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

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

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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

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gastrointestinal neuroendocrine peptides/amines in inflammatory bowel disease

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World Journal of gastroenterology 2017年第28期23卷 5068-5085页

作者： Magdy El-Salhy Tefera Solomon Trygve Hausken Odd Helge Gilja Jan Gunnar Hatlebakk Division of gastroenterology Department of MedicineStord Hospital Department of Clinical Medicine University of Bergen national centre for Functional gastrointestinal Disorders Department of MedicineHaukeland University Hospital Department of Medicine Haraldsplass Diakonale Hospital national centre for ultrasound in gastro enterology Department of MedicineHaukeland University Hospital

Inflammatory bowel disease(IBD) is a chronic recurrent condition whose etiology is unknown,and it includes ulcerative colitis,Crohn's disease,and microscopic colitis. These three diseases differ in clinical manifestations,courses,and prognoses. IBD reduces the patients' quality of life and is an economic burden to both the patients and society. Interactions between the gastrointestinal(GI) neuroendocrine peptides/amines(NEPA) and the immune system are believed to play an important role in the pathophysiology of IBD. Moreover,the interaction between GI NEPA and intestinal microbiota appears to play also a pivotal role in the pathophysiology of IBD. This review summarizes the available data on GI NEPA in IBD,and speculates on their possible role in the pathophysiology and the potential use of this information when developing treatments. GI NEPA serotonin,the neuropeptide Y family,and substance P are proinflammatory,while the chromogranin/secretogranin family,vasoactive intestinal peptide,somatostatin,and ghrelin are antiinflammatory. Several innate and adaptive immune cells express these NEPA and/or have receptors to them. The GI NEPA are affected in patients with IBD and in animal models of human IBD. The GI NEPA are potentially useful for the diagnosis and follow-up of the activity of IBD,and are candidate targets for treatments of this disease.

关键词： Enteric nervous system Enteroendocrine cells Immune cells Inflammatory bowel disease Musashi-1 Neurogenin 3 Stem cells

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Traditional Chinese herbal extracts inducing autophagy as a novel approach in therapy of nonalcoholic fatty liver disease

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World Journal of gastroenterology 2017年第11期23卷 1964-1973页

作者： Cong Liu Jia-Zhi Liao Pei-Yuan Li Division of gastro-enterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

Non-alcoholic fatty liver disease(NAFLD) is one of the leading causes of chronic liver diseases around the world due to the modern sedentary and food-abundant lifestyle, which is characterized by excessive fat accumulation in the liver related with causes other than alcohol abuse. It is widely acknowledged that insulin resistance, dysfunctional lipid metabolism, endoplasmic reticulum stress, oxidative stress, inflammation, and apoptosis/necrosis may all contribute to NAFLD. Autophagy is a protective self-digestion of intracellular organelles, including lipid droplets(lipophagy), in response to stress to maintain homeostasis. Lipophagy is another pathway for lipid degradation besides lipolysis. It is reported that impaired autophagy also contributes to NAFLD. Some studies have suggested that the histological characteristics of NAFLD(steatosis, lobular inflammation, and peri-sinusoid fibrosis) might be improved by treatment with traditional Chinese herbal extracts, while autophagy may be induced. This review will provide insights into the characteristics of autophagy in NAFLD and the related role/mechanisms of autophagy induced by traditional Chinese herbal extracts such as resveratrol, Lycium barbarum polysaccharides, dioscin, bergamot polyphenol fraction, capsaicin, and garlic-derived S-allylmercaptocysteine, which may inhibit the progression of NAFLD. Regulation of autophagy/lipophagy with traditional Chinese herbal extracts may be a novel approach for treating NAFLD, and the molecular mechanisms should be elucidated further in the near future.

关键词： Traditional Chinese herbal extracts Nonalcoholic fatty liver disease Autophagy

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Doctor communication quality and Friends' attitudes influence complementary medicine use in inflammatory bowel disease

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World Journal of gastroenterology 2015年第12期21卷 3663-3670页

作者： Réme Mountifield Jane M Andrews Antonina Mikocka-Walus Peter Bampton Department of gastro-enterology and Hepatology Flinders Medical Centre Flinders University of South Australia IBD Service Department of Gastroenterology and Hepatology and School of Medicine University of Adelaide at Royal Adelaide Hospital School of Nursing and Midwifery University of South Australia

AIM: To examine the frequency of regular complementary and alternative therapy(CAM) use in three Australian cohorts of contrasting care setting and geography, and identify independent attitudinal and psychological predictors of CAM use across all cohorts. METHODS: A cross sectional questionnaire was administered to inflammatory bowel disease(IBD) patients in 3 separate cohorts which differed by geographical region and care setting. Demographics and frequency of regular CAM use were assessed, along with attitudes towards IBD medication and psychological parameters such as anxiety, depression, personality traits and quality of life(QOL), and compared across cohorts. Independent attitudinal and psychological predictors of CAM use were determined using binary logistic regression analysis. RESULTS: In 473 respondents(mean age 50.3 years, 60.2% female) regular CAM use was reported by45.4%, and did not vary between cohorts. Only 54.1%of users disclosed CAM use to their doctor. Independent predictors of CAM use which confirm those reported previously were: covert conventional medication dose reduction(P < 0.001), seeking psychological treatment(P < 0.001), adverse effects of conventional medication(P = 0.043), and higher QOL(P < 0.001).Newly identified predictors were CAM use by family or friends(P < 0.001), dissatisfaction with patient-doctor communication(P < 0.001), and lower depression scores(P < 0.001). CONCLUSION: In addition to previously identified predictors of CAM use, these data show that physician attention to communication and the patient-doctor relationship is important as these factors influence CAM use. Patient reluctance to discuss CAM with physicians may promote greater reliance on social contacts to influence CAM decisions.

关键词： Complementary medicine Alternative therapy Therapy

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Flatography: Detection of gastrointestinal diseases by faecal gas analysis

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World Journal of gastrointestinal Pharmacology and Therapeutics 2015年第4期6卷 111-113页

作者： Evelien F de Groot Tim G de Meij Daniel J Berkhout Marc P van der Schee Nanne K de Boer Department of gastro-enterology and Hepatology VU University Medical Centre Department of Paediatric gastroenterology VU University Medical Centre

Patients presenting with gastro-intestinal symptoms might suffer from a range of possible underlying diseases. An unmet need exists for novel cost-effective,reproducible, easy-to-perform and non-invasive tests. Hippocrates used body odours to diagnose diseases circa 460 before Christ. The art of diagnostic smelling is making a promising high-tech come-back with portable "electronic diagnostic noses". Analysis of faecal volatile organic compounds is a novel field in metabolomics with considerable potential to improve the diagnosis, phenotyping and monitoring of gastro-intestinal disease. Challenges will be to mature over the coming years by development of a standardized methodology for stool sample collection, storage, handling and analysis. Furthermore, key volatiles need to be identified to improve test accuracy and sensitivity by development of sensors tailored toward the accurate identification of disease specific volatiles. If these challenges are adequately faced, analysis of faecal volatiles has realistic potential to considerably improve screening, diagnosis and disease monitoring for gastro-intestinal diseases.

关键词： Flatography Electronic nose Smell Volatile organic

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High rate of complicated idiopathic gallstone disease in pediatric patients of a North American tertiary care center

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World Journal of gastroenterology 2008年第10期14卷 1544-1548页

作者： Denise Herzog Guylaine Bouchard Division of gastro-enterology and Nutrition Sainte Justine Hospital University of Montreal Montreal Quebec Canada

AIM: To assess spectrum and etiology of gallstones and biliary sludge in the pediatric population of a North American tertiary care centre. METHODS: Retrospective review of abdominal ultraso- unds recorded at Saint Justine Hospital over a period of 24 mo (8/2003 to 8/2005) in patients 2 years of age idiopathic gallstone disease was found. These 48 patients represent 2.1% of the population who required ultrasound for abdominal pain. Complicated gallstone disease occurred in 28/48 with idiopathic disease, mainly adolescent girls. Patients with hemolytic disorders, cystic fibrosis, oncologic diseases or kidney transplantation and gallstones were asymptomatic and stones were detected during routine abdominal ultrasound. Twenty two patients < 2 years of age not consulting for abdominal pain had gallstone disease of diverse etiology. Biliary sludge was seen in 84 patients, 78.5% on total parenteral nutrition. In 4 patients, sludge progressed to gallstones. CONCLUSION: Idiopathic gallstone disease and its rate of complication are more frequent in our cohort than expected from previous studies. Adolescent girls with abdominal pain and idiopathic gallstones require special attention for complicated disease course.

关键词： Cholecystectomy Hemolytic disease Cystic fibrosis Pancreatitis Choledocholithiasis

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Research progress on chemopreventive effects of phytochemicals on colorectal cancer and their mechanisms

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World Journal of gastroenterology 2016年第31期22卷 7058-7068页

作者： Teng-Fei Yin Min Wang Ying Qing Ying-Min Lin Dong Wu Department of gastro-enterology Geriatrics Qi-Lu Hospital of Shandong University Department of General Medicine Qi-Lu Hospital of Shandong University Department of General Surgery Qi-Lu Hospital of Shandong University

Colorectal cancer(CRC) is a type of cancer with high morbidity and mortality rates worldwide and has become a global health problem. The conventional radiotherapy and chemotherapy regimen for CRC not only has a low cure rate but also causes side effects. Many studies have shown that adequate intake of fruits and vegetables in the diet may have a protective effect on CRC occurrence, possibly due to the special biological protective effect of the phytochemicals in these foods. Numerous in vitro and in vivo studies have demonstrated that phytochemicals play strong antioxidant, anti-inflammatory and anti-cancer roles by regulating specific signaling pathways and molecular markers to inhibit the occurrence and development of CRC. This review summarizes the progress on CRC prevention using the phytochemicals sulforaphane, curcumin and resveratrol, and elaborates on the specific underlying mechanisms. Thus, we believe that phytochemicals might provide a novel therapeutic approach for CRC prevention, but future clinical studies are needed to confirm the specific preventive effect of phytochemicals on cancer.

关键词： Phytochemicals Sulforaphane Curcumin Resveratrol Colorectal cancer Chemopreventive effects Molecular mechanism

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Danish cohort of monozygotic inflammatory bowel disease twins: Clinical characteristics and inflammatory activity

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World Journal of gastroenterology 2016年第21期22卷 5050-5059页

作者： Frederik Trier Moller Lina Knudsen Marcus Harbord Jack Satsangi Hannah Gordon Lene Christiansen Kaare Christensen Tine Jess Vibeke Andersen Research Unit for Molecular Diagnostics Hospital of Southern Jutland Institute of Regional Health Research University of Southern Denmark Division of Epidemiology and Disease Surveillance Statens Serum Institut Department of gastro-enterology Chelsea and Westminster Hospital centre for Molecular Medicine University of Edinburgh Western General Hospital Danish Ageing Research centre Institute of Public Health University of Southern Denmark Department of Clinical Medicine University of Aalborg

AIM: To describe the establishment of a Danish inflammatory bowel diseases (IBD) twin cohort with focus on concordance of treatment and inflammatory ***: We identified MZ twins, likely to be discordant or concordant for IBD, by merging information from the Danish Twin Register and the national Patient Register. The twins were asked to provide biological samples, questionnaires, and data access to patient files and public registries. Biological samples were collected via a mobile laboratory, which allowed for immediate centrifugation, fractionation, and storage of samples. The mean time from collection of samples to storage in the -80 °C mobile freezer was less than one hour. The diagnoses where validated using the Copenhagen diagnostic ***: We identified 159 MZ IBD twin pairs, in a total of 62 (39%) pairs both twins agreed to participate. Of the supposed 62 IBD pairs, the IBD diagnosis could be confirmed in 54 pairs. The cohort included 10 concordant pairs, whereof some were discordant for either treatment or surgery. The 10 concordant pairs, where both pairs suffered from IBD, included eight CD/CD pairs, one UC/UC pair and one UC/IBDU pair. The discordant pairs comprised 31 UC, 5 IBDU (IBD unclassified), and 8 CD discordant pairs. In the co-twins not affected by IBD, calprotectin was above 100 μg/g in 2 participants, and above 50 μg/g in a further 5 ***: The presented IBD twin cohorts are an excellent resource for bioinformatics studies with proper adjustment for disease-associated exposures including medication and inflammatory activity in the co-twins.

关键词： Digestive system diseases Inflammatory bowel diseases Crohn’ s disease Ulcerative colitis Epidemiologic studies Twins Biobank

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How to perform gastrointestinal ultrasound: anatomy and normal findings

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World Journal of gastroenterology 2017年第38期23卷 6931-6941页

作者： Nathan S S Atkinson Robert V Bryant Yi Dong Christian Maaser Torsten Kucharzik Giovanni Maconi Anil K Asthana Michael Blaivas Adrian Goudie Odd Helge Gilja Dieter Nuernberg Dagmar Schreiber-Dietrich Christoph F Dietrich Translational gastroenterology Unit Oxford University Hospitals NHS Foundation Trust School of Medicine University of Adelaide Department of gastroenterology and Hepatology Royal Adelaide Hospital Department of ultrasound Zhongshan Hospital Fudan University Ambulanzzentrum gastroenterologie Klinikum Lüneburg Department of gastroenterology Stadtisches Klinikum Luneburg gGmbH gastrointestinal Unit Department of Biomedical and Clinical Sciences 'L.Sacco' University Hospital Department of gastroenterology and Hepato-logy The Alfred Hospital Monash University Piedmont Hospital Department of Emergency Medicine Fremantle Hospital and Health Service Emergency Department national centre for ultrasound in gastro- enterology Haukeland University Hospital Department of Clinical Medicine University of Bergen Department of gastroenterology Brandenburg Medical School Med. Klinik 2 Caritas-Krankenhaus Bad Mergentheim

gastrointestinal ultrasound is a practical, safe, cheap and reproducible diagnostic tool in inflammatorybowel disease gaining global prominence amongst clinicians. Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings. In general terms, the examination principally comprises interrogation of the colon, mesentery and small intestine using both lowfrequency and high-frequency probes. Interpretation of findings on GIUS includes assessment of bowel wall thickness, symmetry of this thickness, evidence of transmural changes, assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes, mesentery and luminal motility. In addition to B-mode imaging, transperineal ultrasonography, elastography and contrast-enhanced ultrasonography are useful adjuncts. This supplement expands upon these features in more depth.

关键词： ultrasound Intestinal Inflammatory bowel disease Guidelines Teaching

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