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世界胃肠病学杂志（英文版）
世界胃肠病学杂志（英文版）

潘伯荣

周刊

1007-9327

wjg@wjgnet.com

010-85381901-628

100025

北京市朝阳区东四环中路62号楼远洋国际中心D座903室

世界胃肠病学杂志（英文版）/Journal World Journal of GastroenterologyCSCDCSTPCDSCI
查看更多>>主要报道和刊登国内外、特别是我国消化病学者具有创造性的、有较高学术水平的基础和临床研究论文、研究快报等. 对具有中国特色的研究论文, 如食管癌、胃癌、肝癌、大肠癌、病毒性肝炎、幽门螺杆菌、中医中药、中西医结合和基于作者自己研究工作为主的综述性论文, 将优先发表. 读者对象为基础研究或临床研究的消化专业工作者。
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    National trends in resection of the distal pancreas

    Armando Rosales-VelderrainSteven P BowersRoss F GoldbergTatyan M Clarke...
    4342-4349页
    查看更多>>摘要：AIM:To investigate national trends in distal pancreatectomy (DP) through query of three national patient care databases.METHODS:From the Nationwide Inpatient Sample (NIS,2003-2009),the National Surgical Quality Improvement Project (NSQIP,2005-2010),and the Surveillance Epidemiology and End Results (SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy.Utilization of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code; and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes.In SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure codes.We analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection.RESULTS:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,respectively.Overall,laparoscopy was utilized in 15％ (NIS) and 27％ (NSQIP).No significant increase was seen over the course of the study.Resection was performed for malignancy in 59％ (NIS) and 66％ (NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach (P =0.95 and P =0.96,respectively).Mortality (3％ vs 2％,P =0.05) and reoperation (4％ vs 4％,P =1.0) was not different between laparoscopy and open groups.Overall complications (10％ vs 15％,P ＜ 0.001),hospital costs [44 741 dollars,interquartile range (IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P =0.02] and hospital length of stay (7 d,IQR 4-11 d vs 7 d,IQR 6-10,P ＜0.001) were less when laparoscopy was utilized.One and two year survival after resection for malignancy were unchanged over the course of the study (ductal adenocarinoma 1-year 63.6％ and 2-year 35.1％,P =0.53; intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90％ and 2-year 84％,P =0.25).The majority of resections were performed in teaching hospitals (77％ NIS and 85％ NSQIP),but minimally invasive surgery (MIS) was not more likely to be used in teaching hospitals (15％ vs 14％,P =0.26).Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles (88％ vs 43％,P ＜ 0.001),but were no more likely to utilize MIS at resection.Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching (15％ vs 14％,P =0.72)and lower volume hospitals (14％ vs 15％,P =0.99).No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year (P =0.17 and P =0.96,respectively).CONCLUSION:There appears to be an overall underutilization of laparoscopy for DP.Centralization does not appear to be occurring.Survival and lymph node harvest have not changed.
      原文链接:
    • NETL
    • NSTL
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    • 维普

    Chronic methadone use, poor bowel visualization and failed colonoscopy: A preliminary study

    Siddharth VermaJoshua FogelDavid J BeydaBrett Bernstein...
    4350-4356页
    查看更多>>摘要：AIM:To examine effects of chronic methadone usage on bowel visualization,preparation,and repeat colonoscopy.METHODS:In-patient colonoscopy reports from October,2004 to May,2009 for methadone dependent (MD) patients were retrospectively evaluated and compared to matched opioid naive controls (C).Strict criteria were applied to exclude patients with risk factors known to cause constipation or gastric dysmotility.Colonoscopy reports of all eligible patients were analyzed for degree of bowel visualization,assessment of bowel preparation (good,fair,or poor),and whether a repeat colonoscopy was required.Bowel visualization was scored on a 4 point scale based on multiple prior studies:excellent =1,good =2,fair =3,or poor =4.Analysis of variance (ANOVA) and Pearson x2 test were used for data analyses.Subgroup analysis included correlation between methadone dose and colonoscopy outcomes.All variables significantly differing between MD and C groups were included in both univariate and multivariate logistic regression analyses.P values were two sided,and ＜0.05 were considered statistically significant.RESULTS:After applying exclusionary criteria,a total of 178 MD patients and 115 C patients underwent a colonoscopy during the designated study period.A total of 67 colonoscopy reports for MD patients and 72 for C were included for data analysis.Age and gender matched controls were randomly selected from this population to serve as controls in a numerically comparable group.The average age for MD patients was 52.2 ± 9.2 years (range:32-72 years) years compared to 54.6 ± 15.5 years (range:20-81 years) for C (P =0.27).Sixty nine percent of patients in MD and 65％ in C group were males (P =0.67).When evaluating colonoscopy reports for bowel visualization,MD patients had significantly greater percentage of solid stool (i.e.,poor visualization) compared to C (40.3％ vs 6.9％,P ＜ 0.001).Poor bowel preparation (35.8％ vs 9.7％,P ＜ 0.001) and need for repeat colonoscopy (32.8％ vs 12.5％,P =0.004) were significantly higher in MD group compared to C,respectively.Under univariate analysis,factors significantly associated with MD group were presence of fecal particulate [odds ratio (OR),3.89,95％ CI:1.33-11.36,P =0.01] and solid stool (OR,13.5,95％ CI:4.21-43.31,P ＜ 0.001).Fair (OR,3.82,95％ CI:1.63-8.96,P =0.002) and poor (OR,8.10,95％ CI:3.05-21.56,P ＜ 0.001) assessment of bowel preparation were more likely to be associated with MD patients.Requirement for repeat colonoscopy was also significant higher in MD group (OR,3.42,95％ CI:1.44-8.13,P =0.01).In the multivariate analyses,the only variable independently associated with MD group was presence of solid stool (OR,7.77,95％ CI:1.66-36.47,P =0.01).Subgroup analysis demonstrated a general trend towards poorer bowel visualization with higher methadone dosage.ANOVA analysis demonstrated that mean methadone dose associated with presence of solid stool (poor visualization) was significantly higher compared to mean dosage for clean colon (excellent visualization,P =0.02) or for those with liquid stool only (good visualization,P =0.01).CONCLUSION:Methadone dependence is a risk factor for poor bowel visualization and leads to more repeat colonoscopies.More aggressive bowel preparation may be needed in MD patients.
      原文链接:
    • NETL
    • NSTL
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    Predictive value of symptoms and demographics in diagnosing malignancy or peptic stricture

    Iain A MurrayJoanne PalmerCarolyn WatersHarry R Dalton...
    4357-4362页
    查看更多>>摘要：AIM:To determine which features of history and demographics predict a diagnosis of malignancy or peptic stricture in patients presenting with dysphagia.METHODS:A prospective case-control study of 2000 consecutive referrals (1031 female,age range:17-103 years) to a rapid access service for dysphagia,based in a teaching hospital within the United Kingdom,over 7 years.The service consists of a nurse-led telephone triage followed by investigation (barium swallow or gastroscopy),if appropriate,within 2 wk.Logistic regression analysis of demographic and clinical variables was performed.This includes age,sex,duration of dysphagia,whether to liquids or solids,and whether there are associated features (reflux,odynophagia,weight loss,regurgitation).We determined odds ratio (OR) for these variables for the diagnoses of malignancy and peptic stricture.We determined the value of the Edinburgh Dysphagia Score (EDS) in predicting cancer in our cohort.Multivariate logistic regression was performed and P ＜ 0.05 considered significant.The local ethics committee confirmed ethics approval was not required (audit).RESULTS:The commonest diagnosis is gastro-esophageal reflux disease (41.3％).Malignancy (11.0％) and peptic stricture (10.0％) were also relatively common.Malignancies were diagnosed by histology (97％) or on radiological criteria,either sequential barium swallows showing progression of disease or unequivocal evidence of malignancy on computed tomography.The majority of malignancies were esophago-gastric in origin but ear,nose and throat tumors,pancreatic cancer and extrinsic compression from lung or mediastinal metastatic cancer were also found.Malignancy was statistically more frequent in older patients (aged ＞73 years,OR 1.1-3.3,age ＜ 60 years 6.5％,60-73 years 11.2％,＞ 73 years 11.8％,P ＜ 0.05),males (OR 2.2-4.8,males 14.5％,females 5.6％,P ＜ 0.0005),short duration of dysphagia (≤ 8 wk,OR 4.5-20.7,16.6％,8-26 wk 14.5％,＞ 26 wk 2.5％,P ＜ 0.0005),progressive symptoms (OR 1.3-2.6:progressive 14.8％,intermittent 9.3％,P ＜ 0.001),with weight loss of ≥ 2 kg (OR 2.5-5.1,weight loss 22.1％,without weight loss 6.4％,P ＜ 0.0005) and without reflux (OR 1.2-2.5,reflux 7.2％,no reflux 15.5％,P ＜ 0.0005).The likelihood of malignancy was greater in those who described true dysphagia (food or drink sticking within 5 s of swallowing than those who did not (15.1％ vs 5.2％ respectively,P ＜ 0.001).The sensitivity,specificity,positive predictive value and negative predictive value of the EDS were 98.4％,9.3％,11.8％ and 98.0％ respectively.Three patients with an EDS of 3 (high risk EDS ≥ 3.5) had malignancy.Unlike the original validation cohort,there was no difference in likelihood of malignancy based on level of dysphagia (pharyngeal level dysphagia 11.9％ vs mid sternal or lower sternal dysphagia 12.4％).Peptic stricture was statistically more frequent in those with longer duration of symptoms (＞ 6 mo,OR 1.2-2.9,≤ 8 wk 9.8％,8-26 wk 10.6％,＞ 26 wk 15.7％,P ＜ 0.05) and over 60 s (OR 1.2-3.0,age ＜ 60 years 6.2％,60-73 years 10.2％,＞ 73 years 10.6％,P ＜ 0.05).CONCLUSION:Malignancy and peptic stricture are frequent findings in those referred with dysphagia.The predictive value for associated features could help determine need for fast track investigation whilst reducing service pressures.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

    Nicola de BortoliAndrea NacciEdoardo SavarinoIrene Martinucci...
    4363-4370页
    查看更多>>摘要：AIM:To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale,GIS; visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD),pathological acid exposure time (AET) in the absence of esophageal erosions (NERD),and a positive correlation between symptoms and refluxes (hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52 (14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41),linear indentation in the medial edge of the vocal fold (31/41),vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P ＜ 0.05); conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P ＜ 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients,and ineffective esophageal motility was found in 3/41 patients.The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AEF and a positive association between symptoms and refluxes (HE),and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients).It is noteworthy that HE patients had a positive association with typical GERD-related symptoms.Gas refluxes were found more frequently in patients with globus (29.7 ± 3.6) and hoarseness (21.5 ± 7.4)than in patients with heartburn or regurgitation (7.8 ±6.2).Gas refluxes were positively associated with extraesophageal symptoms (P ＜ 0.05).Overall,no differences were found among the three groups of patients in terms of the frequency of laryngeal signs.The proximal reflux was abnormal in patients with ERD/NERD only.The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD,HE,no GERD) were not demonstrated with the RSI and RFS.Moreover,only the number of gas refluxes was found to have a significant association with the RFS (P =0.028 and P =0.026,nominal and numerical correlation,respectively).CONCLUSION:MII-pH analysis confirmed GERD diagnosis in less than 40％ of patients with previous diagnosis of LPR,most likely because of the low specificity of the laryngoscopic findings.
      原文链接:
    • NETL
    • NSTL
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    • 维普

    Alginate controls heartburn in patients with erosive and nonerosive reflux disease

    Edoardo SavarinoNicola de BortoliPatrizia ZentilinIrene Martinucci...
    4371-4378页
    查看更多>>摘要：AIM:To evaluate the effect of a novel alginate-based compound,Faringel,in modifying reflux characteristics and controlling symptoms.METHODS:In this prospective,open-label study,40 patients reporting heartburn and regurgitation with proven reflux disease (i.e.,positive impedance-pH test/evidence of erosive esophagitis at upper endoscopy) underwent 2 h impedance-pH testing after eating a refluxogenic meal.They were studied for 1 h under basal conditions and 1 h after taking 10 mL Faringel.In both sessions,measurements were obtained in right lateral and supine decubitus positions.Patients also completed a validated questionnaire consisting of a 2-item 5-point (0-4) Likert scale and a 10-cm visual analogue scale (VAS) in order to evaluate the efficacy of Faringel in symptom relief.Tolerability of the treatment was assessed using a 6-point Likert scale ranging from very good (1) to very poor (6).RESULTS:Faringel decreased significantly (P ＜ 0.001),in both the right lateral and supine decubitus positions,esophageal acid exposure time [median 10 (25th-75th percentil 6-16) vs 5.8 (4-10) and 16 (11-19) vs 7.5 (5-11),respectively] and acid refluxes [5 (3-8) vs 1 (1-1) and 6 (4-8) vs 2 (1-2),respectively],but increased significantly (P ＜ 0.01) the number of nonacid reflux events compared with baseline [2 (1-3) vs 3 (2-5) and 3 (2-4) vs 6 (3-8),respectively].Percentage of proximal migration decreased in both decubitus positions (60％ vs 32％ and 64％ vs 35％,respectively; P ＜ 0.001).Faringel was significantly effective in controlling heartburn,based on both the Likert scale [3.1(range 1-4) vs 0.9 (0-2); P ＜ 0.001] and VAS score [7.1 (3-9.8) vs 2 (0.1-4.8); P ＜ 0.001],but it had less success against regurgitation,based on both the Likert scale [2.6 (1-4) vs 2.2 (1-4); P =not significant (NS)]and VAS score [5.6 (2-9.6) vs 3.9 (1-8.8); P =NS].Overall,the tolerability of Faringel was very good 5(2-6),with only two patients reporting modest adverse events (i.e.,nausea and bloating).CONCLUSION:Our findings demonstrate that Faringel is well-tolerated and effective in reducing heartburn by modifying esophageal acid exposure time,number of acid refluxes and their proximal migration.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Prevalence of functional dyspepsia and its subgroups in patients with eating disorders

    Antonella SantonicolaMonica SiniscalchiPietro CaponeSerena Gallotta...
    4379-4385页
    查看更多>>摘要：AIM:To study the prevalence of functional dyspepsia (FD) (Rome Ⅲ criteria) across eating disorders (ED),obese patients,constitutional thinner and healthy volunteers.METHODS:Twenty patients affected by anorexia nervosa,6 affected by bulimia nervosa,10 affected by ED not otherwise specified according to diagnostic and statistical manual of mental disorders,4th edition,nine constitutional thinner subjects and,thirtytwo obese patients were recruited from an outpatients clinic devoted to eating behavior disorders.Twentytwo healthy volunteers matched for age and gender were enrolled as healthy controls.All participants underwent a careful clinical examination.Demographic and anthropometric characteristics were obtained from a structured questionnaires.The presence of FD and,its subgroups,epigastric pain syndrome and postprandial distress syndrome (PDS) were diagnosed according to Rome Ⅲ criteria.The intensity-frequency score of broader dyspeptic symptoms such as early satiety,epigastric fullness,epigastric pain,epigastric burning,epigastric pressure,belching,nausea and vomiting were studied by a standardized questionnaire (0-6).Analysis of variance and post-hoc Sheffè tests were used for comparisons.RESULTS:90％ of patients affected by anorexia nervosa,83.3％ of patients affected by bulimia nervosa,90％ of patients affected by ED not otherwise specified,55.6％ of constitutionally thin subjects and 18.2％ healthy volunteers met the Postprandial Distress Syndrome Criteria (x2,P ＜ 0.001).Only one bulimic patient met the epigastric pain syndrome diagnosis.Postprandial fullness intensity-frequency score was significantly higher in anorexia nervosa,bulimia nervosa and ED not otherwise specified groups compared to the score calculated in the constitutional thinner group (4.15 ± 2.08 vs 1.44 ± 2.35,P =0.003; 5.00 ±2.45 vs 1.44 ± 2.35,P =0.003; 4.10 ± 2.23 vs 1.44 ±2.35,P =0.002,respectively),the obese group (4.15 ± 2.08 vs 0.00 ± 0.00,P ＜ 0.001; 5.00 ± 2.45 vs 0.00 ± 0.00,P ＜ 0.001; 4.10 ± 2.23 vs 0.00 ± 0.00,P ＜0.001,respectively) and healthy volunteers (4.15 ± 2.08 vs 0.36 ± 0.79,P ＜ 0.001; 5.00 ± 2.45 vs 0.36 ± 0.79,P ＜ 0.001; 4.10 ± 2.23 vs 0.36 ± 0.79,P ＜0.001,respectively).Early satiety intensity-frequency score was prominent in anorectic patients compared to bulimic patients (3.85 ± 2.23 vs 1.17 ± 1.83,P =0.015),obese patients (3.85 ± 2.23 vs 0.00 ± 0.00,P ＜ 0.001) and healthy volunteers (3.85 ± 2.23 vs 0.05 ± 0.21,P ＜ 0.001).Nausea and epigastric pressure were increased in bulimic and ED not otherwise specified patients.Specifically,nausea intensity-frequencyscore was significantly higher in bulimia nervosa and ED not otherwise specified patients compared to anorectic patients (3.17 ± 2.56 vs 0.89 ± 1.66,P =0.04;2.70 ± 2.91 vs 0.89 ± 1.66,P =0.05,respectively),constitutional thinner subjects (3.17 ± 2.56 vs 0.00 ± 0.00,P =0.004; 2.70 ± 2.91 vs 0.00 ± 0.00,P =0.005,respectively),obese patients (3.17 ± 2.56 vs 0.00 ±0.00,P ＜ 0,001; 3.17 ± 2.56 vs 0.00 ± 0.00,P ＜ 0.001 respectively) and,healthy volunteers (3.17 ± 2.56 vs 0.17 ± 0.71,P =0.002; 3.17 ± 2.56 vs 0.17 ± 0.71,P =0.001,respectively).Epigastric pressure intensityfrequency score was significantly higher in bulimic and ED not otherwise specified patients compared to constitutional thin subjects (4.67 ± 2.42 vs 1.22 ± 1.72,P =0.03; 4.20 ± 2.21 vs 1.22 ± 1.72,P =0.03,respectively),obese patients (4.67 ± 2.42 vs 0.75 ± 1.32,P =0.001; 4.20 ± 2.21 vs 0.75 ± 1.32,P ＜ 0.001,respectively) and,healthy volunteers (4.67 ± 2.42 vs 0.67 ± 1.46,P =0.001; 4.20 ± 2.21 vs 0.67 ± 1.46,P =0.001,respectively).Vomiting was referred in 100％ of bulimia nervosa patients,in 20％ of ED not otherwise specified patients,in 15％ of anorexia nervosa patients,in 22％ of constitutional thinner subjects,and,in 5.6％ healthy volunteers (x2,P ＜ 0.001).CONCLUSION:PDS is common in eating disorders.Is it mandatory in outpatient gastroenterological clinics to investigate eating disorders in patients with PDS?
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Quadruple therapy with moxifloxacin and bismuth for first-line treatment of Helicobacter pylori

    Antonio Francesco CiccaglioneLuigina CelliniLaurino GrossiLeonardo Marzio...
    4386-4390页
    查看更多>>摘要：AIM:To compare triple therapy vs quadruple therapy for 10 d as first-line treatment of Helicobacterpylori (H.pylori) infection.METHODS:Consecutive H.pylori positive patients never treated in the past for this infection were randomly treated with triple therapy of pantoprazole (PAN) 20 mg bid,amoxicillin (AMO) 1 g bid and moxifloxacin (MOX) 400 mg bid for 10 d (PAM) or with quadruple therapy of PAN 20 mg bid,AMO 1 g bid,MOX 400 mg bid and bismuth subcitrate 240 mg bid for 10 d (PAMB).All patients were found positive at 13 C-Urea breath test (UBT) performed within ten days prior to the start of the study.A successful outcome was confirmed with an UBT performed 8 wk after the end of treatment.x2 analysis was used for statistical comparison.Per protocol (PP) and intention-to-treat (ITT) values were also calculated.RESULTS:Fifty-seven patients were enrolled in the PAM group and 50 in the PAMB group.One patient in each group did not return for further assessment.Eradication was higher in the PAMB group (negative:46 and positive:3) vs the PAN group (negative:44 and positive:12).The H.pylori eradication rate was statistically significantly higher in the PAMB group vs the PAM group,both with the PP and ITT analyses (PP:PAMB 93.8％,PAM 78.5％,P ＜ 0.02; ITT:PAMB 92％,PAM 77.1％,P ＜0.03).CONCLUSION:The addition of bismuth subcitrate can be considered a valuable adjuvant to triple therapy in those areas where H.pylori shows a high resistance to fluoroquinolones.
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    • NETL
    • NSTL
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    Adalimumab in prevention of postoperative recurrence of Crohn's disease in high-risk patients

    Mariam AguasGuillermo BastidaElena CerrilloBelén Beltrán...
    4391-4398页
    查看更多>>摘要：AIM:To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn's disease in high-risk patients.METHODS:A multicenter,prospective,observational study was conducted from June 2009 until June 2010.We consecutively included high-risk Crohn's disease patients who had undergone an ileal/ileocolonic resection.High-risk patients were defined as two or more criteria:smokers,penetrating pattern,one or more previous surgical resections or prior extensive resection.Subcutaneous adalimumab was administered 2 wk (±5 d) after surgery at a dose of 40 mg eow,with an initial induction dose of 160/80 mg at weeks 0 and 2.Demographic data,previous and concomitant treatments (antibiotics,5-aminosalicylates,corticosteroids,immunomodulators or biologic therapies),smoking status at the time of diagnosis and after the index operation and number of previous resections (type and reason for surgery) were all recorded.Biological status was assessed with C-reactive protein,erythrocyte sedimentation rate and fecal calprotectin.One year (± 3 mo) after surgery,an ileocolonoscopy and/or magnetic resonance enterography was performed.Endoscopic recurrence was defined as Rutgeerts score ≥ i2.Morphological recurrence was based on magnetic resonance (MR) score ≥ MR1.RESULTS:Twenty-nine patients (55.2％ males,48.3％ smokers at diagnosis and 13.8％ after the index operation),mean age 42.3 years and mean duration of the disease 13.8 years were included in the study.A mean of 1.76 (range:1-4) resections previous to adalimumab administration and in 37.9％ was considered extensive resection.51.7％ had previously received infliximab.Immunomodulators were given concomitantly to 17.2％ of patients.Four of the 29 (13.7％) developed clinical recurrence,6/29 (20.7％) endoscopic recurrence and 7/19 (36.8％) morphological recurrence after 1-year.All patients with clinical recurrence showed endoscopic and morphological recurrence.A high degree of concordance was found between clinical-endoscopic recurfence (κ =0.76,P ＜ 0.001) and clinical-morphological recurrence (κ =0.63,P =0.003).Correlation between endoscopic and radiological findings was good (comparing the 5-point Rutgeerts score with the 4-point MR score,a score of i4 was classified as MR3,i3 as MR2,and i2-i1 as MR1) (P ＜ 0.001,rs =0.825).During follow-up,five (17.2％) patients needed adalimumab dose intensification (40 mg/wk); Mean time to intensification after the introduction of adalimumab treatment was 8 mo (range:5 to 11 mo).In three cases (10.3％),a biological change was needed due to a worsening of the disease after the dose intensification to 40 mg/wk.One patient suffered an adverse event.CONCLUSION:Adalimumab seems to be effective and safe in preventing postoperative recurrence in a selected group of patients who had undergone an intestinal resection for their CD.
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    • NETL
    • NSTL
    • 万方数据
    • 维普

    Tissue transglutaminase levels above 100 U/mL and celiac disease: A prospective study

    Amani MubarakVictorien M WoltersFrits HJ Gmelig-MeylingFiebo JW ten Kate...
    4399-4403页
    查看更多>>摘要：AIM:To investigate whether a tissue-transglutaminase antibody (tTGA) level ≥ 100 U/mL is sufficient for the diagnosis of celiac disease (CD).METHODS:Children suspected of having CD were prospectively included in our study between March 2009 and September 2011.All patients with immune globulin A deficiency and all patients on a gluten-free diet were excluded from the study.Anti-endomysium antibodies (EMA) were detected by means of immunofluorescence using sections of distal monkey esophagus (EUROIMMUN,Luebeck,Germany).Serum anti-tTGA were measured by means of enzyme-linked immunosorbent assay using human recombinant tissue transglutaminase (ELiA Celikey IgA kit Phadia AB,Uppsala,Sweden).The histological slides were graded by a single experienced pathologist using the Marsh classification as modified by Oberhuber.Marsh Ⅱ and Ⅲ lesions were considered to be diagnostic for the disease.The positive predictive values (PPVs),negative predictive values (NPVs),sensitivity and specificity of EMA and tTGA along with their 95％ CI (for the cut off values ＞ 10 and ≥ 100 U/mL) were calculated using histology as the gold standard for CD.RESULTS:A total of 183 children were included in the study.A total of 70 (38.3％) were male,while 113 (61.7％) were female.The age range was between 1.0 and 17.6 years,and the mean age was 6.2 years.One hundred twenty (65.6％) patients had a small intestinal biopsy diagnostic for the disease; 3 patients had a Marsh Ⅱ lesion,and 117 patients had a Marsh Ⅲ lesion.Of the patients without CD,only 4 patients had a Marsh Ⅰ lesion.Of the 183 patients,136 patients were positive for EMA,of whom 20 did not have CD,yielding a PPV for EMA of 85％ (95％ CI:78％-90％) and a corresponding specificity of 68％ (95％ CI:55％-79％).The NPV and specificity for EMA were 91％ (95％ CI:79％-97％) and 97％ (95％ CI:91％-99％),respectively.Increased levels of tTGA were found in 130 patients,although only 116 patients truly had histological evidence of the disease.The PPV for tTGA was 89％ (95％ CI:82％-94％),and the corresponding specificity was 78％ (95％ CI:65％-87％).The NPV and sensitivity were 92％ (95％ CI:81％-98％) and 97％ (95％ CI:91％-99％),respectively.A tTGA level ≥ 100 U/mL was found in 87 (47.5％) patients,all of whom were also positive for EMA.In all these 87 patients,epithelial lesions confirming CD were found,giving a PPV of 100％ (95％CI:95％-100％).The corresponding specificity for this cutoff value was also 100％ (95％ CI:93％-100％).Within this group,a total of 83 patients had symptoms,at least gastrointestinal and/or growth retardation.Three patients were asymptomatic but were screened because they belonged to a group at risk for CD (diabetes mellitus type 1 or positive family history).The fourth patient who lacked CD-symptoms was detected by coincidence during an endoscopy performed for gastro-intestinal bleeding.CONCLUSION:This study confirms based on prospective data that a small intestinal biopsy is not necessary for the diagnosis of CD in symptomatic patients with tTGA ≥ 100 U/mL.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    Comparison of bacterial quantities in left and right colon biopsies and faeces

    Anna LyraSofia ForsstenPeter RolnyYvonne Wettergren...
    4404-4411页
    查看更多>>摘要：AIM:To compare quantities of predominant and pathogenic bacteria in mucosal and faecal samples.METHODS:Twenty patients undergoing diagnostic colonoscopy with endoscopically and histologically normal mucosa were recruited to the study,14 subjects of which also supplied faecal (F) samples between 15 d to 105 d post colonoscopy.Mucosal biopsies were taken from each subject from the midportion of the ascending colon (right side samples,RM) and the sigmoid (left side samples,LM).Predominant intestinal and mucosal bacteria including clostridial 165 rRNA gene clusters Ⅳ and Ⅹ Ⅳ ab,Bacteroidetes,Enterobacteriaceae,Bifidobacterium spp.,Akkermansia muciniphila (A.muciniphila),Veillonella spp.,Collinsella spp.,Faecalibacterium prausnitzii (F.prausnitzii) and putative pathogens such as Escherichia coli (E.coli),Clostridium difficile (C.difficile),Helicobacter pylori (H.pylori) and Staphylococcus aureus (S.aureus) were analysed by quantitative polymerase chain reaction (qPCR).Host DNA was quantified from the mucosal samples with human glyceraldehyde 3-phosphate dehydrogenase gene targeting qPCR.Paired t tests and the Pearson correlation were applied for statistical analysis.RESULTS:The most prominent bacterial groups were clostridial groups Ⅳ and ⅩⅣa+b and Bacteroidetes and bacterial species F.prausnitzii in both sample types.H.pylori and S.aureus were not detected and C.difficile was detected in only one mucosal sample and three faecal samples.E.coli was detected in less than half of the mucosal samples at both sites,but was present in all faecal samples.All detected bacteria,except Enterobacteriaceae,were present at higher levels in the faeces than in the mucosa,but the different locations in the colon presented comparable quantities (RM,LM and F followed by P1 for RM vs F,P2 for LM vs F and P3 for RM vs LM:4.17±0.60 log10/g,4.16±0.56 log10/g,5.88±1.92 log10/g,P1 =0.011,P2 =0.0069,P3 =0.9778 forA.muciniphila; 6.25 ± 1.3 log10/g,6.09 ± 0.81 log10/g,8.84 ± 1.38 log10/g,P1 ＜ 0.0001,P2 =0.0002,P3 =0.6893for Bacteroidetes; 5.27 ± 1.68 log10/g,5.38 ± 2.06 log10/g,8.20 ± 1.14 log10/g,P1 ＜ 0.0001,P2 ≤ 0.0001,P3 =0.7535 for Bifidobacterium spp.; 6.44 ± 1.15 log10/g,6.07 ±1.45 log10/g,9.74±1.13 log10/g,P1 ＜ 0.0001,P2 ≤0.0001,P3 =0.637 for Clostridium cluster Ⅳ; 6.65 ± 1.23log10/g,6.57 ± 1.52 log10/g,9.13± 0.96 log10/g,P1 ＜0.0001,P2 ≤ 0.0001,P3 =0.9317 for Clostridium cluster ⅩⅣa; 4.57 ± 1.44 log10/g,4.63 ± 1.34 log10/g,7.05 ±2.48 log10/g,P1 =0.012,P2 =0.0357,P3 =0.7973 for Collinsella spp.; 7.66 ± 1.50 log10/g,7.60 ± 1.05 log10/g,10.02 ± 2.02 log10/g,P1 ≤ 0.0001,P2 =0.0013,P3 =0.9919 forF.prausnitzsii; 6.17 ± 1.3 log10/g,5.85 ± 0.93 log10/g,7.25 ± 1.01 log10/g,P1 =0.0243,P2 =0.0319,P3 =0.6982 for Veillonella spp.; 4.68 ± 1.21 log10/g,4.71 ± 0.83 log10/g,5.70 ± 2.00 log10/g,P1 =0.1927,P2 =0.0605,P3 =0.6476 for Enterobacteriaceae).The Bifidobacterium spp.counts correlated significantly between mucosal sites and mucosal and faecal samples (Pearson correlation coefficients 0.62,P =0.040 and 0.81,P =0.005 between the right mucosal sample and faeces and the left mucosal sample and faeces,respectively).CONCLUSION:Non-invasive faecal samples do not reflect bacterial counts on the mucosa at the individual level,except for bifidobacteria often analysed in probiotic intervention studies.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普