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Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis

World Journal of gastroenterology 2015年第11期21卷 3282-3290页

作者： Enayatullah Baki Philipp Zwickel Anna Zawierucha Robert Ehehalt Daniel Gotthardt Wolfgang Stremmel Annika Gauss Division of gastroenterology University of Heidelberg Outpatient clinic of gastroenterology

AIM:To evaluate the outcome of anti-tumor necrosis factor alpha(anti-TNFα) therapy in outpatients with ulcerative colitis at a tertiary referral ***:All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the University Hospital Heidelberg between January 2011 and February 2014 were retrospectively *** with a followup period of less than 6 mo from start of anti-TNFα therapy were *** records of all eligible individuals were carefully ***-free clinical remission of a duration of at least 3 mo,colectomy rate,duration of anti-TNFα therapy,need for anti-TNFα dose escalation,and the occurrence of adverse events were evaluated as the main outcome ***:Seventy-two patients were included(35 treated with infliximab,17 with adalimumab,20 with both consecutively).Median follow-up was 27 mo(range:6-87 mo).Steroid-free clinical remission was achieved by 22.2% of the patients(median duration:21 mo until end of follow-up; range:3-66 mo).Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve *** overall colectomy rate was 20.8%.Nearly 50% of the patients underwent anti-TNFα dose escalation during the follow-up *** both the infliximab and the adalimumab treated patients,non-response to anti-TNFα therapy was the major reason for treatment discontinuation.18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse ***:Real-life remission rates of ulcerative colitis under anti-TNFα are overall low,but some patients have a clear long-term benefit.

关键词： Inflammatory bowel disease Tumor necrosis factor α

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Capsule endoscopy

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World Journal of gastroenterology 2009年第13期15卷 1584-1586页

作者： Miguel Muoz-Navas gastroenterology Department University Clinic of Navarra

Capsule endoscopy(CE) is a simple,safe,non-invasive,reliable technique,well accepted and tolerated by the patients,which allows complete exploration of the small *** advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine,such as obscure gastrointestinal bleeding,Crohn's disease,small bowel tumors,polyposis syndromes,*** has become the gold standard for the diagnosis of most diseases of the small *** this technique has also been used for esophageal and colonic diseases.

关键词： Capsule endoscopy Small intestine Gastrointestinal hemorrhage Crohn's disease Gastro-intestinal neoplasms Intestinal polyposis

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Crohn's disease presenting as acute gastrointestinal hemorrhage

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World Journal of gastroenterology 2016年第16期22卷 4073-4078页

作者： Amareshwar Podugu Kanwarpreet Tandon Fernando J Castro Department of gastroenterology Cleveland Clinic Florida

Severe gastrointestinal (GI) hemorrhage is a rare complication of Crohn’s disease (CD). Although several surgical and non-surgical approaches have been described over the last 2 decades this complication still poses significant diagnostic and therapeutic challenges. Given the relative infrequency of severe bleeding in CD, available medical literature on this topic is mostly in the form of retrospective case series and reports. In this article we review the risk factors, diagnostic modalities and treatment options for the management of CD presenting as GI hemorrhage.

关键词： Crohn’ s disease Recurrence Gastrointestinal hemorrhage Biologic agents Risk factors

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Diagnosis and management of angioedema with abdominal involvement:A gastroenterology perspective

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World Journal of gastroenterology 2010年第39期16卷 4913-4921页

作者： Ugochukwu C Nzeako gastroenterology HepatologyGastrointestinal EndoscopyWatson Clinic LLP

Abdominal involvement in angioedema is often a challenge to *** onset abdominal pain is its most common presenting symptom,and misdiagnosis may lead to unnecessary surgical *** with the types and presentations of angioedema can be invaluable to clinicians as they consider the differential diagnoses of a patient presenting with abdominal pain. Detailed personal and family histories,careful physical examination of the patient,combined with knowledge of angioedema types,can help clinicians perform their diagnostic *** accurate diagnosis is essential in order to provide appropriate treatment to patients with *** upon the diagnosis,treatment may be the avoidance of provoking factors(such as allergens or medications),inhibiting histamine-provoked reactions,or treating C1 esterase inhibitor deficiency.

关键词： Acquired angioedema Angiotensin-converting enzyme-induced angioedema Gastrointestinal Hereditary angioedema C1 esterase inhibitor deficiency

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Gender disparities and woman-specific trends in Barrett’s esophagus in the United States:An 11-year nationwide populationbased study

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World Journal of Methodology 2025年第1期15卷 60-71页

作者： Karina Fatakhova Faisal Inayat Hassam Ali Pratik Patel Attiq Ur Rehman Arslan Afzal Muhammad Sarfraz Shiza Sarfraz Gul Nawaz Ahtshamullah Chaudhry Rubaid Dhillon Arthur Dilibe Benjamin Glazebnik Lindsey Jones Emily Glazer Division of gastroenterology and Hepatology Mather Hospital and Zucker School of Medicine at Hofstra UniversityPort JeffersonNY 11777United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Division of gastroenterology and Hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Division of gastroenterology and Hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States Department of Internal Medicine East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of gastroenterology Hepatologyand NutritionCleveland Clinic FoundationClevelandOH 44195United States Department of Internal Medicine Mather Hospital and Hofstra University ZuckerSchool of MedicinePort JeffersonNY 11777United States

BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not *** practice guidelines include male gender as a predisposing factor for BE and *** population-based clinical evidence regarding female gender remains *** To study comparative trends of gender disparities in patients with BE in the United *** A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)*** with a primary or secondary diagnosis code of BE were *** major outcome of interest was determining the gender disparities in patients with *** analysis for respective outcomes for females was also reported to ascertain any time-based *** We identified 1204190 patients with BE for the study *** the included patients,717439(59.6%)were men and 486751(40.4%)were *** mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(***),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of *** and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among

关键词： Barrett’s esophagus Gender disparity Epidemiological trends Esophageal adenocarcinoma Screening endoscopy Female gender Risk factors

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Factoring the intestinal microbiome into the pathogenesis of autoimmune hepatitis

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World Journal of gastroenterology 2016年第42期22卷 9257-9278页

作者： Albert J Czaja Division of gastroenterology and Hepatology Mayo Clinic College of Medicine

The intestinal microbiome is a reservoir of microbial antigens and activated immune cells. The aims of this review were to describe the role of the intestinal microbiome in generating innate and adaptive immune responses, indicate how these responses contribute to the development of systemic immune-mediated diseases, and encourage investigations that improve the understanding and management of autoimmune hepatitis. Alterations in the composition of the intestinal microflora(dysbiosis) can disrupt intestinal and systemic immune tolerances for commensal bacteria. Toll-like receptors within the intestine can recognize microbe-associated molecular patterns and shape subsets of T helper lymphocytes that may cross-react with host antigens(molecular mimicry). Activated gutderived lymphocytes can migrate to lymph nodes, and gut-derived microbial antigens can translocate to extra-intestinal sites. Inflammasomes can form within hepatocytes and hepatic stellate cells, and they can drive the pro-inflammatory, immune-mediated, and fibrotic responses. Diet, designer probiotics, vitamin supplements, re-colonization methods, antibiotics, drugs that decrease intestinal permeability, and molecular interventions that block signaling pathways may emerge as adjunctive regimens that complement conventional immunosuppressive management. In conclusion, investigations of the intestinal microbiome are warranted in autoimmune hepatitis and promise to clarify pathogenic mechanisms and suggest alternative management strategies.

关键词： Intestinal microbiome Inflammasomes Autoimmune hepatitis Dysbiosis Toll-like receptors

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Assessment of multi-modality evaluations of obscure gastrointestinal bleeding

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World Journal of gastroenterology 2017年第4期23卷 614-621页

作者： Ryan Law Jithinraj E Varayil Louis M Wong Kee Song Jeff Fidler Joel G Fletcher John Barlow Jeffrey Alexander Elizabeth Rajan Stephanie Hansel Brenda Becker Joseph J Larson Felicity T Enders David H Bruining Nayantara Coelho-Prabhu Division of gastroenterology and Hepatology Mayo Clinic Division of Radiology Mayo Clinic Division of Health Sciences Research Mayo Clinic

AIMTo determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic *** cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary *** hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9, P < 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding *** is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.

关键词： Double balloon enteroscopy Computed tomography enterography Video capsule enteroscopy Obscure gastrointestinal bleeding

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Esophageal dilations in eosinophilic esophagitis: A single center experience

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World Journal of gastroenterology 2014年第28期20卷 9549-9555页

作者： Andrew Ukleja Jennifer Shiroky Amitesh Agarwal Daniela Allende Department of gastroenterology Cleveland Clinic Florida the University of Texas Medical Branch at Galveston Cleveland clinic

AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic... 详细信息

关键词： Balloon dilation Dysphagia Esophagus disorder Esophageal stricture Esosinophilic esophagitis

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Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function

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World Journal of gastroenterology 2016年第20期22卷 4918-4925页

作者： Madhusudhan R Sanaka Umar Hayat Prashanthi N Thota Ramprasad Jegadeesan Monica Ray Scott L Gabbard Neha Wadhwa Rocio Lopez Mark E Baker Sudish Murthy Siva Raja Department of gastroenterology Q3 Cleveland Clinic Department of Radiology Cleveland Clinic Department of Cardiothoracic Surgery Cleveland Clinic

AIM: To assess and compare the esophageal function after peroral endoscopic myotomy(POEM) vs other conventional treatments in ***: Chart review of all achalasia patients who underwent POEM, laparoscopic Heller myotomy(LHM) or pneumatic dilation(PD) at our institution between January 2012 and March 2015 was performed. Patient demographics, type of achalasia, prior treatments, pre- and post-treatment timed barium swallow(TBE) and high-resolution esophageal manometry(HREM) findings were compared between the three treatment groups. Patients who had both pre- and 2 mo posttreatment TBE or HREM were included in the final analysis. TBE parameters compared were barium column height, width and volume of barium remaining at 1 and 5 min. HREM parameters compared were basal lower esophageal sphincter(LES) pressures and LES-integrated relaxation pressures(IRP). Data are presented as mean ± SD, median [25th, 75 th percentiles] or frequency(percent). Analysis of variance, KruskalWallis test, Pearsons χ~2 test and Fishers Exact tests were used for ***: A total of 200 achalasia patients were included of which 36 underwent POEM, 22 underwent PD and 142 underwent LHM. POEM patients were older(55.4 ± 16.8 years vs 46.5 ± 15.7 years, P = 0.013) and had higher BMI than LHM(29.1 ± 5.9 kg/m^2 vs 26 ± 5.1 kg/m^2, P = 0.012). More number of patients in POEM and PD groups had undergone prior treatments compared to LHM group(72.2% vs 68.2% vs 44.3% respectively, P = 0.003). At 2 mo post-treatment, all TBE parameters including barium column height, width and volume remaining at 1 and 5 min improved significantly in all three treatment groups(P = 0.01 to P < 0.001) except the column height at 1 min in PD group(P = 0.11). At 2 mo post-treatment, there was significant improvement in basal LES pressure and LES-IRP in both LHM(40.5 mm Hg vs 14.5 mm Hg and 24 mm Hg vs 7.1 mm Hg respectively, P < 0.001) and POEM groups(38.7 mm Hg vs 11.4 mm Hg and 23.6 mm Hg vs 6.6 mm Hg res

关键词： Achalasia Dysphagia Heller myotomy Peroral endoscopic myotomy Manometry Pneumatic dilation

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Biologics:how far can they go in Crohn’s disease?

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gastroenterology Report 2022年第1期10卷 155-170页

作者： Katie A.Dunleavy Darrell S.Pardi Division of gastroenterology and Hepatology Mayo ClinicRochesterMNUSA

Crohn’s disease is a chronic gastrointestinal inflammatory disorder,characterized by episodes of relapsing and remitting *** the disease mechanism becomes better elucidated,there is a significant increase in the number of available biologic *** article summarizes and synthesizes current Food and Drug Administration-approved biological therapy for Crohn’s disease and examines the positioning of medical therapy as emerging biologics break onto the market.

关键词： Crohn’s disease medical treatment biologics anti-TNFs anti-integrins anti-interleukins JAK inhibitors S1Pinhibitors

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