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Digesting gluten with oral endopeptidases to improve the management of celiac disease

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World Journal of gastroenterology 2024年第26期30卷 3201-3205页

作者： Katelin Durham Mirac Nedim Ince department of internal medicine Division of Gastroenterology and HepatologyUniversity of IowaCarver College of Medicineand the Iowa City Veterans Affairs Medical CenterIowa CityIA 52242United States

In our editorial,we want to comment on the article by Stefanolo et al titled“Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet”.Celiac disease is an immune-mediated disorder triggered by dietary gluten in genetically predisposed *** avoiding gluten can permit patients to live symptom-free,ongoing voluntary or involuntary exposure to gluten is common and associated with persistent villous atrophy in small bowel *** villous atrophy predisposes patients to life threatening complications,such as osteoporotic fractures or malignancies,therapeutic adjuncts to gluten-free diet become important to improve patients’quality of life and,if these adjuncts can be shown to improve villous atrophy,avoid *** administration of enzyme preparations,such as endopeptidases that digest gluten and mitigate its antigenicity to trigger inflam-mation,is one clinical strategy under *** article is about the utility of one endopeptidase isolated from Aspergillus *** critique findings of this clinical trial and also summarize endopeptidase-based as well as other strategies and how they can complement gluten-free diet in the management of celiac disease.

关键词： Celiac disease Gluten-free diet Endopeptidase Villous atrophy Aspergillus niger Adjunct therapy

Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 241-248页

作者： Chao Sun George Boon-Bee Goh Wan-Cheng Chow Wah-Kheong Chan Grace Lai-Hung Wong Wai-Kay Seto Yi-Hsiang Huang Han-Chieh Lin I-Cheng Lee Hye Won Lee Seung Up Kim Vincent Wai-Sun Wong Jian-Gao Fan center for Fatty Liver Disease Department of GastroenterologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Lab of Pediatric Gastroenterology and NutritionShanghai 200092China department of gastroenterology&hepatology Singapore General HospitalSingaporeSingapore gastroenterology and hepatology Unit Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia department of medicine and Therapeutics and State Key Laboratory of Digestive Disease The Chinese University of Hong KongHong KongChina department of medicine The University of Hong KongHong KongChina Institute of Clinical medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina Division of gastroenterology and hepatology Taipei Veterans General HospitalTaipeiTaiwanChina Faculty of medicine National Yang Ming Chiao Tung University School of MedicineTaipeiTaiwanChina department of internal medicine Yonsei University College of MedicineSeoulKorea

Background:Nonalcoholic fatty liver disease(NAFLD)is associated with impaired renal function,and both diseases often occur alongside other metabolic ***,the prevalence and risk factors for impaired renal function in patients with NAFLD remain *** objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD ***:All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective *** fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase(FAST),Agile 3+and Agile 4 *** renal function and chronic kidney disease(CKD)were defined by an estimated glomerular filtration rate(eGFR)with value of<90 mL/min/1.73 m^(2) and<60 mL/min/1.73 m^(2),respectively,as estimated by the CKD-Epidemiology Collaboration(CKD-EPI)***:Among 529 included NAFLD patients,the prevalence rates of impaired renal function and CKD were 37.4%and 4.9%,*** multivariate analysis,a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+and Agile 4 scores were independent risk factors for CKD(P<0.05).Furthermore,increased fasting plasma glucose(FPG)and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome(P<0.05).Compared with patients with normoglycemia,those with prediabetes[FPG≥5.6 mmol/L or hemoglobin A1c(HbA1c)≥5.7%]were more likely to have impaired renal function(P<0.05).Conclusions:Agile 3+and Agile 4 are reliable for identifying NAFLD patients with high risk of *** glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

关键词： Nonalcoholic fatty liver disease Impaired renal function Agile 3+ Agile 4 Metabolic syndrome

Gastroesophageal reflux following peroral endoscopic myotomy for achalasia:Bumps in the road to success

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World Journal of gastroenterology 2024年第29期30卷 3461-3464页

作者： David Itskoviz Stephen David Howard Malnick Kaplan medical center Institute of Gastroenterology and HepatologyHebrew University Medical School of JerusalemRehovot 76100Israel Kaplan medical center Department of Internal Medicine CHebrew University Medical School of JerusalemRehovot 76100Israel

Achalasia can significantly impair the quality of *** clinical presentation typically includes dysphagia to both solids and liquids,chest pain,and *** can be delayed in patients with atypical presentations,and they might receive a wrong diagnosis,such as gastroesophageal reflux disease(GERD),owing to overlapping symptoms of both *** the cause of achalasia is poorly understood,its impact on the motility of the esophagus and gastroesophageal junction is well *** treatment modalities have been utilized,with the most common being surgical Heller myotomy with concomitant fundoplication and pneumatic balloon ***,peroral endoscopic myotomy(POEM)has gained popularity as an effective treatment for achalasia,despite a relatively high incidence of GERD occurring after treatment compared to other *** magnitude of post-POEM GERD depends on its definition and is influenced by patient and procedure-related *** longterm sequelae of post-POEM GERD are yet to be determined,but it appears to have a benign course and is usually manageable with clinically available *** risk factors for post-POEM GERD and modifying the POEM procedure in selected patients may improve the overall success of this technique.

关键词： Achalasia Per-oral endoscopic myotomy Gastroesophageal reflux Pneumatic dilatation Heller myotomy Proton pump inhibitor Acidic fermentation

Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases:A systematic review and meta-analysis

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World Journal of gastroenterology 2024年第7期30卷 742-758页

作者： Eyad Gadour Abeer Awad Zeinab Hassan Khalid Jebril Shrwani Bogdan Miutescu Hussein Hassan Okasha department of gastroenterology and hepatology King Abdulaziz Hospital-National GuardAhsa 31982Saudi Arabia department of internal medicine Faculty of MedicineZamzam University CollegeKhartoum 11113Sudan department of Hepatogastroenterology Kasar Alainy HospitalFaculty of MedicineCairo UniversityCairo 11451Egypt department of internal medicine Stockport Hospitals NHS Foundation TrustManchester SK27JEUnited Kingdom Public Health Authority Saudi Center for Disease Prevention and ControlJazan 45142Saudi Arabia department of Clinical Infection Microbiology and ImmunologyInstitute of Infection and Global HealthSchool of Medicine and Life SciencesUniversity of LiverpoolLiverpoolUnited Kingdom department of gastroenterology and hepatology Victor Babes University of Medicine and PharmacyTimisoara 300041Romania Advanced Regional Research center in gastroenterology and hepatology Victor Babes University of Medicine and PharmacyTimisoara 30041Romania department of internal medicine Division of Gastroenterology and HepatologyKasr Al-Aini School of MedicineCairo UniversityCairo 11562Egypt

BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent *** applications range from the diagnosis to the treatment of various liver ***,this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver *** To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and *** PubMed,Medline,Cochrane Library,Web of Science,and Google Scholar databases were extensively searched until October *** methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias *** addition,statistical analyses were performed using the Comprehensive Meta-Analysis *** Overall,45 articles on EUS were included(28 on diagnostic role and 17 on therapeutic role).Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4%for focal liver lesions(FLL)and 96.6%for parenchymal liver ***-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases(3.1%and 8.7%,respectively).Analysis of data from four studies showed that EUS-guided liver abscess had high clinical(90.7%)and technical success(90.7%)without significant ***,EUS-guided interventions for the treatment of gastric varices(GV)have high technical success(98%)and GV obliteration rate(84%)with few complications(15%)and rebleeding events(17%).CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

关键词： Focal liver lesion Liver abscess drainage Fine needle aspiration Gastric varices Endoscopic ultrasound

Prospective study of hepatitis B and D epidemiology and risk factors in Romania:A 10-year update

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World Journal of hepatology 2024年第4期16卷 640-649页

作者： Speranta Iacob Liana Gheorghe Mirela Onica Laura Huiban Corina Silvia Pop Ciprian Brisc Roxana Sirli Carmen Ester Cristina Mihaela Brisc Sorina Diaconu Ion Rogoveanu Larisa Sandulescu Deiana Vuletici Anca Trifan department of gastroenterology Carol Davila University of Medicine and PharmacyBucharest 050474Romania department of gastroenterology and hepatology Fundeni Clinical InstituteBucharest 022328Romania department of gastroenterology Grigore T Popa University of Medicine and PharmacyIasi 700115Romania Institute of gastroenterology and hepatology Saint Spiridon County HospitalIasi 700111Romania department of gastroenterology and medical Oncology University Emergency Clinical HospitalBucharest 050098Romania Faculty of medicine and Pharmacy University of OradeaOradea 410087Romania department of gastroenterology Emergency County HospitalOradea 410169Romania center for Advanced Research in gastroenterology and hepatology Department of Gastroenterology and Hepatology“Victor Babeş”University of Medicine and PharmacyTimisoara 300041Romania department of gastroenterology and hepatology TimişCounty Emergency Clinical Hospital"Pius Branzeu"Timisoara 300723Romania department of internal medicine II and gastroenterology University Emergency Clinical HospitalBucharest 050098Romania department of gastroenterology University of Medicine and PharmacyCraiova 200349Romania department of Cardiology Emergency County HospitalCraiova 200642Romania department of gastroenterology Research Center of Gastroenterology and HepatologyUniversity of Medicine and PharmacyCraiova 200349Romania department of gastroenterology Emergency County HospitalCraiova 200642Romania department of gastroenterology Faculty of MedicineGrigore T Popa University of Medicine and PharmacyIasi 700115Romania

BACKGROUND The global burden of hepatitis D virus(HDV)infection represents a major medical challenge and a public health crisis ***,there is a lack of accurate data on the epidemiology and risk factors for *** B virus(HBV)and HDV coinfection causes the most severe form of viral hepatitis,leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection,including the need for liver transplantation and *** To investigate the epidemiology,natural history,risk factors and clinical management of HBV and HDV coinfection in Romanian *** This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in *** consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were *** with acute hepatitis or incomplete data were *** the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period,963 met the inclusion *** for anti-HDV antibodies and HDV RNA was performed for all *** and risk factor data were collected by investigators using medical charts and patient *** data were stored in an anonymized online database during the *** The prevalence of HBV was 3.8%;among these patients,the prevalence of HBV/HDV coinfection was 33.1%.The median age of the study population was 54.0 years,and it consisted of 55.1%men.A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years *** with HBV/HDV coinfection were significantly older than those with HBV monoinfection(P=0.03).Multivariate multiple regression analysis identified female gender(P=0.0006),imprisonment(P<0.0001),older age at diagnosis(P=0.01)and sexual contact with persons with known viral hepatitis(P=0.0003)as significant risk factors for *** This study shows that HDV infection among those with HBV re

关键词： Epidemiology Hepatitis B Hepatitis D Natural history Risk factors Romania

Recent advances in the understanding and management of chronic pancreatitis pain

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胰腺病学杂志(英文) 2024年第1期7卷 35-44页

作者： Walker Jessica Babyok Olivia L. Saloman Jami L. Phillips Anna Evans department of internal medicine University of Pittsburgh Medical Center Pittsburgh PA United States Division of gastroenterology Hepatology and Nutrition Department of Medicine School of Medicine University of Pittsburgh Pittsburgh PA United States center for Pain Research Center for Neuroscience School of Medicine University of Pittsburgh Pittsburgh PA United States

Abdominal pain is the most common symptom of chronic pancreatitis (CP) and is often debilitating for patients and very difficult to treat. To date, there exists no cure for the disease. Treatment strategies focus on symptom management and on mitigation of disease progression by reducing toxin exposure and avoiding recurrent inflammatory events. Traditional treatment protocols start with medical management followed by consideration of procedural or surgical intervention on selected patients with severe and persistent pain. The incorporation of adjuvant therapies to treat comorbidities including psychiatric disorders, exocrine pancreatic insufficiency, mineral bone disease, frailty, and malnutrition, are in its early stages. Recent clinical studies and animal models have been designed to improve investigation into the pathophysiology of CP pain, as well as to improve pain management. Despite the array of tools available, many therapeutic options for the management of CP pain provide incomplete relief. There still remains much to discover about the neural regulation of pancreas-related pain. In this review, we will discuss research from the last 5 years that has provided new insights into novel methods of pain phenotyping and the pathophysiology of CP pain. These discoveries have led to improvements in patient selection for optimization of outcomes for both medical and procedural management, and identification of potential future therapies.

关键词： Central sensitization Chronic pancreatitis Pain phenotyping Peripheral sensitization

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 1097-1108页

作者： Hassam Ali Faisal Inayat Vishali Moond Ahtshamullah Chaudhry Arslan Afzal Zauraiz Anjum Hamza Tahir Muhammad Sajeel Anwar Dushyant Singh Dahiya Muhammad Sohaib Afzal Gul Nawaz Amir H Sohail Muhammad Aziz department of gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States department of internal medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan department of internal medicine Saint Peter's University Hospital and Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States department of internal medicine St.Dominic's HospitalJacksonMS 39216United States department of internal medicine Rochester General HospitalRochesterNY 14621United States department of internal medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States department of internal medicine UHS Wilson Medical CenterJohnsonNY 13790United States Division of gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansasKS 66160United States department of internal medicine Louisiana State University HealthShreveportLA 71103United States department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States department of gastroenterology and hepatology The University of ToledoToledoOH 43606United States

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III *** aids in significant weight loss and improves obesity-related medical *** its effectiveness,postoperative care still has *** evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after ***,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB *** To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing *** Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of *** resultant risk scores were derived from the coefficients of statistically significant *** performance of the model was evaluated using receiver operating curves through 5-fold *** Of the 26 initial variables,six predictors were *** included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk *** risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of *** training,the same model performed satisfactorily

关键词： Roux-en-Y gastric bypass Venous thromboembolism Machine learning Bariatric surgery Predictive modeling

Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis:A propensity-matched analysis

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World Journal of Experimental medicine 2024年第2期14卷 75-88页

作者： Hassam Ali Faisal Inayat Waqas Rasheed Arslan Afzal Ahtshamullah Chaudhry Pratik Patel Attiq Ur Rehman Muhammad Sajeel Anwar Gul Nawaz Muhammad Sohaib Afzal Amir H Sohail Subanandhini Subramanium Dushyant Singh Dahiya Deepa Budh Babu P Mohan Douglas G Adler department of gastroenterology and hepatology East Carolina University Brody School of MedicineGreenvilleNC 27834United States department of internal medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan department of internal medicine Texas Tech University Health Sciences CenterLubbockTX 79430United States department of internal medicine St.Dominic’s HospitalJacksonMS 39216United States department of gastroenterology Mather Hospital and Hofstra University Zucker School of MedicinePort JeffersonNY 11777United States department of hepatology Geisinger Wyoming Valley Medical CenterWilkes-BarrePA 18711United States department of internal medicine UHS Wilson Medical CenterJohnson CityNY 13790United States department of internal medicine Louisiana State University HealthShreveportLA 71103United States department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Division of gastroenterology Hepatologyand MotilityThe University of Kansas School of MedicineKansas CityKS 64108United States department of internal medicine St.Barnabas Hospital and Albert Einstein College of MedicineBronxNY 10457United States department of gastroenterology and hepatology University of Utah School of MedicineSalt Lake CityUT 84132United States center for Advanced Therapeutic Endoscopy Porter Adventist HospitalCentura HealthDenverCO 80210United States

BACKGROUND Patients with acute pancreatitis(AP)frequently experience hospital readmissions,posing a significant burden to healthcare *** peripancreatic fluid collection(APFC)may negatively impact the clinical course of *** could worsen symptoms and potentially lead to additional ***,clinical evidence regarding the specific association between APFC and early readmission in AP remains *** the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare *** To evaluate the association between APFC and 30-day readmission in patients with *** This retrospective cohort study is based on the Nationwide Readmission Database for *** with a primary diagnosis of AP were *** were categorized into those with and without APFC.A 1:1 propensity score matching for age,gender,and Elixhauser comorbidities was *** primary outcome was early readmission *** outcomes included the incidence of inpatient complications and healthcare *** analyses used Mann-Whitney U andχ2 tests,while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios(aHR).Kaplan-Meier curves and log-rank tests verified readmission *** A total of 673059 patients with the principal diagnosis of AP were *** these,5.1%had APFC on initial *** propensity score matching,each cohort consisted of 33914 *** with APFC showed a higher incidence of inpatient complications,including septic shock(3.1%vs 1.3%,P<0.001),portal venous thrombosis(4.4%vs 0.8%,P<0.001),and mechanical ventilation(1.8%vs 0.9%,P<0.001).The length of stay(LOS)was longer for APFC patients[4(3-7)vs 3(2-5)days,P<0.001],as were hospital charges($29451 vs$24418,P<0.001).For 30-day readmissions,APFC patients had a higher rate(15.7%vs 6.5%,P<0.001)and a longer median readmission LOS(4 vs 3 days,P<0.001).The APF

关键词： Acute pancreatitis Acute peripancreatic fluid collections Readmission predictors Inpatient complications Healthcare utilization and costs

Is endoscopic ultrasound a promising technique in the diagnosis and treatment of liver diseases?

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World Journal of gastroenterology 2024年第22期30卷 2920-2922页

作者： Enver Zerem Željko Puljiz Boris Zdilar Suad Kunosic Admir Kurtcehajic Omar Zerem department of medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Sarajevo CantonBosnia and Herzegovina department of gastroenterology and hepatology University Clinical Center SplitSplit 21000Croatia department of medicine Croatian Military AcademyZagreb 10000Croatia department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina department of gastroenterology and hepatology Blue Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina department of internal medicine Cantonal Hospital“Safet Mujić”MostarMostar 88000Bosnia and Herzegovina

Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver *** some countries,its use is restricted to radiologists,limiting access for other clinicians,such as *** ultrasound,as a novel technique,plays a crucial role in diagnosis and treatment of digestive ***,its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists,leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.

关键词： Endoscopic ultrasound Percutaneous ultrasound Liver biopsy Fine needle aspiration Focal liver lesion Liver abscess drainage