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Efficacy of the vaccination in inflammatory bowel disease

World Journal of gastroenterology 2013年第9期19卷 1349-1353页

作者： Elisa Carrera Rebeca Manzano Elena Garrido Department of gastroenterology University Hospital of Guadalajara 19002 Guadalajara Spain Department of gastroenterology Sureste Hospital Arganda 28500 Madrid Spain Inflammatory Bowel Disease clinic Department of Gastroenterology University Hospital Ramón y Cajal 28034 Madrid Spain

Inflammatory bowel disease (IBD) is associated with conditions that may predispose to infections, such as the lack of an appropriate innate immune response to infectious agents, malnutrition, surgery, and immunosuppressive and biological drugs. Some of these infections may be preventable by vaccination. Therefore, for this particular patient population, the benefits of implementing a well-established immunization protocol in daily clinical practice are potentially even greater than for the general population. In recent years international consensus guidelines have been published, but in spite of theses recommendations, studies have shown that a significant number of patients with IBD remain inadequately immunized. Another important issue regarding immunization in this population is that vaccine efficacy among patients receiving immunosuppressive therapies has been variable. In a healthy population, a humoral immune response to hepatitis B vaccination (HBV) is expected in > 90%, whereas a much lower rate is achieved in the IBD patients. Immunosuppressive, anti-tumor necrosis factor therapy and disease activity have been implicated in the impaired efficacy of the vaccination. The serological response to HBV should be confirmed and patients with an inadequate response should receive a second full series of vaccine. Modified dosing regimens, including doubling the standard antigen dose, might increase the effectiveness. Response to influenza, pneumococcal and tetanus immunization is still not clear, as there are studies that show a normal response to the vaccination while others demonstrate a lack of efficacy. We pose a series of questions on the efficacy of the different vaccinations recommended for IBD patients and attempt to answer them using scientific evidence.

关键词： Vaccination Efficacy Infections Immunization Inflammatory bowel disease Immunosuppressive medications Hepatitis B vaccines Influenza vaccines Pneumococcal vaccines Tetanus vaccines

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A rare cause of gastro-intestinal hemorrhage in a patient with a Roux-en-Y gastric bypass

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gastroenterology Report 2016年第1期4卷 84-86,I0003页

作者： Richard H.Cartabuke Paresh P.Mehta Kevin El-Hayek J.Michael Henderson Carol A.Burke Department of Internal Medicine Cleveland ClinicClevelandOhioUSA Department of gastroenterology and Hepatology Cleveland ClinicClevelandOhioUSA Department of General Surgery Cleveland ClinicClevelandOhioUSA

This case illustrates a rare cause of gastro-intestinal bleeding following bariatric *** it is essential to rule out common causes of variceal formation accompanied by intermittent,profuse bleeding,there should be a high degree of suspicion of this rare etiology in patients who have previously undergone alteration of their anatomy,especially Roux-en-Y gastric bypass(RYGB).The case emphasizes the need for a multidisciplinary medical-surgical team in evaluating and treating patients who present with complex intra-abdominal pathology.

关键词： gastro-intestinal bleeding superior mesenteric venous thrombosis Roux-en-Y gastric bypass

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Weight loss interventions in living donor liver transplantation as a tool in expanding the donor pool: A systematic review and metaanalysis

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World Journal of gastroenterology 2021年第24期27卷 3682-3692页

作者： Sushrut Trakroo Nakul Bhardwaj Rajat Garg Jamak Modaresi Esfeh Department of Hospital Medicine Cleveland ClinicClevelandOH 44195United States Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Department of gastroenterology and Transplant Hepatology Cleveland ClinicClevelandOH 44195United States

BACKGROUND With increasing rates of liver transplantation and a stagnant donor pool,the annual wait list removals have remained *** donor liver transplantation(LDLT)is an established modality in expanding the donor pool and is the primary method of liver donation in large parts of the *** living donors,including those with hepatic steatosis,have been used to expand the donor ***,due to negative effects of steatosis on graft and recipient outcomes,current practice excludes overweight or obese donors with more than 10%macro vesicular *** has limited a potentially important source to help expand the donor *** loss is known to improve or resolve steatosis and rapid weight loss with short-term interventions have been used to convert marginal donors to low-risk donors in a small series of *** is,however,a lack of a consensus driven standardized approach to such *** To assess the available data on using weight loss interventions in potential living liver donors with steatotic livers and investigated the feasibility,efficacy,and safety of using such donors on the donor,graft and recipient *** principal objective was to assess if using such treated donor livers,could help expand the donor *** We performed a comprehensive literature review and meta-analysis on studies examining the role of short-term weight loss interventions in potential living liver donors with hepatic steatosis with the aim of increasing liver donation rates and improving donor,graft,and recipient *** A total of 6 studies with 102 potential donors were *** subjects were males(71).All studies showed a significant reduction in body mass index postintervention with a mean difference of-2.08(-3.06,1.10,I2=78%).A significant reduction or resolution of hepatic steatosis was seen in 93 of the 102(91.2%).Comparison of pre-and post-intervention liver biopsies showed a significant reduction in steatosis wi

关键词： Living donor liver transplant Living liver donors Liver steatosis Weight loss interventions Donor outcomes Recipient outcomes

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Kayexalate-induced colonic ulcer

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gastroenterology Report 2014年第3期2卷 235-236页

作者： Mazen Albeldawi Varun Gaur Luke Weber Department of gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA Department of Internal Medicine Cleveland ClinicClevelandOHUSA

A 61-year-old male presents to the emergency room with complaints of fatigue,dizziness and bright red blood per rectum(BRBPR)for 2 *** medical history was significant for gastroesophageal reflux disease,non-steroidal antiinflammatory drug(NSAID)induced ulcer,and end-stage renal disease(GFR<30)status post 2 failed renal *** medications include pantoprazole and sodium polystyrene sulfonate in sorbitol(Kayexalate 30 g/d orally).On esophagogastroduodenoscopy(EGD)there was a single shallow,flat,non-bleeding gastric ulcer(3mm)in the pre-pyloric region of the stomach with no stigmata of bleeding.A colonoscopy was performed showing evidence of colitis and localized ulcerations in the cecum which were *** revealed basophilic,nonpolarizable,rhomboid-like crystals without evidence of necrosis.

关键词： Kayexalate medication side effect gastrointestinal bleed

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Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders

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World Journal of Gastrointestinal Endoscopy 2019年第1期11卷 31-40页

作者： Petko Karagyozov Irina Boeva Ivan Tishkov Department of Interventional gastroenterology Clinic of Gastroenterology Acibadem City Clinic Tokuda Hopsital

Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy(SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future *** SOC(D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors(extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree,unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography(ERCP)alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.

关键词： Per-oral cholangioscopy Digital single-operator cholangioscopy Difficult stones Indeterminate strictures Endoscopic retrograde cholangiopancreatography Biliary interventions

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Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer

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World Journal of gastroenterology 2018年第8期24卷 905-916页

作者： Mohamad A Mouchli Lidia Ouk Marianne R Scheitel Alisha P Chaudhry Donna Felmlee-Devine Diane E Grill Shahrooz Rashtak Panwen Wang Junwen Wang Rajeev Chaudhry Thomas C Smyrk Ann L Oberg Brooke R Druliner Lisa A Boardman Division of gastroenterology and Hepatology Mayo Clinic Knowledge and Delivery Center Mayo Clinic Biostatistics and Bioinformatics Health Sciences Research Mayo Clinic Division of Biomedical Statistics and Informatics Health Sciences Research Mayo Clinic Biostatistics and Bioinformatics Health Science Research Center for Individualized Medicine Mayo Clinic Department of Biomedical Informatics Arizona State University Primary Care Internal Medicine Mayo Clinic Center for Innovation Mayo Clinic Department of Laboratory Medicine and Pathology Mayo Clinic

AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.

关键词： Colon cancer Rectal Cancer Advanced adenoma Sessile serrated adenoma High risk polyps Post-polypectomy colorectal cancer

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clinical features of cardiac nodularity-like appearance induced by Helicobacter pylori infection

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World Journal of gastroenterology 2020年第35期26卷 5354-5361页

作者： Toshihiro Nishizawa Kosuke Sakitani Hidekazu Suzuki Shuntaro Yoshida Yosuke Kataoka Yousuke Nakai Hirotoshi Ebinuma Takanori Kanai Osamu Toyoshima Kazuhiko Koike Department of gastroenterology Toyoshima Endoscopy ClinicTokyo 1570066Japan Department of gastroenterology Narita HospitalInternational University of Health and WelfareChiba 2868520Japan Department of gastroenterology Sakitani Endoscopy ClinicChiba 2740825Japan Department of Internal Medicine Tokai University School of MedicineKanagawa 2591193Japan Department of gastroenterology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan Department of Internal Medicine Keio University School of MedicineTokyo 1608582Japan

We have previously reported that Helicobacter pylori(***)-associated nodular gastritis could occur in both the antrum and the *** nodularity-like appearance(hereafter,called as cardiac nodularity)had a high predictive accuracy for the diagnosis of *** *** the previous study,we included only the patients who were evaluated for *** infection for therst time,and excluded patients with a history of ***,the prevalence and clinical features of cardiac nodularity remains *** To perform this cross-sectional study to explore the characteristics of cardiac *** Consecutive patients who underwent esophagogastroduodenoscopy betweenMay,2017 and August,2019 in the Toyoshima Endoscopy clinic were enrolled in this *** included ***-negative,***-positive,and *** patients,and excluded patients with unclear *** status and eradication *** infection was diagnosed according to serum *** antibody and the urea breath test or *** nodularity was defined as a miliary nodular appearance or the presence of scattered whitish circular small colorations within 2 cm of the esophagogastric *** was visualized as whitish in the narrow-band imaging *** collected data on the patients’baseline *** A total of 1078 patients were finally *** ***-negative patients,cardiac nodularity and antral nodularity were recognized in 0.14%*** ***-positive patients,cardiac nodularity and antral nodularity were recognized in 54.5%and 29.5%,*** ***-eradicated patients,cardiac nodularity and antral nodularity were recognized in 4.5%and 0.6%,*** frequency of cardiac nodularity was significantly higher than that of antral nodularity in ***-positive and-eradicated *** frequencies of cardiac nodularity and antral nodularity in ***-eradicated patients were significa

关键词： Cardia Nodularity Helicobacter pylori Diagnosis Gastritis

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Noninvasive assessment of portal hypertension in cirrhosis:Liver stiffness and beyond

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World Journal of gastroenterology 2014年第45期20卷 16811-16819页

作者： Horia Stefanescu Bogdan Procopet Department of Medical and Surgical Sciences University of Bologna Regional Institute of gastroenterology and Hepatology Liver Hemodynamic Unit Hospital Clinic 3rd Medical clinic Iuliu Hatieganu University of Medicine and Pharmacy

Liver stiffness measurement(LSM)is a good,but still limited tool to noninvasively assess complications and prognosis in patients with advanced liver *** review aims to consider the role of LSM for the diagnosis of portal hypertension-related complications and for assessment of prognosis in cirrhotic patients,and to highlight the drawbacks as well as some alternatives for improving the ***,this field is far from being closed,and deserves more *** is still a place for more carefully designed studies to find new,innovative and reliable approaches.

关键词： Liver stiffness Portal hypertension Complication Spleen stiffness Prediction

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Hepatocellular carcinoma in HCV - liver cirrhosis before and after successful DAA treatment

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Hepatoma Research 2019年第10期5卷 1-5页

作者： Zahari Krastev Deian Jelev Donika Krasteva Jordan Genov Teodora Komitova clinic of gastroenterology University Hospital Sv.Ivan RilskiMedical UniversitySofia 1431Bulgaria clinic of gastroenterology University Hospital Tsaritsa Yoanna-ISULMedical UniversitySofia 1527Bulgaria

Chronic hepatitis C virus(HCV)infection is a major cause of liver cirrhosis and hepatocellular carcinoma(HCC)*** recent advancement of direct-acting Antiviral Agents(DAAs)in hepatitis C therapy,resulted in sustained virological response rates of over 90%in treated patients in different stages of liver *** efficacy of DAAs treatment has also been confirmed in real-life cohorts that include subjects with decompensated cirrhosis and therefore seems a promising step to a significant reduction in the recurrence of HCC in patients who achieved complete destruction of the HCC nodules by local *** present a 72-year old patient with HCV-related liver cirrhosis who successfully responded to DAAs treatment after complete destruction of an early HCC nodule.

关键词： Hepatocellular carcinoma hepatitis C virus infection Direct-acting Antiviral Agents hepatocellular carcinoma recurrence

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Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies

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World Journal of gastroenterology 2020年第10期26卷 1098-1106页

作者： Mohamed M Gad C.Roberto Simons-Linares Internal Medicine Department Medicine InstituteCleveland ClinicClevelandOH 44195United States gastroenterology and Hepatology Department Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States

BACKGROUND There is conflincting evidence on the intravenous fluid(IVF)strategy for acute pancreatitis(AP).We perform a metaanalysis of the available *** To investigate if aggressive IVF therapy in AP patients is beneficial to decrease mortality and improve *** Metaanalysis of available randomized controlled trials and cohort studies comparing aggressive IVF vs non-aggressive IVF *** There was no significant difference in mortality between the aggressive(n=1229)and non-aggressive IVF(n=1397)*** receiving aggressive IVF therapy had higher risk for acute kidney injury and acute respiratory distress *** also was no significant difference in the overall incidence of systemic inflammatory response syndrome,persistent organ failure,pancreatic necrosis when comparing both study *** Early aggressive IVF therapy did not improve ***,aggressive IVF therapy could potentially increase the risk for acute kidney injury and pulmonary edema leading to respiratory failure and mechanical *** are needed to investigate which subset of AP patients could benefit from aggressive IVF therapy.

关键词： Acute pancreatitis Intravenous fluid resuscitation Aggressive fluid resuscitation

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