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Relationship of functional gastrointestinal disorders and psychiatric disorders: Implications for treatment

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World Journal of Gastroenterology 2007年第14期13卷 2020-2027页

作者： Carol S north Barry A Hong David H Alpers department of psychiatry the university of texas southwestern medical center at dallas and north texas va health care system DallasTXUnited States department of psychiatry Washington university School of Medicine St. LouisMOUnited States department of Internal Medicine Division of Gastroenterology Washington University School of MedicineSt. LouisMOUnited States

This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome （IBS）, discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of [BS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints （fibromyalgia, temporomandibular joint syndrome）, heart （non-cardiac chest pain）, vascular （post-menopausal syndrome）, and brain （anxiety, depression）. Host IBS patients do not have psychiatric illness per se, but a range of psychoform （psychological complaints in the absence of psychiatric disorder） symptoms that accompany their somatoform （physical symptoms in the absence of medical disorder） complaints. It is not correct to label IBS patients as psychiatric patients （except those more difficult patients with true somatization disorder）. One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IB

关键词： Irritiable bowel syndrome Functionadisorders Gastrointestinal disease Somatization disorderSomatoform Psychoform Psychotropic medicationPsychotherapy Symptoms Psychiatric disorder

New Era: Endoscopic treatment options in obesity–a paradigm shift

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World Journal of Gastroenterology 2019年第32期25卷 4567-4579页

作者： Jason Glass Ahson Chaudhry Muhammad S Zeeshan Zeeshan Ramzan department of Digestive and Liver Diseases University of Texas Southwestern Medical CenterDallasTX 75390United States Division of Gastroenterology and Hepatology Department of MedicineDallas VA Medical CenterVA North Texas Health Care SystemDallasTX 75216United States School of Medicine Temple University HospitalPhiladelphiaPA 19140United States

The prevalence of obesity continues to rise,and along with it comes a multitude of health-related *** healthcare community has consistently struggled with providing treatment options to obese patients,in part due to the reluctance of patients in pursuing the more effective(yet invasive)surgical approaches such as sleeve gastrectomy and Rou-en-Y gastric *** the other hand,the less invasive approach such as lifestyle/behavioral interventions and pharmacotherapy(Orlistat,Phenteramine,Phentermine/Topiramate,Locaserin,Naltrexon/Buproprion,and Liraglutide)have very limited efficacy,especially in the morbidly obese *** our best efforts,the epidemic of obesity continues to rise and pose enormous costs on our healthcare system and *** endoscopy is an evolving field generated to combat this epidemic through minimally invasive *** procedures can be performed in an ambulatory setting,are potentially reversible,repeatable,and pose less complications than their invasive surgical *** modalities are designed to alter gut metabolism by means of space occupation,malabsorption,or *** this review we will discuss different bariatric endoscopic options(such as intragastric balloons,endoscopic sleeve gastroplasty,endoscopic aspiration therapies and gastrointestinal bypass sleeves),their advantages and disadvantages,and suggest a new paradigm where providers may start incorporating this modality in their treatment approach for obese patients.

关键词： Bariatric endoscopy Bariatrics Obesity Intragastric balloon Bariatric medicine AspireAssist Endoscopic sleeve gastroplasty

Additional risk factors associated with thrombosis and pregnancy morbidity in a unique cohort of antiphospholipid antibody-positive patients

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Chinese medical Journal 2022年第6期135卷 658-664页

作者： Chun Li Yu Zuo Song Zhang Una E.Makris David R.Karp Zhanguo Li department of Rheumatology and Immunology Peking University People's HospitalBeijing 100044China Division of Rheumatology Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA Division of Biostatistics Department of Clinical SciencesUT Southwestern Medical CenterDallasTXUSA medical Service VA North Texas Health Care SystemDallasTXUSA Division of Rheumatic Disease Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTXUSA

Background:Antiphospholipid syndrome(APS)is an autoimmune prothrombotic condition with significant *** objective of this study was to identify additional clinical and epidemiological risks of arterial thrombosis,venous thrombosis,and pregnancy morbidities in a large cohort of persistent antiphospholipid antibodies(aPLs)-positive ***:This was a cross-sectional cohort study of 453 consecutive patients with a documented positive aPL who attended Peking university People's *** 453 patients screened,297 patients had persistent positive *** compared asymptomatic aPL carriers with thrombotic and obstetric APS *** the univariate analysis and multivariable logistic regression were used to evaluate the association between different risk factors and APS clinical *** levels of circulating markers of neutrophil extracellular traps(NETs)(cell-free DNA and citrullinated histone H3[Cit-H3])were assessed and compared among aPL-positive carriers with or without autoimmune disease and APS ***:Additional risk factors associated with arterial thrombosis among aPL-positive carriers included:smoking(odds ratio[OR]=6.137,95%confidence interval[CI]=2.408-15.637,P=0.0001),hypertension(OR=2.368,95%CI=1.249-4.491,P=0.008),and the presence of underlying autoimmune disease(OR=4.401,95%CI=2.387-8.113,P<0.001).Additional risks associated with venous thrombosis among aPL carriers included:smoking(OR=4.594,95%CI=1.681-12.553,P=0.029)and the presence of underlying autoimmune disease(OR=6.330,95%CI=3.355-11.940,P<0.001).The presence of underlying autoimmune disease(OR=3.301,95%CI=1.407-7.744,P=0.006)is the additional risk,which demonstrated a significant association with APS pregnancy *** circulating levels of cell-free DNA and Cit-H3 were observed among APS patients and aPL patients with autoimmune diseases compared with those aPL carriers without underlying autoimmune ***,control neutrophils that

关键词： Antiphospholipid antibodies Antiphospholipid syndrome Arterial thrombosis Pregnancy risk Venous thrombosis

Lymphocyte-to-monocyte ratio can predict mortality in pancreatic adenocarcinoma

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第1期8卷 60-66页

作者： Gurshawn Singh Ammar Nassri David Kim Hong Zhu Zeeshan Ramzan department of Medicine Division of Gastroenterology and HepatologyUniversity of Texas Southwestern Medical Center at Dallas department of Internal Medicine University of Texas at Austin Dell Medical School department of Internal Medicine University of Texas Southwestern Medical Center at Dallas department of Clinical Science Simmons Comprehensive Cancer CenterUT Southwestern Medical Center Gastrointestinal Section Department of Internal MedicineVA North Texas Healthcare System

AIMTo determine if the lymphocyte-to-monocyte ratio (LMR) could be helpful in predicting survival in patients with pancreatic adenocarcinoma. METHODSWe retrospectively reviewed the medical records of all patients diagnosed with pancreatic adenocarcinoma in the va north texas healthcare system from January 2005 to December 2010. The LMR was calculated from peripheral blood cell counts obtained at the time of diagnosis of pancreatic cancer by dividing the absolute lymphocyte count by the absolute monocyte count. A Univariable Cox regression analysis was performed using these data, and hazard ratios (HR) and 95%CI were calculated. The median LMR (2.05) was used to dichotomize patients into high-LMR and low-LMR groups and the log rank test was used to compare survival between the two groups. RESULTSWe identified 97 patients with pancreatic adenocarcinoma (all men, 66% white, 30% African-American). The mean age and weight at diagnosis were 66.0 ± 0.9 (SEM) years and 80.4 ± 1.7 kg respectively. Mean absolute lymphocyte and monocyte values were 1.50 ± 0.07 K/μL and 0.74 ± 0.03 K/μL respectively. Mean, median and range of LMR was 2.36, 2.05 and 0.4-12 respectively. In the univariable Cox regression analysis, we found that an increased LMR was a significant indicator of improved overall survival in patients with pancreatic adenocarcinoma (HR = 0.83; 95%CI: 0.70-0.98; P = 0.027). Kaplan-Meier analysis revealed an overall median survival of 128 d (95%CI: 80-162 d). The median survival of patients in the high-LMR (> 2.05) group was significantly greater than the low-LMR group (≤ 2.05) (194 d vs 93 d; P = 0.03), validating a significant survival advantage in patients with a high LMR. CONCLUSIONThe LMR at diagnosis is a significant predictor for survival and can provide useful prognostic information in the management of patients with pancreatic adenocarcinoma.

关键词： Prognosis Lymphocyte-to-monocyte ratio Pancreatic adenocarcinoma Mortality Biomarker

Autoimmune gastritis:Pathologist's viewpoint

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World Journal of Gastroenterology 2015年第42期21卷 12179-12189页

作者： Irene Coati Matteo Fassan Fabio Farinati David Y Graham Robert M Genta Massimo Rugge department of Medicine (DIMED) Surgical Pathology Unit University of Padua department of Surgery Oncology and Gastroenterology Gastroenterology Unit University of Padua department of Medicine Veterans Administration Hospital Baylor College of Medicine Houston Miraca Life Sciences Research Institute departments of Pathology and Medicine VA North Texas Health Care System and University of Texas Southwestern Medical Center Dallas

Western countries are seeing a constant decline in the incidence of Helicobacter pylori-associated gastritis, coupled with a rising epidemiological and clinical impact of autoimmune gastritis. This latter gastropathy is due to autoimmune aggression targeting parietal cells through a complex interaction of auto-antibodies against the parietal cell proton pump and intrinsic factor, and sensitized T cells. Given the specific target of this aggression, autoimmune gastritis is typically restricted to the gastric corpus-fundus mucosa. In advanced cases, the oxyntic epithelia are replaced by atrophic(and metaplastic) mucosa, creating the phenotypic background in which both gastric neuroendocrine tumors and(intestinal-type) adenocarcinomas may develop. Despite improvements in our understanding of the phenotypic changes or cascades occurring in this autoimmune setting, no reliable biomarkers are available for identifying patients at higher risk of developing a gastric neoplasm. The standardization of autoimmune gastritis histology reports and classifications in diagnostic practice is a prerequisite for implementing definitive secondary prevention strategies based on multidisciplinary diagnostic approaches integratingendoscopy, serology, histology and molecular profiling.

关键词： Autoimmune gastritis Metaplasia Carcinoids Operati

Endoscopic balloon catheter dilatation via retrograde or static technique is safe and effective for cricopharyngeal dysfunction

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World Journal of Gastrointestinal Endoscopy 2017年第4期9卷 183-188页

作者： Vinay Chandrasekhara Joyce Koh Lakshmi Lattimer Kerry B Dunbar William J Ravich John O Clarke Division of Gastroenterology and Hepatology Department of Internal Medicinethe Johns Hopkins Medical Institutions Gastroenterology Division Department of Internal MedicineUniversity of Pennsylvania Health System Perelman center for Advanced Medicine South Pavilion Gastroenterology and Liver Diseases Depart-ment of Internal Medicinethe George Washington University Division of Gastroenterology and Hepatology Department of MedicineUniversity of Texas Southwestern Medical SchoolDallas VA Medical Center

To evaluate the safety and efficacy of upper esophageal sphincter (UES) dilatation for cricopharyngeal (CP) dysfunction. To determine if: (1) indication for dilatation; or (2) technique of dilatation correlated with symptom improvement. METHODSAll balloon dilatations performed at our institution from over a 3-year period were retrospectively analyzed for demographics, indication and dilatation site. All dilatations involving the UES underwent further review to determine efficacy, complications, and factors that predict success. Dilatation technique was separated into static (stationary balloon distention) and retrograde (brusque pull-back of a fully distended balloon across the UES). RESULTSFour hundred and eighty-eight dilatations were reviewed. Thirty-one patients were identified who underwent UES dilatation. Median age was 63 years (range 27-81) and 55% of patients were male. Indications included dysphagia (28 patients), globus sensation with evidence of UES dysfunction (2 patients) and obstruction to echocardiography probe with cricopharyngeal (CP) bar (1 patient). There was evidence of concurrent oropharyngeal dysfunction in 16 patients (52%) and a small Zenker’s diverticula (≤ 2 cm) in 7 patients (23%). Dilator size ranged from 15 mm to 20 mm. Of the 31 patients, 11 had dilatation of other esophageal segments concurrently with UES dilatation and 20 had UES dilatation alone. Follow-up was available for 24 patients for a median of 2.5 mo (interquartile range 1-10 mo), of whom 19 reported symptomatic improvement (79%). For patients undergoing UES dilatation alone, follow-up was available for 15 patients, 12 of whom reported improvement (80%). Nineteen patients underwent retrograde dilatation (84% response) while 5 patients had static dilatation (60% response); however, there was no significant difference in symptom improvement between the techniques (P = 0.5). Successful symptom resolution was also not significantly affected by dilator size, oropharyngeal dysfunc

关键词： Cricopharygeal dysfunction Cricopharyngeal bar Dysphagia Esophageal dilatation Endoscopic balloon dilation

Postcolonoscopy appendicitis in a patient with active ulcerative colitis

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World Journal of Gastrointestinal Endoscopy 2010年第6期2卷 232-234页

作者： Natalie M Bachir Linda A Feagins departments of Medicine University of Texas Southwestern Medical Center at Dallas andthe VA North Texas Health Care System

Complications due to diagnostic colonoscopy are uncommon and acute appendicitis is a very rare complication of *** poses a diagnostic challenge as the presentation of appendicitis is similar to that of other complications of colonoscopy such as perforation or postpolypectomy *** is hypothesized that postcolonoscopy appendicitis might be associated with obstruction of the appendiceal lumen with fecal matter during *** of the previous reports in the literature have described findings of appendicitis after colonoscopy in a patient with active ulcerative *** present a case of a 28 yearold man with active ulcerative colitis who underwent colonoscopy and subsequently developed acute appendicitis.

关键词： Postcolonoscopy appendicitis Ulcerative colitis Complications Colonoscopy

Contained colonic perforation due to cecal retroflexion

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World Journal of Gastroenterology 2016年第11期22卷 3285-3288页

作者： Zhuo Geng Deepak Agrawal Amit G Singal Stephen Kircher Samir Gupta department of Internal Medicine Case Western Reserve University - Metrohealth Medical Center Cleveland OH 44109 United States department of Internal Medicine Division of Digestive and Liver Diseases University of Texas Southwestern Medical Center Dallas TX 75390 United States department of Radiology University of Texas Southwestern Medical Center Dallas TX 75390 United States Veterans Affairs San Diego healthcare system San Diego CA 92161 United States department of Internal Medicine Division of Gastroenterology and the Moores Cancer Center University of California San Diego San Diego CA 92103 United States

Complications of cecal retroflexion performed during colonoscopy have not previously been reported to occur. We report a case of contained colonic perforation secondary to using cecal retroflexion technique to examine the colon, and review available published reports of complications associated with this technique. We conclude that complications may rarely occur with use of cecal retroflexion, and that the clinical benefit of this technique is uncertain.

关键词： Cecal retroflexion Colonoscopy Cecum

Pharmacotherapy for the management of achalasia: Current status, challenges and future directions

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 145-155页

作者： Ammar Nassri Zeeshan Ramzan department of Internal Medicine University of Texas at Austin Dell Medical School Gastrointestinal Section Department of Internal Medicine VA North Texas Healthcare System department of Medicine Division of Gastroen-terology and Hepatology University of Texas Southwestern Medical Center at Dallas

This article reviews currently available pharmacological options available for the treatment of achalasia, with a special focus on the role of botulinum toxin(BT) injection due to its superior therapeutic effect and side effect profile. The discussion on BT includes the role of different BT serotypes, better pharmacological formulations, improved BT injection techniques, the use of sprouting inhibitors, designer recombinant BT formulations and alternative substances used in endoscopic injections. The large body of ongoing research into achalasia and BT may provide a stronger role for BT injection as a form of minimally invasive, cost effective and efficacious form of therapy for patients with achalasia. The article also explores current issues and future research avenues that may prove beneficial in improving the efficacy of pharmacological treatment approaches in patients with achalasia.

关键词： Botulinum toxin Pharmacotherapy Botox Achalasia Sp