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Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture

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World Journal of Gastroenterology 2017年第6期23卷 1044-1050页

作者： Dirk Walter Sylvia Hartmann Eva Herrmann Jan Peveling-Oberhag Wolf O Bechstein Stefan Zeuzem Martin-Leo Hansmann Mireen Friedrich-Rust Jorg G Albert department of internal medicine I Johann Wolfgang Goethe-University Hospital Dr.Senckenberg Institute for Pathology Johann Wolfgang Goethe-University Hospital Institute of Biostatistics and Mathematical Modeling Johann Wolfgang Goethe-University Hospital department for Gastroenterology Hepatology and EndocrinologyRobert-Bosch Hospital department of General and Visceral Surgery Johann Wolfgang Goethe-University Hospital

To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).METHODSAll patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at university hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing *** hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).CONCLUSIONEC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.

关键词： Indeterminate biliary stricture endoscopy endoscopic retrograde cholangiopancreatography eosinophilic cholangitis bile duct stenosis IgG4-related disease primary sclerosing cholangitis

Fecal tumor M2 pyruvate kinase is not a specific biomarker for colorectal cancer screening

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World Journal of Gastroenterology 2007年第19期13卷 2768-2769页

作者： Yogesh M Shastri Jürgen M Stein department of medicine I-ZAFES Division of Gastroenterology and Clinical Nutrition Johann Wolfgang Goethe-University Hospital Frankfurt am Main Germany

TO THE EDITORWe read with great interest and a bit of surprise the article by Tonus et al. We would share herein our comments about it. The specificity of the fecal tumor M2 pyruvate kinase 0VI2-PK） reported by Tonus et al for diagnosing colorectal cancer （CRC） is 93%. This is considerably higher than in any of the previously published studies. In our work, the maximum specificity of fecal M2- PK is 78% （Table 1）. There is a vast difference of 15% between the previous studies and the current study of Tonus et al, which is difficult to explain. We are skeptical about such a high specificity reported by the authors.

关键词： Gastroenterology

Transarterial administration of integrin inhibitor loaded nanoparticles combined with transarterial chemoembolization for treating hepatocellular carcinoma in a rat model

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World Journal of Gastroenterology 2016年第21期22卷 5042-5049页

作者： Jun Qian Elsie Oppermann Andreas Tran Ulli Imlau Kun Qian Thomas Josef Vogl department of Radiology Union Hospital Huazhong University of Science and Technology Institute for Diagnostic and Interventional Radiology Johann Wolfgang Goethe University

AIM: To compare the effect of transarterial chemoembolization(TACE) plus GRGDSP(Gly-Arg-Gly-Asp-SerPro, integrin-inhibitor) loaded nanoparticles with TACE alone or TACE + GRGDSP in a rat model of liver tumor. METHODS: Morris hepatoma 3924 A tumors were implanted in the livers of 30 ACI rats. The ACI rats were divided randomly into three groups(10 animals each). Tumor volume before treatment(V1) was examined by magnetic resonance imaging(MRI), and then, after laparotomy and placement of a PE-10 catheter into the hepatic artery, the following interventional protocols were performed: TACE(mitomycin C + lipiodol + degradable starch microspheres) + GRGDSP loaded nanoparticles for group A; TACE + GRGDSP for group B(control group 1); TACE alone for group C(control group 2). Tumor volume(V2) was assessed by MRI and the mean ratio of the post-treatment to pretreatment tumor volumes(V2/V1) was calculated. Immunohistochemical analysis was performed to assess the quantification of matrix metalloprotein 9(MMP-9) and vascular endothelial growth factor(VEGF) positive tumor cells in each treatment ***: The mean tumor growth ratios(V2/V1) were 1.3649 ± 0.1194 in group A, 2.0770 ± 0.1595 in group B, and 3.2148 ± 0.1075 in group C. Compared with groups B and C, group A showed a significant reduction in tumor volume. Lower expression of MMP-9 and VEGF in hepatocellular carcinoma was observed in group A than in groups B and C. The angiogenesis of tumor was evaluated using anti-VEGF antibodies, and the metastasis of tumor was assessed using antiMMP-9 antibody. MMP-9 and VEGF were expressed in all specimens. The immunoexpression of these proteins was confirmed by the presence of red cytoplasmic staining in tumor cells. Lower expression of MMP-9 and VEGF in hepatocellular carcinoma was observed in group A than in groups B and ***: Transarterial administration of integrin inhibitor loaded nanoparticles combined with TACE evidently retards tumor growth and intrahepatic met

关键词： Hepatocellular carcinoma Transarterial chemoembolization Integrin inhibitor Nanoparticles Matrix metalloprotein 9 Vascular endothelial growth factor ACI rats

Gastroenteric tube feeding: Techniques, problems and solutions

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World Journal of Gastroenterology 2014年第26期20卷 8505-8524页

作者： Irina Blumenstein Yogesh M Shastri Jürgen Stein department of Gastroenterology and Clinical Nutrition Johann Wolfgang Goethe University Clinic Gastroenterology and Clinical Nutrition Hospital Sachsenhausen Crohn Colitis Clinical Research Center RheinMain

Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ***,despite the benefits and widespread use of enteral tube feeding,some patients experience *** review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding,together with associated complications and special *** conducted an extensive literature search on PubMed,Embase and Medline using index terms relating to enteral access,enteral feeding/nutrition,tube feeding,percutaneous endoscopic gastrostomy/jejunostomy,endoscopic nasoenteric tube,nasogastric tube,and refeeding *** literature showed common routes of enteral access to include nasoenteral tube,gastrostomy and jejunostomy,while complications fall into four major categories:mechanical,e.g.,tube blockage or removal;gastrointestinal,e.g.,diarrhea;infectious e.g.,aspiration pneumonia,tube site infection;and metabolic,e.g.,refeeding syndrome,*** the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route,gastrointestinal complications are without doubt the most *** associated with enteral tube feeding can be reduced by careful observance of guidelines,including those related to food composition,administration rate,portion size,food temperature and patient supervision.

关键词： Enteral tube feeding Percutaneous endoscopic gastrostomy Refeeding syndrome Enteral nutrition Buried bumper syndrome Nasoenteral tubes Colocutaneous fistulae

Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI

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World Journal of Gastroenterology 2006年第11期12卷 1699-1705页

作者： Christoph F Dietrich wolfgang Kratzer Deike Strobel Etienne Danse Robert Fessl Alfred Bunk Udo Vossas Karlheinz Hauenstein Wilhelm Koch wolfgang Blank Matthijs Oudkerk Dietbert Hahn Christian Greis department of internal medicine ⅱ johann wolfgang goethe university hospital 60590 FrankfurtGermany department of internal medicine Ⅰ university hospital Ulm 89070Germany Medical Clinic Ⅰ university hospital Erlangen 91054Germany department of Radiology university hospital St.Luc Brussels 1200Belgium department of Radiology Central hospital Augsburg 86156Germany department for Visceral Thoracic and Vascular Surgery University HospitalDresden 01307Germany department of Radiology Marien hospital DUsseldorf 40479Germany department of Radiology university hospital Rostock 18055Germany Medical Clinic Ⅱ Leopoldina hospital Schweinfurt 97422Germany department of internal medicine hospital am Steinenberg Reutlingen 72764Germany department of Radiology university hospital Groningen 9700Netherlands department of Radiology university hospital Würzburg 97080Germany Clinical Research Bracco Altana Pharma Konstanz 78467Germany

AIM： To evaluate contrast-enhanced ultrasonography （CEUS） using SonoVue in the detection of liver metastases in patients with known extrahepatic primary tumors versus the combined gold standard comprising CT, MRI and clinical/histological data. METHODS： It is an international multicenter study, and there were 12 centres and 125 patients （64 males, 61 females, aged 59 ± 11 years） involved, with 102 patients per protocol. Primary tumors were colorectal in 35%, breast in 27%, pancreatic in 17% and others in 21%. CEUS using SonoVue was employed with a Iow-mechanical-index technique and contrast-specific software using Siemens Elegra, Philips HDI 5000 and Acuson Sequoia; continuous scanning for at least five minutes. RESULTS： CEUS with SonoVue increased significantly the number of focal liver lesions detected versus unenhanced sonography. In 31.4% of the patients, more lesions were found after contrast enhancement. The total numbers of lesions detected were comparable with CEUS （55）, triple-phase spiral CT （61） and HRI with a liverspecific contrast agent （53）. Accuracy of detection of metastatic disease （i.e. at least one metastatic lesion） was significantly higher for CEUS （91.2%） than for unenhanced sonography （81.4%） and was similar to that of triple-phase spiral CT （89.2 %）. In 53 patients whose CEUS examination was negative, a follow-up examination 3-6 months later confirmed the absence of metastatic lesions in 50 patients （94.4%）. CONCLUSION： CEUS is proved to be reliable in the detection of liver metastases in patients with known extrahepatic primary tumors and suspected liver lesions.

关键词： CT MRI Metastasis Detection SonoVue

Differential changes in intrinsic innervation and interstitial cells of Cajal in small bowel atresia in newborns

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World Journal of Gastroenterology 2010年第45期16卷 5716-5721页

作者： Stefan Gfroerer Roman Metzger Henning Fiegel Priya Ramachandran Udo Rolle department of Paediatric Surgery Johann Wolfgang Goethe-University Frankfurt/MTheodor-Stern-Kai 760590 Frankfurt/MGermany department of Paediatric Surgery University of Leipzig04103 LeipzigGermany department of Pediatric Surgery Kanchi Kamakoti Childs Trust Hospital12-A ChennaiIndia

AIM: To investigate morphological changes of the enteric nervous system (ENS) and the interstitial cells of Cajal (ICCs) in small bowel ***: Resected small bowel specimens from affected patients (n = 7) were divided into three parts (proximal, atretic, distal). Standard histology and enzyme immunohistochemistry anti-S100, anti-protein gene product (PGP) 9.5, anti-neurofilament (NF), antic-kit-receptor (CD117) was carried out on conventional paraffin sections of the proximal and distal part. RESULTS: The neuronal and glial markers (PGP 9.5, NF, S-100) were expressed in hypertrophied ganglia and nerve fibres within the myenteric and submucosal plexuses. Furthermore, the submucous plexus contained typical giant ganglia. The innervation pattern of the proximal bowel resembled intestinal neuronal dysplasia. The density of myenteric ICCs was clearly reduced in the proximal bowel, whereas a moderate number of muscular ICCs were found. The anti-CD117 immunore- action revealed additional numerous mast cells. The distal bowel demonstrated normal morphology and density of the ENS, the ICCs and the mast ***: The proximal and distal bowel in small bowel atresia revealed clear changes in morphology and density of the ENS and ICCs.

关键词： Small bowel atresia Enteric nervous system Gastrointestinal motility Interstitial cells of Cajal

Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification

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World Journal of Gastroenterology 2021年第40期27卷 6939-6950页

作者： Jasmin Schuhbaur Melissa Schweizer Jana Philipp Julian Schmidberger Patrycja Schlingeloff wolfgang Kratzer department of internal medicine I University Hospital UlmUlm 89081Germany

BACKGROUND When Echinococcus multilocularis infects humans as a false intermediate host,alveolar echinococcosis(AE)usually manifests primarily intrahepatically and is initially *** the disease remains undiagnosed and untreated,progressive growth occurs,reminiscent of malignant *** only curative therapy is complete resection,which is limited to localised stages,and palliative drug therapy is used ***,early diagnosis and reliable detection of AE lesions are *** this reason,abdominal ultrasonography,as the most common primary imaging for AE,relies on classification *** To investigate how hepatic AE lesion sonomorphology changes over time in the Echinococcosis Multilocularis Ulm Classification(EMUC)-ultrasound(US)*** Based on data from Germany’s national echinococcosis database,we evaluated clinical and US imaging data for 59 patients according to the AE case definition in our preliminary retrospective longitudinal *** had to be at least two liver sonographies≥6 mo apart,≥1 hepatic AE lesion,and complete documentation in all US *** minimum interval between two separately evaluated US examinations was 4 *** AE reference lesion was the largest hepatic AE lesion at the time of the first US *** classify the sonomorphologic pattern,we used *** addition to classifying the findings of the original US examiner,all reference lesions at each examination time point were assigned EMUC-US patterns in a blinded fashion by two investigators experienced in US *** analysis was performed using SAS version 9.4(SAS Institute Inc.,Cary,NC,United Stated).P values<0.05 were considered statistically *** The preliminary study included 59 patients,38(64.5%)women and 21(35.6%)*** mean age at initial diagnosis was 59.9±16.9 *** the time of initial ultrasonography,a hailstorm pattern was present in 42.4%(25/59)of cases,a hemangioma-like pat

关键词： Alveolar echinococcosis Echinococcus multilocularis Ultrasonography Sonomorphology Pattern change

Intestinal-borne dermatoses significantly improved by oral application of Escherichia coli Nissle 1917

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World Journal of Gastroenterology 2016年第23期22卷 5415-5421页

作者： Elina Manzhalii Daniel Hornuss wolfgang Stremmel department of Propedeutics of internal medicine 2 Bogomolets National Medical University department of Gastroenterology University Hospital of Heidelberg

AIM: To evaluate the effect of oral Escherichia coli (E. coli) Nissle application on the outcome of intestinal-borne ***: In a randomized, controlled, non-blinded prospective clinical trial 82 patients with intestinal-borne facial dermatoses characterized by an erythematous papular-pustular rash were screened. At the initiation visit 37 patients entered the experimental arm and 20 patients constituted the control arm. All 57 patients were treated with a vegetarian diet and conventional topical therapy of the dermatoses with ointments containing tetracycline, steroids and retinoids. In the experimental arm patients received a one month therapy with oral E. coli Nissle at a maintenance dose of 2 capsules daily. The experimental group was compared to a non-treatment group only receiving the diet and topical therapy. The primary outcome parameter was improvement of the dermatoses, secondary parameters included life quality and adverse events. In addition the immunological reaction profile (IgA, interleucin-8 and interferon-α) was determined. Furthermore the changes of stool consistency and the microbiota composition over the time of intervention were ***: Eighty-nine percent of the patients with acne, papular-pustular rosacea and seborrhoic dermatitis responded to E. coli Nissle therapy with significant amelioration or complete recovery in contrast to 56% in the control arm (P 107 CFU/g stool) was observed in 79% and 63%

关键词： Intestinal-borne dermatoses Escherichia coli Nissle 1917 Immunological response IgA Interleukin-8 Interferon-α Gut microbiota

Successful combination of direct antiviral agents in livertransplanted patients with recurrent hepatitis C virus

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World Journal of Gastroenterology 2018年第12期24卷 1353-1360页

作者： Christian Rupp Theresa Hippchen Manuel Neuberger Peter Sauer Jan Pfeiffenberger wolfgang Stremmel Daniel Nils Gotthardt Arianeb Mehrabi Karl-Heinz Weiss department of internal medicine IV University Hospital of Heidelberg Interdisciplinary Endoscopy Unit University Hospital of Heidelberg department of General Visceral and Trans- plantation Surgery University Hospital of Heidelberg

AIM To analyze the safety and efficiency of direct-actingantiviral(DAA) regimens in liver-transplanted patients with hepatitis C virus(HCV) *** Between January 2014 and December 2016, 39 patients with HCV reinfection after liver transplantation were treated at our tertiary referral center with sofosbuvir(SOF)-based regimens, including various combinations with interferon(IFN), daclatasvir(DAC), simeprivir(SIM) and/or ledipasvir(LDV). Thirteen patients were treated with SOF + IFN ± RBV. Ten patients were treated with SOF + DAC ± RBV. Fiveteen patients were treated with fixed-dose combination of SOF + LDV ± RBV. One patient was treated with SOF + SIM + RBV. Three patients with relapse were retreated with SOF + LDV + RBV. The treatment duration was 12-24 wk in all cases. The decision about the HCV treatment was made by specialists at our transplant center, according to current available or recommended *** The majority of patients were IFN-experienced(29/39, 74.4%) and had a history of hepatocellular carcinoma(26/39, 66.7%) before liver transplantation. Sustained virological response at 12 wk(SVR12) was achieved in 10/13(76.9%) of patients treated with SOF + IFN ± RBV. All patients with relapse were treated with fixed-dose combination of SOF + LDV + RBV. Patients treated with SOF + DAC + RBV or SOF + LDV + RBV achieved 100% SVR12. SVR rates after combination treatment with inhibitors of the HCV nonstructural protein(NS)5 A and NS5 B for 24 wk were significantly higher, as compared to all other therapy regimens(P = 0.007). Liver function was stable or even improved in the majority of patients during treatment. All antiviral therapies were safe and well-tolerated, without need of discontinuation of treatment or dose adjustment of immunosuppression. No serious adverse events or any harm to the liver graft became overt. No patient experienced acute cellular rejection during the study period. CONCLUSION Our cohort of liver-transplanted patient

关键词： Hepatitis C virus Recurrence Direct acting antivirals Liver transplantation Sustained virological response