity contribute to induce cell damage and *** quinone has been demonstrated to have neuroprotective properties in different experimental models of neurodegeneration,although the link between pyrroloquinoline quinone-promoted metabolism and improved neuronal viability in some of such contexts is still to be fully ***,we review the general properties of pyrroloquinoline quinone and its capacity to modulate metabolic and mitochondrial mechanisms in physiological *** addition,we analyze the neuroprotective properties of pyrroloquinoline quinone in different neurodegenerative conditions and consider future perspectives for pyrroloquinoline quinone’s potential in health and disease.

关键词： metabolism mitochondria neurodegenerative disease neuroprotection pyrroloquinoline quinone retinal diseases

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Obstructive jaundice due to a rare periampullary tumor

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World Journal of gastrointestinal Oncology 2013年第10期5卷 195-197页

作者： Anjana Sathyamurthy Abhishek Choudhary Dennis Ng Shuaib Okponobi Alberto Diaz-Arias Ajitinder Grewal Ghassan M Hammoud division of gastro-enterology and Hepatology University of Missouri-Columbia Department of Pathology and Anatomical Sciences University of Missouri Health Sciences Center

Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes.A 92-year-old female presented with obstructive *** exam she had pale conjunctiva and icteric *** examination revealed tenderness in the upper *** data was consistent with obstructive *** tomography of the abdomen revealed a dilated gall bladder and a common bile duct(CBD)with no evidence of liver lesions or pancreatic head *** ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area,dilated CBD(9 mm),a prominent pancreatic duct(4.1 mm)and a hydropic gall bladder with no *** retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare *** analyses with immunohistochemical stains were positive for cytokeratin,synaptophysin,S-100 protein,neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic *** gangliocytic paraganglioma is a rare benign tumor of the small *** presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive *** resection is a curative therapy in the absence of local invasion or distant metastasis.

关键词： Gangliocytic paraganglioma Periampullary tumor Spindle-shaped Epitheloid Ganglion cells Jaundice Duodenum Endoscopic mucosal resection

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Geographic differences in low-dose aspirin-associated gastroduodenal mucosal injury

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World Journal of gastroenterology 2015年第25期21卷 7709-7717页

作者： Katsunori Iijima Tooru Shimosegawa division of gastro- enterology Tohoku University Graduate School of Medicine

Aspirin, even at low doses, has been known to cause upper gastro-intestinal complications, such as gastroduodenal ulcers, despite the definite benefits from its antithrombotic effects. Helicobacter pylori(H. pylori) is major pathogen responsible for gastroduodenal ulcerformation. There have been conflicting results about the potential interaction between these two ulcerogenic factors and the geographic areas involved. In Western countries, the prevalence of gastroduodenal ulcers is consistently higher in H. pylori-positive low-dose aspirin(LDA) users than in H. pylori-negative ones, suggesting that H. pylori infection exacerbates LDA-induced gastroduodenal mucosal injury in these geographic areas. Meanwhile, previous studies from Japan have generally reported a similar prevalence of LDA-induced gastroduodenal mucosal injury regardless of the presence of H. pylori infection, indicating that the infection is not an overall exacerbating factor for drug-induced injury. H. pylori infection could have a synergistic or antagonistic interaction with LDA use in adverse gastroduodenal events depending on gastric acid secretion. It is wellrecognized that the net effect of H. pylori infection on gastric acid secretion shows considerable geographic variation at the population level. While gastric acid secretion levels were not decreased and were wellpreserved in most patients with H. pylori infection from Western countries, the majority of Japanese patients with H. pylori infection exhibited decreased gastric acid secretion. Such large geographic differences in the net effect of H. pylori infection on gastric acid secretion could be at least partly responsible for the geographically distinct interaction between LDA use and H. pylori infection on adverse gastroduodenal lesions.

关键词： Helicobacter pylori Low-dose aspirin Gastricacid secretion gastroduodenal ulcers Geographicvariation

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