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Dietary compliance in celiac disease

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World Journal of gastroenterology 2017年第15期23卷 2635-2639页

作者： Hugh James Freeman Department of Medicine (gastro-enterology) University of British Columbia

Celiac disease is an immune-mediated disorder that causes severe architectural disturbance in the small intestinal mucosa of genetically-predisposed *** absorption of multiple nutrients results and diarrhea and weight loss *** has accumulated that a strict gluten-free diet can result in resolution of diarrhea,weight gain and normalization of nutrient *** addition,histopathological changes also normalize,but this histopathological res-ponse appears to be time-dependent,sex-dependent and *** to a gluten-free diet is difficult and costly resulting in poor compliance and only a limited clinical *** poses a risk for later long-term complications,including malignancy.A major practical clinical problem is the assessment of compliance to the gluten-free *** symptoms may resolve and serological antibody markers may improve,multiple studies have documented ongoing architectural disturbance and inflammatory change,and with these continued inflammatory changes,a persistent risk for long-term *** immunological studies have suggested that peptides can be detected in both urine and fecal specimens that may be indicative of limited *** the same time,multiple biopsy studies have demonstrated that complete normalization of the mucosa may occur in some patients within 6 mo of initiation of a gluten-free diet,but more often,up to 2 years or more may be required before repeated biopsies eventually show mucosal recovery and mucosal healing.

关键词： Gluten-free diet Compliance Dietary recall Celiac disease Fecal immunoreactive peptides Tissue transglutaminase antibodies

Systematic review: Safety of balloon assisted enteroscopy in Crohn's disease

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World Journal of gastroenterology 2016年第40期22卷 8999-9011页

作者： Ahilan Arulanandan Parambir S Dulai Siddharth Singh William J Sandborn Denise Kalmaz Division of gastro-enterology University of California San Diego

AIM To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy(BAE) in Crohn's disease(CD). METHODS Systematic review(PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy(DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease *** Per procedure perforation rate of diagnostic BAE in CD was 0.15%(95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications(0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12%(95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications(0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74%(95%CI: 0.85-3.55). Eighty-six percentof therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients. CONCLUSION Diagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

关键词： Crohn’s disease Balloon Enteroscopy Safety Perforation Stricture

Restoring homeostasis of CD4^+ T cells in hepatitis-B-virusrelated liver fibrosis

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World Journal of gastroenterology 2015年第38期21卷 10721-10731页

作者： Li-Sha Cheng Yun Liu Wei Jiang Department of gastro-enterology Zhongshan HospitalFudan University

Immune-mediated liver injury is widely seen during hepatitis B virus(HBV) infection. Unsuccessful immune clearance of HBV results in chronic hepatitis and increases the risk of liver cirrhosis and hepatocellular carcinoma. HBV-related liver fibrosis(HBVLF),occurring as a result of HBV-induced chronic hepatitis,is a reversible,intermediate stage of chronic hepatitis B(CHB) and liver cirrhosis. Therefore,defining the pathogenesis of HBVLF is of practical significance for achieving better clinical outcomes. Recently,the homeostasis of CD4+ T cells was considered to be pivotal in the process of HBVLF. To better uncover the underlying mechanisms,in this review,we systematically retrospect the impacts of different CD4+T-cell subsets on CHB and HBVLF. We emphasize CD4+ T-cell homeostasis and the important balance between regulatory T(Treg) and T helper 17(Th17) cells. We discuss some cytokines associated with Treg and Th17 cells such as interleukin(IL)-17,IL-22,IL-21,IL-23,IL-10,IL-35 and IL-33,as well as surface molecules such as programmed cell death protein 1,cytotoxic T lymphocyte-associated antigen 4,T cell immunoglobulin domain and mucin domain-containing molecule 3 and cannabinoid receptor 2 that have potential therapeutic implications for the homeostasis of CD4+ T cells in CHB and HBVLF.

关键词： Homeostasis Regulatory T cells T helper 17 cells C

Update on the endoscopic treatments for achalasia

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World Journal of gastroenterology 2016年第39期22卷 8670-8683页

作者： Dushant S Uppal Andrew Y Wang Division of gastro-enterology and Hepatology University of Virginia Health System

Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. Highresolution manometry allows for definitive diagnosis and classification of achalasia, with type Ⅱ being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation(PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy(POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient's clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.

关键词： Per oral endoscopic myotomy Dilation Achalasia Treatment Endoscopy Myotomy Per oral

Removal of a large foreign body in the rectosigmoid colon by colonoscopy using gastrolith forceps

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World Journal of Clinical Cases 2016年第5期4卷 135-137页

作者： Xiao-Dong Lin Guang-Yao Wu Song-Hu Li Zong-Quan Wen Fu Zhang Shao-Ping Yu Department of gastro-enterology Dongguan Kanghua Hospital

Rectal foreign bodies are man-made injury that occurs *** management depends on its depth and the consequence it *** here report a case of rectal foreign body(a glass bottle measuring about 38 mm×75 mm)which was located 13-15 cm from the *** patient had no sign of perforation,and we managed to remove it using endoscopy with gastrolith forceps.

关键词： Foreign body Rectosigmoid Endoscopy Removal gastrolith forceps

Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer

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World Journal of gastroenterology 2015年第32期21卷 9503-9511页

作者： Yu Zhang Li-Ping Ye Xin-Li Mao Department of gastro-enterology Taizhou Hospital of Zhejiang Province Wenzhou Medical College

Minimally invasive endoscopic resection has become an increasingly popular method for patients with small(less than 3.5 cm in diameter) gastric subepithelial tumors(SETs) originating from the muscularis propria(MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.

关键词： Gastric subepithelial tumors Endoscopic treatment

Direct-acting antiviral agents against hepatitis C virus and lipid metabolism

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World Journal of gastroenterology 2017年第31期23卷 5645-5649页

作者： tatsuo kanda mitsuhiko moriyama division of gastro-enterology and hepatology department of medicine nihon university school of medicine

Hepatitis C virus (HCV) infection induces steatosis and is accompanied by multiple metabolic alterations including hyperuricemia, reversible hypocholesterolemia and insulin resistance. Total cholesterol, low-density lipoprotein-cholesterol and triglyceride levels are increased by peginterferon and ribavirin combination therapy when a sustained virologic response (SVR) is achieved in patients with HCV. Steatosis is significantly more common in patients with HCV genotype 3 but interferon-free regimens are not always effective for treating HCV genotype 3 infections. HCV infection increases fatty acid synthase levels, resulting in the accumulation of fatty acids in hepatocytes. Of note, low-density lipoprotein receptor, scavenger receptor class B type I and Niemann-Pick C1-like 1 proteins are candidate receptors that may be involved in HCV. They are also required for the uptake of cholesterol from the external environment of hepatocytes. Among HCV-infected patients with or without human immunodeficiency virus infection, changes in serum lipid profiles are observed during interferon-free treatment and after the achievement of an SVR. It is evident that HCV affects cholesterol metabolism during interferon-free regimens. Although higher SVR rates were achieved with interferon-free treatment of HCV, special attention must also be paid to unexpected adverse events based on host metabolic changes including hyperlipidemia.

关键词： Cholesterol Hepatitis C virus Interferon-free Lipid metabolism

Feasibility of initial endoscopic common bile duct stone removal in patients with acute cholangitis

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World Journal of Clinical Cases 2017年第7期5卷 280-285页

作者： Akira Yamamiya Katsuya Kitamura Yu Ishii Yuta Mitsui Tomohiro Nomoto Hitoshi Yoshida Division of gastro- enterology Department of MedicineShowa University School of Medicine

AIM To investigate the feasibility of initial endoscopic common bile duct(CBD) stone removal in patients with acute cholangitis(AC).METHODS A single-center,retrospective study was conducted between April 2013 and December 2014 and was approved by the Medical Ethics Committee at our *** informed consent was obtained from each patient prior to the *** cohort comprised 31 AC patients with CBD stones who underwent endoscopic biliary drainage(EBD) for na?ve papilla within 48 h after AC *** retrospectively divided the participants into two groups: 19 patients with initial endoscopic CBD stone removal(initial group) and 12 patients with delayed endoscopic CBD stone removal(delayed group).We evaluated the feasibility of initial endoscopic CBD stone removal in patients with *** We observed no significant differences between the groups regarding patient *** to the assessments based on the Tokyo Guidelines,the AC severity of patients with initial endoscopic CBD stone removal was mild to *** use of antithrombotic agents before EBD was less frequent in the initial group than in the delayed group(11% vs 58%,respectively; P = 0.004).All the patients underwent successful endoscopic CBD stone removaland adverse events did not differ significantly between the *** number of endoscopic retrograde cholangiopancreatography procedures was significantly lower in the initial group than in the delayed group [median(interquartile range) 1(1-1) vs 2(2-2),respectively; P < 0.001].The length of hospital stay was significantly shorter for the initial group than for the delayed group [10(9-15) vs 17(14-20),respectively; P = 0.010].CONCLUSION Initial endoscopic CBD stone removal in patients with AC may be feasible when AC severity and the use of antithrombotic agents are carefully considered.

关键词： Acute cholangitis Common bile duct stone Feasibility Initial endoscopic common bile stone removal Endoscopic retrograde cholangiopancreatography

Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment

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World Journal of gastroenterology 2017年第40期23卷 7310-7320页

作者： Asad Jehangir Henry P Parkman Department of Internal Medicine Reading Health System Department of gastro-enterology Temple University Hospital

AIM To examine the relationship of chronic scheduled opioid use on symptoms, healthcare utilization and employment in gastroparesis(Gp) patients. Methods Patients referred to our tertiary care academic center from May 2016 to July 2017, with established diagnosis or symptoms suggestive of Gp filled out the Patient Assessment of Upper GI Symptoms, abdominal pain and demographics questionnaires, and underwent gastric emptying and blood tests. They were asked about taking pain medicines and the types, doses, and duration. We used Mann Whitney U test, Analysis of Variance, Student's t test and χ2 tests where appropriate for data *** Of 223 patients with delayed gastric emptying, 158(70.9%) patients were not taking opioids(Gp NO), 22(9.9%) were taking opioids only as needed, while 43(19.3%) were on chronic(> 1 mo) scheduled opioids(Gp CO), of which 18 were taking opioids forreasons that included gastroparesis and/or stomach pain. Median morphine equivalent use was 60 mg per day. Gp CO reported higher severities of many gastrointestinal symptoms compared to Gp NO including nausea(mean ± SE of mean of 4.09 ± 0.12 vs 3.41 ± 0.12, P = 0.011), retching(2.86 ± 0.25 vs 1.98 ± 0.14, P = 0.003), vomiting(2.93 ± 0.24 vs 2.07 ± 0.15, P = 0.011), early satiety(4.17 ± 0.19 vs 3.57 ± 0.12, P = 0.004), post-prandial fullness(4.14 ± 0.18 vs 3.63 ± 0.11, P = 0.022), loss of appetite(3.64 ± 0.21 vs 3.04 ± 0.13, P = 0.039), upper abdominal pain(3.86 ± 0.20 vs 2.93 ± 0.13, P = 0.001), upper abdominal discomfort(3.74 ± 0.19 vs 3.09 ± 0.13, P = 0.031), heartburn during day(2.55 ± 0.27 vs 1.89 ± 0.13, P = 0.032), heartburn on lying down(2.76 ± 0.28 vs 1.94 ± 0.14, P = 0.008), chest discomfort during day(2.42 ± 0.20 vs 1.83 ± 0.12, P = 0.018), chest discomfort at night(2.40 ± 0.23 vs 1.61 ± 0.13, P = 0.003), regurgitation/reflux during day(2.77 ± 0.25 vs 2.18 ± 0.13, P = 0.040) and bitter/acid/sour taste in the mouth(2.79 ± 0.27 vs 2.11 ± 0.14, P = 0.028). Gp CO had a longer durati

关键词： Opioid gastroparesis Symptoms Hospitalizations Employment