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gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus

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World Journal of Gastroenterology 2017年第36期23卷 6694-6704页

作者： Midori Fujishiro Akifumi Kushiyama Hiroki Yamazaki Sunao Kaneko Yuko Koketsu Takeshi Yamamotoya Takako Kikuchi Hideyuki Sakoda Ryo Suzuki Takashi Kadowaki Department of Diabetes and Metabolic diseases Graduate School of Medicine the University of Tokyo division of Diabetes and Metabolism Institute for Adult Diseases Asahi Life Foundation Department of Diabetes and Metabolic diseases Shinko Hospital Department of Medical Science Graduate School of Medicine University of Hiroshima division of Neurology Respirology Endo-crinology and Metabolism Department of Internal Medicine Faculty of Medicine University of Miyazaki

AIM To unravel relationships between gastrointestinal(GI)symptoms impairing quality of life(QOL)and clinical profiles of diabetes mellitus(DM)patients. METHODS We enrolled 134 outpatients with type 2 *** age was 64.7 years,mean body mass index was 24.7 RESULTS Lower abdominal symptoms were found to be more frequent than those affecting the upper *** duration and medications showed associations with GI *** identified differences in peak prevalences of the five ***(P=0.02vs 10-14 years)and total GI symptoms(P=0.01 and P=0.02 vs 5-9 years and 10-14 years,respectively)peaked at a diabetes duration of 15-19 ***(P=0.004)and postprandial fullness(P=0.03)tended to increase with disease *** and diarrhea showed bimodal peaks,with the first early and the second late(e.g.,P=0.03 at 15-19 years vs 10-14years for diarrhea)in the disease ***,GI symptoms showed clustering that reflected the region of the GI tract affected,i.e.,constipation and diarrhea had similar frequencies(P<0.0001). CONCLUSION Our study highlights the importance of questioning patients about QOL impairment due to abdominal symptoms,especially in the early and the late periods of diabetes.

关键词： Gastrointestinal symptoms Questionnaire survey Disease duration Type 2 diabetes Quality of life Gastrointestinal tract regions

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Genes & diseases 2016年第4期3卷 252-256页

作者： Le Min division of Endocrinology Diabetes and HypertensionBrigham and Women’s Hospital221 Longwood AvenueBostonMA02115USA

Immune checkpoint inhibition against advance malignancies was named breakthrough discovery by the science magazine in *** numerous clinical studies,monoclonal antibodies against the immune checkpoints,CTLA4,PD1 and PD1 ligand PDL1 have shown promising tumor response in different type of metastatic *** adverse events are *** endocrine disorders,hypophysitis and thyroiditis are among the most common side effects associated with immune checkpoint inhibition ***,a very rare endocrine disorder occurs in about one tenth of the patients receiving anti-CTLA4 ***,on the other hand,is more commonly seen in patients receiving anti-PD1 *** addition,both thyroiditis and hypophysitis are common in patients receiving combination treatment with anti-CTLA4 and anti-PD1 *** time to onset of hypophysitis and thyroiditis is *** of the endocrine disorders occur within 12 weeks after initiation of the immune checkpoint inhibition *** can manifest as total anterior pituitary hormone deficiency or isolated pituitary hormone *** insipidus is *** and gonadotropin deficiencies may be reversible but ACTH deficiency appears *** can present as hypothyroidism or thyrotoxicosis followed by *** appears *** identifying the onset of hypophysitis and thyroiditis and proper management of these endocrine disorders will improve the quality of the life and the outcome of this novel immunotherapy.

关键词： Cancer Hypophysitis Immune checkpoint inhibition Immune-related adverse events Thyroiditis

Comparison of hepatitis C virus testing recommendations in high-income countries

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World Journal of Hepatology 2018年第10期10卷 743-751页

作者： Risha Irvin Kathleen Ward Tracy Agee Noele P Nelson Claudia Vellozzi David L Thomas Alexander J Millman division of Infectious diseases Johns Hopkins University School of Medicine division of Viral Hepatitis Centers for Disease Control and Prevention

AIM To investigate hepatitis C virus(HCV) testing recommendations from the United States and other high-income *** A comprehensive search for current HCV testing recommendations from the top quartile of United Nations Human Development Index(HDI) countries(very high HDI) was performed using Google and reviewed from May 1-October 30, 2014 and re-reviewed April 1-October 2, 2017. RESULTS Of the 51 countries identified, 16 had HCV testing recom-mendations from a government body or recommendations issued collaboratively between a government and a medical organization. Of these 16 countries, 15 had HCV testing recommendations that were primarily risk-based and highlight behaviors, exposures, and conditions that are associated with HCV transmission in that region. In addition to risk-based testing, the HCV Guidance Panel(United States) incorporates recommendations for aone-time test for individuals born during 1945-1965(the birth cohort) without prior ascertainment of risk into their guidance. In addition to the United States, six other countries either have an age-based testing recommendation or recommend one-time testing for all adults independent of risk factors typical of the region. CONCLUSION This review affirmed the similarities of the HCV Guidance Panel's guidance with those of recommendations from very high HDI countries.

关键词： Hepatitis C Testing Recommendations Mass screening Guidelines

Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective

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World Journal of Gastroenterology 2016年第34期22卷 7742-7747页

作者： Marco Fiore Sebastiano Leone Department of Anesthesiological Surgical and Emergency SciencesSecond University of Naples division of Infectious diseases "San Giuseppe Moscati" Hospital

Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients,not even the antifungals used for the prophylaxis,neither optimal treatment. We reviewed,in order to focus the epidemiology,characteristics,and,considering the high mortality rate of SFP,the use of optimal empirical antifungal therapy the current literature.

关键词： Cirrhosis Critically ill patient Spontaneous fungal peritonitis Life-threatening infections Fungal ascitis Nosocomial spontaneous peritonitis

Viral hepatitis:Innovations and expectations

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World Journal of Gastroenterology 2022年第5期28卷 517-531页

作者： Simona Leoni Alberto Casabianca Benedetta Biagioni Ilaria Serio division of Internal Medicine Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

Viral hepatitis is a significant health problem worldwide,associated with morbidity and *** B,C,D,and occasionally E viruses(HBV,HCV,HDV,and HEV)can evolve in chronic infections,whereas hepatitis A virus(HAV)frequently produces acute self-limiting *** the last years,different studies have been performed to introduce new antiviral *** most important goal in the treatment of viral hepatitis is to avoid chronic liver disease and *** review analyzes currently available therapies,in particular for viruses associated with chronic liver *** focus is especially on HBV and HCV therapies,investigating new drugs already introduced in clinical practice and clinical *** also describe new entry inhibitors,developed for the treatment of chronic HDV and HBV and currently available treatments for *** last drugs introduced have shown important efficacy in HCV,with achievable target HCV elimination by ***,renewed interest in curative HBV therapies has been registered;current nucleotide/nucleoside analogs positively impact liver-related complications,ensuring high safety and *** approaches to HBV cure are based on new antivirals,targeting different steps of the HBV life cycle and immune *** improved knowledge of the HDV life cycle has facilitated the development of some direct-acting agents,as bulevirtide,the first drug conditionally approved in Europe for HDV associated compensated liver *** studies are required to identify a new therapeutic approach in hepatitis E,especially in immunosuppressed patients.

关键词： Viral hepatitis Chronic liver disease Treatments Antiviral Immunotherapy Vaccination

Current guidelines for the management of celiac disease:A systematic review with comparative analysis

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World Journal of Gastroenterology 2022年第1期28卷 154-175页

作者： Alberto Raiteri Alessandro Granito Alice Giamperoli Teresa Catenaro Giulia Negrini Francesco Tovoli division of Internal Medicine Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

BACKGROUND Wheat and other gluten-containing grains are widely consumed,providing approximately 50%of the caloric intake in both industrialised and developing *** widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease *** condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global ***,in recent years,the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease(CD)from obscurity to global *** modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of *** scientific societies,mainly from Europe and America,have proposed guidelines based on CD's most recent *** To identify the most recent scientific guidelines on CD,aiming to find and critically analyse the main *** We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English *** was lastly accessed on 1 March *** We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical *** were noted in the possibility of a no-biopsy diagnosis,HLA testing,follow-up protocols,and *** We found a relatively high concordance between the guidelines for *** modifications have occurred in the last years,especially about the possibility of a no-biopsy diagnosis in *** modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.

关键词： Celiac disease Gluten Gluten-free diet Gluten sensitivity Clinical guidelines Non-invasive diagnosis Histopathological findings Serological markers Genetics

Liver fibrosis in non-alcoholic fatty liver disease-diagnostic challenge with prognostic significance

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World Journal of Gastroenterology 2015年第39期21卷 11077-11087页

作者： Per Stal division of Gastroenterology and Hepatology Karolinska InstitutetDepartment of Digestive DiseasesHuddinge K63Karolinska University Hospital

Non-alcoholic fatty liver disease(NAFLD) is the mostcommon liver disease in the Western world, with a prevalence of 20%. In a subgroup of patients, inflammation, ballooning degeneration of hepatocytes and a varying degree of fibrosis may develop, a condition named non-alcoholic steatohepatitis. Advanced liver fibrosis(stage F3) and cirrhosis(stage F4) are histologic features that most accurately predict increased mortality in both liver-related and cardiovascular diseases. Patients with advanced fibrosis or cirrhosis are at risk for complications such as hepatocellular carcinoma and esophageal varices and should therefore be included in surveillance programs. However, liver disease and fibrosis are often unrecognized in patients with NAFLD, possibly leading to a delayed diagnosis of complications. The early diagnosis of advanced fibrosis in NAFLD is therefore crucial, and it can be accomplished using serum biomarkers(e.g., the NAFLD Fibrosis Score, Fib-4 Index or BARD) or non-invasive imaging techniques(transient elastography or acoustic radiation force impulse imaging). The screening of risk groups, such as patients with obesity and/or type 2 diabetes mellitus, for NAFLD development with these non-invasive methods may detect advanced fibrosis at an early stage. Additionally, patients with a low risk for advanced fibrosis can be identified, and the need for liver biopsies can be minimized. This review focuses on the diagnostic challenge and prognostic impact of advanced liver fibrosis in NAFLD.

关键词： Non-alcoholic fatty liver disease Fibrosis Mortality Biomarkers Elastography

Molecular prognostic prediction in liver cirrhosis

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World Journal of Gastroenterology 2015年第36期21卷 10262-10273页

作者： Nicolas Goossens Shigeki Nakagawa Yujin Hoshida division of Liver diseases Department of MedicineLiver Cancer ProgramTisch Cancer InstituteIcahn School of Medicine at Mount Sinai division of Gastroenterology and Hepatology Geneva University Hospital

The natural history of cirrhosis varies and therefore prognostic prediction is critical given the sizable patient population. A variety of clinical prognostic indicators have been developed and enable patient risk stratification although their performance is somewhat limited especially within relatively earlier stage of disease. Molecular prognostic indicators are expected to refine the prediction,and potentially link a subset of patients with molecular targeted interventions that counteract poor prognosis. Here we overview clinical and molecular prognostic indicators in the literature,and discuss critical issues to successfully define,evaluate,and deploy prognostic indicators as clinical scores or tests. The use of liver biopsy has been diminishing due to sampling variability on fibrosis assessment and emergence of imaging- or lab testbased fibrosis assessment methods. However,recent rapid developments of genomics technologies and selective molecular targeted agents has highlighted the need for biopsy tissue specimen to explore and establish molecular information-guided personalized/stratified clinical care,and eventually achieve "precision medicine".

关键词： Cirrhosis Gene expression Prognosis Hepatocellular

Endoscopic retrograde cholangiopancreatography with ampullary biopsy vs ERCP alone:a matched-pairs controlled evaluation of outcomes and complications

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Gastroenterology Report 2017年第4期5卷 277-281,I0002页

作者： Sunil Dacha Saurabh Chawla Jai Eun Lee Steven A.Keilin Qiang Cai Field F.Willingham Department of Medicine Division of Digestive DiseasesEmory University School of MedicineAtlantaGAUSA Department of Medicine Division of GastroenterologyGeorgia Regents UniversityAugustaGAUSA

Background and aims:Biopsy of the ampulla of Vatermay be performed to evaluate for ampullary adenomas,suspected ampullary tumors and immunohistological staining for autoimmune *** biopsies are commonly performed at the time of endoscopic retrograde cholangiopancreatography(ERCP).Due to the well-established complication rate following ERCP,the contribution of ampullary biopsy as a potential independent risk factor would require a controlled ***:A matched-pairs,case-control analysis was performed for patients undergoing ERCP with or without ampullary *** analysis involved a retrospective review of adult patients at a tertiary-care center who underwent ampullary biopsies during ERCP compared(via procedural complexity)with a matched control group who underwent ERCP without ampullary ***:Of 159 procedures involving ampullary biopsy,54 ERCPs that met the inclusion criteria were performed with ampullary biopsy and included in the analysis *** cohort was compared with 54 patients undergoing ERCP without ampullary biopsy,matched by American Society for Gastrointestinal Endoscopy(ASGE)grade of procedural *** were no patients with sphincter of Oddi *** biopsies suggested a diagnosis in 75.9% of the procedures including 12 adenomas,5 adenocarcinomas and 1 intraductal papillary mucinous *** major and minor complications,the overall complication rate with biopsy(9.3%)was equivalent to the complication rate in the control group without ampullary biopsy(9.3%,P>0.99).The incidence of post-procedure pancreatitis was not significantly different between the two groups(5.6% vs 3.7%,P=0.6).Age and pancreatic duct manipulation,but not ampullary biopsy,were associated with complications on multivariate analysis in the study ***:Ampullary biopsy performed during ERCP had a high diagnostic yield and was not associated with an increased rate of post-procedure complica

关键词： endoscopic retrograde cholangiopancreatography ampullary biopsy complications