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Update on the endoscopic treatments for achalasia

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

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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

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Esophagogastric junction distensibility assessed using the functional lumen imaging probe

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World Journal of gastroenterology 2017年第7期23卷 1289-1297页

作者： Joan W Chen Joel H Rubenstein Department of gastro-enterology and hepatology University of Michigan Health SystemsAnn ArborMI 48109United States

To assess reference values in the literature for esophageal distensibility and cross-sectional area in healthy and diseased subjects measured by the functional lumen imaging probe (FLIP).METHODSSystematic search and review of articles in Medline and Embase pertaining to the use of FLIP in the esophagus was conducted in accordance with the PRISMA guidelines. Cross-sectional area and distensibility at the esophagogastric junction (EGJ) were abstracted for normal subjects, achalasia, and gastroesophageal reflux disease (GERD) patients, stratified by balloon length and volume of *** achalasia studies (n = 154), 3 GERD (n = 52), and 5 studies including healthy controls (n = 98) were included in the systematic review. Normative data varied widely amongst studies of healthy volunteers. In contrast, studies in achalasia patients uniformly demonstrated low point estimates in distensibility ≤ 1.6 mm2/mmHg prior to treatment that increased to ≥ 3.4 mm2/mmHg following treatment at 40mL bag volume. In GERD patients, distensibility fell to the range of untreated achalasia (≤ 2.85 mm2/mmHg) following *** may be a useful tool in assessment of treatment efficacy in achalasia. The drastic drop in EGJ distensibility after fundoplication suggests that FLIP measurements need to be interpreted in the context of esophageal body motility and highlights the importance of pre-operative screening for dysmotility. Future studies using standardized FLIP protocol and balloon size are needed.

关键词： Impedance planimetry gastroesophageal reflux disease Esophageal distensibility Achalasia

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Novel CD9-targeted therapies in gastric cancer

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World Journal of gastroenterology 2015年第11期21卷 3206-3213页

作者： Yoko Murayama Kenji Oritani Shusaku Tsutsui Department of gastro-enterology and hepatology Itami City Hospital Department of Hematology/Oncology Graduate School of MedicineOsaka University

There are 33 human tetraspanin proteins,emerging as key players in malignancy,the immune system,fertilization,cellular signaling,adhesion,morphology,motility,proliferation,and tumor ***9,a member of the tetraspanin family,associates with and influences a variety of cell-surface *** these interactions,CD9 modifies multiple cellular events,including adhesion,migration,proliferation,and ***9 is therefore considered to play a role in several stages during cancer *** CD9 expression is generally related to venous vessel invasion and metastasis as well as poor *** found that treatment of mice bearing human gastric cancer cells with anti-CD9 antibody successfully inhibited tumor progression via antiproliferative,proapoptotic,and antiangiogenic effects,strongly indicating that CD9 is a possible therapeutic target in patients with gastric ***,we describe the possibility of CD9 manipulation as a novel therapeutic strategy in gastric cancer,which still shows poor prognosis.

关键词： CD9 Tetraspanin Gastric cancer Tumo-rigenicity The

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Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

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World Journal of hepatology 2017年第22期9卷 959-966页

作者： Pik-Eu Chang Boon-Bee George Goh Victoria Ekstrom Ming-Liang Ong Chee-Kiat Tan Department of gastro enterology and hepatology Singapore General Hospital Duke-NUS Medical School

To evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis. METHODSWe used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality. RESULTSWe identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years (range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients (71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death (OR = 5.39, 95%CI: 1.85-15.71). CONCLUSIONSevere hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.

关键词： Severe Mortality Albumin Incidence Hypoxic hepatitis Predictors Etiology Prognosis

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Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients

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World Journal of gastroenterology 2017年第28期23卷 5237-5245页

作者： Rafael Veiga Picon Franciele Sabadin Bertol Cristiane Valle Tovo Angelo Zambam de Mattos gastroenterology and hepatology Unit Nossa Senhora da Conceicao Hospital gastro-enterology and hepatology Unit Federal University of Health Sciences of Porto Alegre gastroenterology and hepatology Unit Pontifical Catholic University of Rio Grande do Sul

To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian *** is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute decompensation score (CLIF-C AD) and CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regarding 28-d and 90-d mortality, as well as to compare them to other prognostic models, such as Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), Child-Pugh (CP) score, and the CLIF-C Organ Failure score (CLIF-C OF). All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil. Prognostic performances were evaluated by means of the receiver operating characteristic (ROC) curves, area under the curves (AUC) and 95%*** hundred and thirteen cirrhotic patients were included. At admission, 18 patients had acute-on-chronic liver failure (ACLF) and 95 individuals had acute decompensation (AD) without ACLF, of which 24 eventually developed ACLF during the course of hospitalization (AD evolving to ACLF group). The AD group had significantly lower 28-d (9.0%) and 90-d (18.3%) mortality as compared to the AD evolving to ACLF group and to the ACLF group (both P < 0.001). On the other hand, 28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group (P = 0.542 and P = 0.708, respectively). Among patients with ACLF, at 28 d from the diagnosis, CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line, with an AUC (95%CI) of 0.71 (95%CI: 0.54-0.88, P = 0.021). Among patients with AD, all prognostic scores performed significantly better than the reference line regarding 28-d mortality, presenting with similar AUCs: CLIF-C AD score 0.75 (95%CI: 0.63-0.88), CP score 0.72 (95%CI: 0.59-0.85), MELD score 0.75 (95%CI: 0.61-0.90),

关键词： Cirrhosis Acute-on-chronic liver failure Mortality Prediction Prognosis Acute decompensation of cirrhosis

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Obstructive jaundice due to a rare periampullary tumor

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World Journal of gastrointestinal Oncology 2013年第10期5卷 195-197页

作者： Anjana Sathyamurthy Abhishek Choudhary Dennis Ng Shuaib Okponobi Alberto Diaz-Arias Ajitinder Grewal Ghassan M Hammoud Division of gastro-enterology and hepatology University of Missouri-Columbia Department of Pathology and Anatomical Sciences University of Missouri Health Sciences Center

Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes.A 92-year-old female presented with obstructive *** exam she had pale conjunctiva and icteric *** examination revealed tenderness in the upper *** data was consistent with obstructive *** tomography of the abdomen revealed a dilated gall bladder and a common bile duct(CBD)with no evidence of liver lesions or pancreatic head *** ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area,dilated CBD(9 mm),a prominent pancreatic duct(4.1 mm)and a hydropic gall bladder with no *** retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare *** analyses with immunohistochemical stains were positive for cytokeratin,synaptophysin,S-100 protein,neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic *** gangliocytic paraganglioma is a rare benign tumor of the small *** presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive *** resection is a curative therapy in the absence of local invasion or distant metastasis.

关键词： Gangliocytic paraganglioma Periampullary tumor Spindle-shaped Epitheloid Ganglion cells Jaundice Duodenum Endoscopic mucosal resection

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Mini-loop ligation of a bleeding duodenal Dieulafoy's lesion

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World Journal of gastroenterology 2013年第22期19卷 3505-3507页

作者： Marija Gomeri Pali Neven Ljubii Division of gastro-enterology and hepatology Department of Internal Medicine Medical and Dental Faculty "Sestre Milosrdnice" University Hospital Center University of Zagreb 10000 Zagreb Croatia

Two percent of gastrointestinal hemorrhages are caused by Dieulafoy's lesions, which are located in duodenum in only 15% of cases. There are no recommendations regarding the prime endoscopic treatment technique for this condition. A 61-year-old woman presented with melena without signs of hemodynamic instability. During an urgent upper endoscopy, blood oozing from the normal mucosa of the duodenum was seen and this was classified as a Dieulafoy's lesion. A mini-loop was opened at the rim of a transparent ligation chamber, at the end of the endoscope, and after aspiration of the lesion, closed and detached. Complete hemostasis was achieved without early or postponed complications. In every day clinical practice, mini-loop ligation is rarely used because of possible complications, such as site ulceration, organ perforation, re-bleeding and possible inexperience of the operator. To the best of our knowledge this is the first case of successful treatment of bleeding duodenal Dieulafoy's lesion by mini-loop ligation.

关键词： Dieulafoy’s lesion Duodenum Endoscopy Mini-loop Hemostasis

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Magnetic resonance imaging in children and adolescents with chronic inflammatory bowel disease

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World Journal of gastroenterology 2014年第5期20卷 1180-1191页

作者： Hans-Joachim Mentzel Steffen Reinsch Monika Kurzai Martin Stenzel section of Pediatric Radiology Department of Radiology University Hospital Jena- Friedrich-Schiller-University Jena section of Pediatric gastro-enterology Department of Pediatrics University Hospital Jena Friedrich-Schiller-University Jena

Inflammatory bowel diseases(IBD) represent challenges, both from a diagnostic, and therapeutic point of view. Deep-seated anatomic structures are difficult to assess by ultrasound technique alone. As radiation-free alternative cross-sectional imaging method, magnetic resonance imaging of the intestinal structures is costly and time-consuming. Examination of pediatric patients imply additional considerations: reduction of body motions in younger children and consideration of the most appropriate preparation, and examination technique. The demanding Sellink technique is the only means for appropriately distending the lesser intestine in order to detect small bowel strictures. Oral intake of contrast medium(CM) alone shows its limitations regarding distensibility. The need for intravenous contrast media application needs to be considered, too. Active inflammation of both intestinal wall, and mesentery can be demonstrated accurately. Nevertheless, viable alternatives to CM application is desirable, considering non-negligible adverse reactions. Recent data suggest diffusion weighted imaging might fill this diagnostic gap. Irrespective of sequence technique chosen, bowel movement remains a major obstacle. Antispasmolytics in their function as smooth muscle relaxants help in improving image quality, however, their use in children might be off-label. Optimal preparation for the examination and appropriate imaging technique allow for diagnosing typical patterns of changes in IBD, such as bowel wall thickening, ulcers, mural stratification, strictures, creeping fat, and comb sign, and lymphadenopathy. The article gives a detailed overview of current significance of magnetic resonance imaging pediatric patients suffering from IBD, considering indications, limitations, and safety aspects.

关键词： Children, Adolescents, Inflammatory bowel disease, Crohn’ s disease, Ulcerative colitis, Magnetic resonance imaging, Enterography

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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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