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Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease

World Journal of gastroenterology 2006年第31期12卷 5028-5032页

作者： S Riestra F Domínguez E Fernández-Ruiz E García-Riesco R Nieto E Fernández L Rodrigo gastroenterology section and gastroenterology servicehospital central de asturias Spain gastroenterology section and Pathology servicehospital Valle del Nalón Spain gastroenterology section and Biochemistry servicehospital de Cabuenes Spain

AIM： To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS： A 15 year-trend （1990 to 2004） in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS： Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies （7.6%）; an increase in the use of such was observed over the study period （1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004）. Celiac disease was diagnosed in 22 patients （2.2%）, this being more frequent in women than in men （3% and 1% respectively）. Fourteen out of 514 （2.7%） patients with anaemia, 12 out of 141 （8.5%） with chronic diarrhoea and 8 out of 42 （19%） with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION： Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

关键词： Duodenal biopsy Upper gastrointestinal endoscopy Celiac disease Anemia Chronic diarrhea

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Liver parasites:A global endemic and journey from infestation to intervention

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World Journal of gastroenterology 2025年第1期31卷 8-15页

作者： Yumna Shahid Bushra Emman Shahab Abid department of Medicine Section of GastroenterologyAga Khan University HospitalKarachi 75500SindhPakistan Aga Khan Medical College Aga Khan University HospitalKarachi 75500SindhPakistan

Parasites have coexisted with humans throughout history,forming either symbiotic relationships or causing significant morbidity and *** liver is particularly vulnerable to parasitic infections,which can reside in,pass through,or be transported to the liver,leading to severe *** editorial explores various parasites that infect the liver,their clinical implications,and diagnostic considerations,as discussed in the article“Parasites of the liver:A global problem?”.Parasites reach the liver primarily through oral ingestion,mucosal penetration,or the bloodstream,with some larvae even penetrating the *** parasites such as cestodes(Echinococcus),trematodes(Clonorchis,Opisthorchis),nematodes(Ascaris),and protozoa(Entamoeba histolytica)can also cause systemic infections like visceral leishmaniasis,malaria,cryptosporidiosis,and *** infections like clonorchiasis and opisthorchiasis are linked to persistent hepatobiliary inflammation,potentially progressing to cholangiocarcinoma,a fatal bile duct cancer,particularly prevalent in Southeast *** global nature of liver parasite infestations is alarming,with hundreds of millions affected ***,control over treatment quality remains *** the significant public health threat posed by these parasites,international medical organizations must prioritize improved diagnosis,treatment,and preventive *** educational efforts and enhancing healthcare provider training are critical steps toward mitigating the global impact of parasitic liver diseases.

关键词： Liver flukes Nematodes Cestodes Trematodes Protozoa Parasites

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Endoscopic ultrasonographic appearance of gastric emphysema

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World Journal of gastroenterology 2005年第11期11卷 1719-1721页

作者： Maw-Soan Soon Hsu-Heng Yen Anny Soon Otto S Lin department of gastroenterology gastroenterology section

Emphysematous gastritis (or phlegmonous gastritis) and gastric emphysema (or gastric pneumatosis) are variations of conditions associated with the presence of intramural air in the stomach. The presence of air in the gastric wall is a very rare clinical condition, associated with bacterial infection, increased intragastric pressure from gastric outlet obstruction, gastric mucosal disruption or air dissection from the mediastinum. In adults, this can occur in the setting of instrumentation-related injury, gastric outlet obstruction by gastric, duodenal or pancreatic malignancies or bowel ischemia. Here we describe a case of gastric emphysema related to repeated biliary stenting and partial duodenal obstruction in a patient with inoperable periampullary cancer, and provide the first description of the endoscopic ultrasonographic findings of gastric emphysema in the literature. In our case, endoscopic ultrasound showed a band of bright echogenicity arising from the submucosa layer, representing air in the gastric wall.

关键词： Endoscopic ultrasound Gastric emphysema Gastric pneumatosis

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Prevalence of non-Helicobacter pylori duodenal ulcer in Karachi,Pakistan

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World Journal of gastroenterology 2005年第23期11卷 3562-3565页

作者： Javed Yakoob Wasim Jafri Nadim Jafri Muhammad Islam Shahab Abid Saeed Hamid Hasnain AliShah Hizbullah Shaikh section of gastroenterology

AIM:To determine the prevalence of non-Helicobacter pylori (H pylori)-related duodenal ulcer in patients with acid-peptic diseases. METHODS: Medical records of patients who attended the gastroenterology department at Aga Khan University Hospital from 1999 to 2001 and had endoscopic diagnosis of duodenal ulcers were reviewed. Duodenal ulcer associated with H pylori was diagnosed on the basis of endoscopy, rapid urease test and histopathology whereas histories of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) related duodenal ulcers. Non-H pylori, non-NSAID duodenal ulcers were those without H pylori infection and history of NSAID intake. Co-morbid conditions associated were noted. RESULTS: Of 2 260 patients, 10% (217/2 260) had duodenal ulcer. Duodenal ulcer related to H pylori infection accounted for 53% (116/217), NSAID-related 10% (22/217), non-H pylori non-NSAID 29% (62/217), and 8% (17/217) had both H pylori infection and histories of NSAID intake. Fifteen percent (18/116)_patients had past histories of peptic ulcer disease in H pylori infection, while 8% (5/62) in non-H pylori non-NSAID ulcer. Co-morbid conditions in H pylori infection were seen in 23% (27/116) and 34% (21/62) in non-H pylori non-NSAID ulcer. CONCLUSION: Incidence of H pylori infection related with duodenai ulcer is common. In the presence of co-morbids, non-H pylori and non-NSAID duodenal ulcer is likely to be present.

关键词： H pylori Acid-peptic diseases

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Duodenal biopsy may be avoided when high transglutaminase antibody titers are present

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World Journal of gastroenterology 2009年第38期15卷 4775-4780页

作者： Santiago Vivas Jose G Ruiz de Morales Sabino Riestra Laura Arias Dolores Fuentes Noemi Alvarez Sara Calleja Mercedes Hernando Blanca Herrero Javier Casqueiro Luis Rodrigo department of gastroenterology Hospital de León Institute of Biomedicine University of León Immunology section Hospital de León department of gastroenterology Hospital Universitario Central de Asturias department of Pathology Hospital de León department of Pediatrics Hospital de León Faculty of Biology and Environmental Sciences University of León

AIM:To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be ***: A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG ***: Adults showed less severe histopathology (26% vs 63%, Pdependent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after ***: Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.

关键词： Biopsy Celiac disease Diagnosis Duodenum Transglutaminases

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Irritable bowel syndrome:Diagnosis and pathogenesis

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World Journal of gastroenterology 2012年第37期18卷 5151-5163页

作者： Magdy El-Salhy section for gastroenterology Department of MedicineStord Helse-Fonna Hospital section for gastroenterology Institute of MedicineUniversity of Bergen

Irritable bowel syndrome (IBS) is a common gastro-intestinal (GI) disorder that considerably reduces the quality of life. It further represents an economic burden on society due to the high consumption of healthcare resources and the non-productivity of IBS patients. The diagnosis of IBS is based on symptom assessment and the Rome Ⅲ criteria. A combination of the Rome Ⅲ criteria, a physical examination, blood tests, gastros-copy and colonoscopy with biopsies is believed to be necessary for diagnosis. Duodenal chromogranin A cell density is a promising biomarker for the diagnosis of IBS. The pathogenesis of IBS seems to be multifactorial, with the following factors playing a central role in the pathogenesis of IBS:heritability and genetics, dietary/intestinal microbiota, low-grade inflammation, and disturbances in the neuroendocrine system (NES) of the gut. One hypothesis proposes that the cause of IBS is an altered NES, which would cause abnormal GI motility, secretions and sensation. All of these abnormalities are characteristic of IBS. Alterations in the NES could be the result of one or more of the following:genetic factors, dietary intake, intestinal flora, or lowgrade inflammation. Post-infectious IBS (PI-IBS) and inflammatory bowel disease-associated IBS (IBD-IBS) represent a considerable subset of IBS cases. Patients with PI-and IBD-IBS exhibit low-grade mucosal inflammation, as well as abnormalities in the NES of the gut.

关键词： Cholecystokinin Chromogranin A Diagno-sis Diet Endocrine cells Intestinal flora Hereditary Low-grade inflammation Peptide YY Serotonin

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Primary sclerosing cholangitis: Updates in diagnosis and therapy

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World Journal of gastroenterology 2005年第1期11卷 7-16页

作者： Piero Portincasa Michele Vacca Antonio Moschetta Michele Petruzzelli Giuseppe Palasciano Karel J.van Erpecum Gerard P.van Berge-Henegouwen section of Internal Medicine department of gastroenterology and Hepatology

Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown origin mostly found in males, and characterized by diffuse inflammation and fibrosis of both intra- and extra-hepatic bile ducts. So far, PSC is considered as an autoimmune hepatobiliary disease. In most cases the progression of PSC towards liver cirrhosis and liver failure is slow but irreversible, and liver transplantation is currently the only definitive treatment. In recent years,PSC has been an area of active research worldwide with great interest in etiology, pathogenesis, diagnosis, and therapeutic options such as hydrophilic ursodeoxycholic acid and immunosuppressive agent tacrolimus. Recent updates on clinical and therapeutic aspects of PSC are discussed in the present review.

关键词： Sclerosing cholangitis Diagnosis Therapy

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Genetic background in nonalcoholic fatty liver disease: A comprehensive review

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World Journal of gastroenterology 2015年第39期21卷 11088-11111页

作者： Fabio Salvatore Macaluso Marcello Maida Salvatore Petta section of gastroenterology DIBIMIS University of Palermo

In the Western world, nonalcoholic fatty liver disease(NAFLD) is considered as one of the most significant liver diseases of the twenty-first century. Its development is certainly driven by environmental factors, but it is also regulated by genetic background. The role of heritability has been widely demonstratedby several epidemiological, familial, and twin studies and case series, and likely reflects the wide interindividual and inter-ethnic genetic variability in systemic metabolism and wound healing response processes. Consistent with this idea, genome-wide association studies have clearly identified Patatin-like phosholipase domain-containing 3 gene variant I148 M as a major player in the development and progression of NAFLD. More recently, the transmembrane 6 superfamily member 2 E167 K variant emerged as a relevant contributor in both NAFLD pathogenesis and cardiovascular outcomes. Furthermore, numerous casecontrol studies have been performed to elucidate the potential role of candidate genes in the pathogenesis and progression of fatty liver, although findings are sometimes contradictory. Accordingly, we performed a comprehensive literature search and review on the role of genetics in NAFLD. We emphasize the strengths and weaknesses of the available literature and outline the putative role of each genetic variant in influencing susceptibility and/or progression of the disease.

关键词： Nonalcoholic fatty liver disease Nonal-coholic ste

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Effects of six months losartan administration on liver fibrosis in chronic hepatitis C patients: A pilot study

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World Journal of gastroenterology 2005年第48期11卷 7560-7563页

作者： Silvia Sookoian María Alejandra Fernández Gustavo Casta(n|~)o Instituto de Investigaciones Médicas A.Lanari Cathedra of Physiopathology gastroenterology section

AIM： TO evaluate the safety and efficacy of chronic administration of Iosartan on hepatic fibrosis in chronic hepatitis C patients.METHODS： Fourteen patients with chronic hepatitis C non-responders （n = 10）, with contraindications （n = 2） or lack of compliance （n = 2） to interferon plus ribavirin therapy and liver fibrosis were enrolled. Liver and renal function test, clinical evaluation, and liver biopsies were performed at baseline and after Iosartan administration at a dose of 50 mg/d during the 6 mo. The control group composed of nine patients with the same inclusion criteria and paired liver biopsies （interval 6-14 mo）. Histological activity index （HAI） with fibrosis stage was assessed under blind conditions by means of Ishak＇s score. Subendothelial fibrosis was evaluated by digital image analyses.RESULTS： The changes in the fibrosis stage were significantly different between Iosartan group （decrease of 0.5±1.3） and controls （increase of 0.89±1.27; P〈0.03）. In the treated patients, a decrease in fibrosis stage was observed in 7/14 patients vs 1/9 control patients （P〈0.04）. A decrease in sub-endothelial fibrosis was observed in the Iosartan group. No differences were found in HAI after Iosartan administration. Acute and chronic decreases in systolic arterial pressures （P〈0.05） were observed after the Iosartan administration, without changes in mean arterial pressure or renal function.CONCLUSION： Chronic AT-Ⅱ type 1 receptor （AT1R） blockade may reduce liver fibrosis in patients with chronic hepatitis C.

关键词： Hepatitis C Liver fibrosis Losartan AT1R Chronic liver disease Angiotensin Ⅱ

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Proton pump inhibitors and all-cause mortality risk among cancer patients

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World Journal of Clinical Oncology 2025年第1期16卷 34-42页

作者： Arunkumar Krishnan Carolin Victoria Schneider declan Walsh department of Supportive Oncology Atrium Health Levine CancerCharlotteNC 28204United States department of Medicine Section of Hematology and OncologyWake Forest University School of MedicineWinston-SalemNC 27101United States department of Medicine Ⅲ GastroenterologyMetabolic Diseasesand Intensive CareUniversity Hospital RWTH AachenAachen 52074Germany

BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related *** evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater *** To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize *** This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare *** study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer *** prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)*** primary outcome was all-cause *** patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding *** Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these *** a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individual

关键词： All-cause mortality Cancer Histamine-2 receptor antagonists Mortality Malignancy Proton pump inhibitors Carcinoma Outcome

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