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paediatric and adult colonic manometry: A tool to help unravel the pathophysiology of constipation

World Journal of gastroenterology 2010年第41期16卷 5162-5172页

作者： Philip G Dinning Marc A Benninga Bridget R Southwell S Mark Scott Department of gastroenterology St George Hospital University of New South Wales Kogarah Sydney 2217 Australia Department of Pediatric gastroenterology and Nutrition Emma Children's Hospital/AMC Amsterdam 1105 AZ The Netherlands Murdoch Childrens Research Institute Royal Children's Hospital Parkville Melbourne 3052 Australia Department of paediatrics University of Melbourne Melbourne 3052 Australia Queen Mary University London Barts and the London School of Medicine and Dentistry London E11BB United Kingdom

Colonic motility subserves large bowel functions, including absorption, storage, propulsion and defaecation. Co-lonic motor dysfunction remains the leading hypothesis to explain symptom generation in chronic constipation, a heterogeneous condition which is extremely prevalent in the general population, and has huge socioeconomic impact and individual suffering. Physiological testing plays a crucial role in patient management, as it is now accepted that symptom-based assessment, although im-portant, is unsatisfactory as the sole means of directing therapy. Colonic manometry provides a direct method for studying motor activities of the large bowel, and this review provides a contemporary understanding of how this technique has enhanced our knowledge of normalcolonic motor physiology, as well as helping to elucidate pathophysiological mechanisms underlying constipation. Methodological approaches, including available catheter types, placement technique and recording protocols, are covered, along with a detailed description of re-corded colonic motor activities. This review also criti-cally examines the role of colonic manometry in current clinical practice, and how manometric assessment may aid diagnosis, classification and guide therapeutic inter-vention in the constipated individual. Most importantly, this review considers both adult and paediatric patients. Limitations of the procedure and a look to the future are also addressed.

关键词： Colon Constipation Manometry paediatric Adult

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Diet therapy for inflammatory bowel diseases: The established and the new

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World Journal of gastroenterology 2016年第7期22卷 2179-2194页

作者： Franziska Durchschein Wolfgang Petritsch Heinz F Hammer Department of Internal Medicine Division of Gastroenterology and Hepatology Medical University of Graz

Although patients with inflammatory bowel diseases(IBD) have a strong interest in dietary modifications as part of their therapeutic management, dietary advice plays only a minor part in published guidelines. The scientific literature shows that dietary factors might influence the risk of developing IBD, that dysbiosis induced by nutrition contributes to the pathogenesis of IBD, and that diet may serve as a symptomatic treatment for irritable bowel syndrome-like symptoms in IBD. The role of nutrition in IBD is underscored by the effect of various dietary therapies. In paediatric patients with Crohn's disease(CD) enteral nutrition(EN) reaches remission rates similar to steroids. In adult patients, however, EN is inferior to corticosteroids. EN is not effective in ulcerative colitis(UC). Total parenteral nutrition in IBD is not superior to steroids or EN. The use of specific probiotics in patients with IBD can be recommended only in special clinical situations. There is no evidence for efficacy of probiotics in CD. By contrast, studies in UC have shown a beneficial effect in selected patients. For patients with pouchitis, antibiotic treatment followed by probiotics, like VSL#3 or Lactobacillus GG, is effective. When probiotics are used, the risk of bacterial translocation and subsequent bacteremia has to be considered. More understanding of the normal intestinal microflora, and better characterization of probiotic strains at the phenotypic and genomic levels is needed as well as clarification of the mechanisms of action in different clinical settings. A FODMAP reduced diet may improve symptoms in IBD.

关键词： enteral nutrition parenteral nutrition probiotics fermentable oligo-, di-, and monosaccharidesand polyols Crohn's disease ulcerative colitis

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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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Noninvasive biomarkers in non-alcoholic fatty liver disease:Current status and a glimpse of the future

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World Journal of gastroenterology 2014年第31期20卷 10851-10863页

作者： Emer Fitzpatrick Anil Dhawan paediatric Liver GI and Nutrition Centre King’s College London School of Medicine at King’s College Hospital

The development of non invasive biomarkers of disease has become a major focus of interest in nonalcoholic fatty liver disease(NAFLD). The large prevalence of the disease and the invasive nature of the investigation means that screening with liver biopsy is impractical.In addition to screening, the differentiation of those with simple steatosis vs steatohepatitis and fibrosis is clinically important as the prognosis of each differs.Serum biomarkers may be a combination of simple markers derived from large data sets or direct markers of disease activity. Serum markers of inflammation,apoptosis and oxidative stress in addition to fibrosis have been extensively studied in patients with NAFLD.Other techniques such as transient elastography,magnetic resonance elastography and acoustic radiation force imaging are becoming more established as noninvasive methods of detecting fibrosis in a variety of chronic liver conditions in addition to NAFLD. Newer high throughput methods such as proteomics and glycomics allow the nonhypothesis-driven identification of novel markers and may also potentially contribute to our understanding of the pathogenesis of the condition.This review addresses some of the methodological issues which need to be considered in the search for the ideal biomarker. It is likely that a combination of serum biomarkers and techniques such as transient elastography may provide the optimal diagnostic discrimination however this remains to be proven in large studies.

关键词： Noninvasive biomarkers Nonalcoholic fatty liver di

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paediatric non-alcoholic fatty liver disease: a more complex disease than in the adulthood?

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Hepatobiliary Surgery and Nutrition 2019年第3期8卷 270-273页

作者： María Teresa Arias-Loste Paula Iruzubieta Javier Crespo Department of gastroenterology and Hepatology University Hospital Marqués de ValdecillaSantanderSpain Investigation Institute Marques de Valdecilla InfectionImmunity and Digestive Diseases GroupIDIVALSantanderSpain

While the association between obesity,type 2 diabetes(T2D)and the presence of steatosis has been established since the beginning of the last century(1),it was not until 1980 that the first references were made about a form of histologic liver lesion designated as non-alcoholic steatohepatitis(NASH).NASH is characterised by the presence of a variable degree of steatosis accompanied by lobular inflammatory infiltrate and hepatocellular damage with or without fibrosis.Subsequently,the broader term of non-alcoholic fatty liver disease(NAFLD)was accepted,which more accurately encompass the entire spectrum of lesions that appear in these patients(2).Ever since then,NAFLD has become progressively the primary cause of chronic liver disease in developed countries(3).

关键词： liver NAFLD damage

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Crohn’s and colitis in children and adolescents

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World Journal of gastroenterology 2012年第41期18卷 5862-5869页

作者： Andrew S Day Oren Ledder Steven T Leach Daniel A Lemberg Department of gastroenterology Sydney Children's HospitalRandwickSydneyNSW 2031Australia School of Women's and Children's Health University of New South WalesSydneyNSW 2031Australia Department of paediatrics University of Otago ChristchurchChristchurch 8140New Zealand

Crohn's disease and ulcerative colitis can be grouped as the inflammatory bowel diseases(IBD).These conditions have become increasingly common in recent years,including in children and young people.Although much is known about aspects of the pathogenesis of these diseases,the precise aetiology is not yet understood,and there remains no cure.Recent data has illustrated the importance of a number of genes-several of these are important in the onset of IBD in early life,including in infancy.Pain,diarrhoea and weight loss are typical symptoms of paediatric Crohn's disease whereas bloody diarrhoea is more typical of colitis in children.However,atypical symptoms may occur in both conditions:these include isolated impairment of linear growth or presentation with extra-intestinal manifestations such as erythema nodosum.Growth and nutrition are commonly compromised at diagnosis in both Crohn's disease and colitis.Consideration of possible IBD and completion of appropriate investi-gations are essential to ensure prompt diagnosis,thereby avoiding the consequences of diagnostic delay.Patterns of disease including location and progression of IBD in childhood differ substantially from adultonset disease.Various treatment options are available for children and adolescents with IBD.Exclusive enteral nutrition plays a central role in the induction of remission of active Crohn's disease.Medical and surgical therapies need to considered within the context of a growing and developing child.The overall management of these chronic conditions in children should include multi-disciplinary expertise,with focus upon maintaining control of gut inflammation,optimising nutrition,growth and quality of life,whilst preventing disease or treatment-related complications.

关键词：溃疡性结肠炎青少年儿童鸡传染性法氏囊病慢性疾病出血性腹泻发病机理典型症状

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Outcomes and patients' perspectives of transition from paediatric to adult care in inflammatory bowel disease

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World Journal of gastroenterology 2016年第8期22卷 2611-2620页

作者： Alice L Bennett David Moore Peter A Bampton Robert V Bryant Jane M Andrews Department of gastroenterology Royal Adelaide Hospital North Terrace Adelaide SA 5000 Australia Department of gastroenterology Flinders Medical Centre Flinders Drive Bedford Park SA 5042 Australia School of Medicine University of Adelaide Adelaide SA 5000 Australia Department of gastroenterology Women's and Children's Hospital Adelaide SA 5006 Australia School of Medicine Flinders University Adelaide SA 5001 Australia

AIM: To describe the disease and psychosocialoutcomes of an inflammatory bowel disease(IBD) transition cohort and their perspectives.METHODS: Patients with IBD, aged > 18 years, who had moved from paediatric to adult care within 10 years were identified through IBD databases at three tertiary hospitals. Participants were surveyed regarding demographic and disease specific data and their perspectives on the transition process. Survey response data were compared to contemporaneously recorded information in paediatric service case notes. Data were compared to a similar age cohort who had never received paediatric IBD care and therefore who had not undergone a transition process. RESULTS: There were 81 returned surveys from 46 transition and 35 non-transition patients. No statistically significant differences were found in disease burden, disease outcomes or adult roles and responsibilities between cohorts. Despite a high prevalence of mood disturbance(35%), there was a very low usage(5%) of psychological services in both cohorts. In the transition cohort, knowledge of their transition plan was reported by only 25/46 patients and the majority(54%) felt they were not strongly prepared. A high rate(78%) of discussion about work/study plans was recorded prior to transition, but a near complete absence of discussion regarding sex(8%), and other adult issues was recorded. Both cohorts agreed that their preferred method of future transition practices(of the options offered) was a shared clinic appointment with all key stakeholders. CONCLUSION: Transition did not appear to adversely affect disease or psychosocial outcomes. Current transition care processes could be optimised, with better psychosocial preparation and agreed transition plans.

关键词： Transition care Crohn’s disease Ulcerative colitis Chronic illness Inflammatory bowel disease Patien

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Endoscopic management of sigmoid volvulus in children

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World Journal of Gastrointestinal Endoscopy 2016年第12期8卷 439-443页

作者： Filippo Parolini Paolo Orizio Anna Lavinia Bulotta Miguel Garcia Magne Giovanni Boroni Gianpaolo Cengia Fabio Torri Daniele Alberti Department of paediatric Surgery "Spedali Civili" Children’s Hospital Unit of Digestive Endoscopy and gastroenterology "ASST Garda-Manerbio" Hospital Department of Clinical and Experimental Sciences University of Brescia

Sigmoid volvulus(SV)is extremely uncommon in children and is usually associated with a long-standing history of constipation or pseudo-obstruction.An early diagnosis and management are crucial in order to prevent the appearance of hemorrhagic infarction of the twisted loop,avoiding further complications such as necrosis,perforation and sepsis.In patients with no evidence of peritonitis or ischemic bowel,treatment starts with resuscitation and detorsion of the SV,accomplished by means of sigmoidoscopy and concomitant rectal tube placement.The bowel is then prepared and surgery is undertaken electively during the same hospitalization.We report a detailed review of the literature focusing on technical details,risks and benefits of endoscopic management of SV in childhood.

关键词： Sigmoid volvulus Contrast enema Children Endoscopy Surgery

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paediatric cholestatic liver disease:Diagnosis,assessment of disease progression and mechanisms of fibrogenesis

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World Journal of Gastrointestinal Pathophysiology 2010年第2期1卷 69-84页

作者： Tamara N Pereira Meagan J Walsh Peter J Lewindon Grant A Ramm The Hepatic Fibrosis Group The Queensland Institute of Medical Research Department of gastroenterology Royal Children's Hospital

Cholestatic liver disease causes significant morbidity and mortality in children.The diagnosis and management of these diseases can be complicated by an inability to detect early stages of fibrosis and a lack of adequate interventional therapy.There is no single gold standard test that accurately reflects the presence of liver disease,or that can be used to monitor fibrosis progression,particularly in conditions such as cystic fibrosis.This has lead to controversy over how suspected liver disease in children is detected and diagnosed.This review discusses the challenges in using commonly available methods to diagnose hepatic fibrosis and monitor disease progression in children with cholestatic liver disease.In addition,the review examines the mechanisms hypothesised to be involved in the development of hepatic fibrogenesis in paediatric cholestatic liver injury which may ultimately aid in identifying new modalities to assist in both disease detection and therapeutic intervention.

关键词： Cystic fibrosis Biliary atresia Liver biopsy Ultrasound Hepatic fibrosis Cirrhosis Hepatic stellatecell Bile acid Chemotaxis Monocyte chemotaxis protein-1

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Transition care in inflammatory bowel disease: A needs assessment survey of Quebec gastroenterologists and allied nurses

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第3期8卷 186-192页

作者： Matthew Strohl Xun Zhang Dominique Lévesque Talat Bessissow Department of Internal Medicine McGill University Health Center Research Institute McGill University Health Centre Department of Pediatric gastroenterology McGill University Health Center Department of gastroenterology Montreal General Hospital C7-200 McGill University Health Center

AIM To determine the tools needed and problems encountered during the transition of inflammatory bowel disease(IBD) patients from pediatric to adult gastroenterologists(GIs) in Québec, Canada.METHODS We conducted a needs assessment survey of Quebec health care professionals(HCPs). The survey was handed out to 136 Québec HCPs at a local conference in 2013. Additionally, it was emailed to any other HCPs in Quebec involved in caring for IBD patients. The completed surveys were compiled to derive descriptive data. Further specific subgroup analysis was then conducted. RESULTS Among the conference attendees and individuals emailed 77(28.2%) completed the questionnaire. Respondents included adult GIs(61.3%), pediatric GIs(20.8%) and IBD nurses(18.3%). The majority of respondents believed that a standardized structure is important for a successful transition. Adult and pediatric GIs equally felt that patients were inadequately prepared for the transition(P = 0.6). There were significant differences between adult and pediatric GIs when it came to resource availability(55.6% vs 90.9%, P = 0.002) and perceived need of a formal transition clinic(21.7% vs 68.8%, P = 0.0006). Both transition program and medical summaries were identified as the most valuable tools to improve transition. CONCLUSION As described in previous studies, our survey reinforces the importance of a transition program, education for young adult IBD patients and the need to improve communication between adult and pediatric GIs.

关键词：煽动性的肠疾病转变儿科学加拿大工具护理专业人员

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