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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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    Biliary cysts: Etiology, diagnosis and management

    Beata Jablo(n)ska
    4801-4810页
    查看更多>>摘要：Biliary cysts (BC) are rare dilatations of different parts of a biliary tract.They account for approximately 1％ of all benign biliary diseases.BC occur the most frequently in Asian and female populations.They are an important problem for pediatricians,gastroenterologists,radiologists and surgeons.Clinical presentation and management depend on the BC type.Cholangiocarcinoma is the most serious and dangerous BC complication.The other complications associated with BC involve cholelithiasis and hepatolithiasis,cholangitis,acute and chronic pancreatitis,portal hypertension,liver fibrosis and secondary liver cirrhosis and spontaneous cyst perforation.Different BC classifications have been described in the literature.Todani classification dividing BC into five types is the most useful in clinical practice.The early diagnosis and proper treatment are very important,because BC are associated with a risk of carcinogenesis.A malignancy risk increases with the age.Radiological investigations (ultrasonography,computed tomography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography) play an important role in BC diagnostics.Currently,prenatal diagnosis using ultrasonography is possible.It allows to differentiate biliary disorders in fetals and to perform the early surgical treatment that improves results.In most patients,total cyst excision with Roux-Y hepaticojejunostomy is the treatment of choice.Surgical treatment of BC is associated with high success rate and low morbidity and mortality.The early treatment is associated with a lower number of complications.Patients following BC surgery require permanent and careful postoperative observation using laboratory and imaging investigations because of possibility of biliary anastomosis stricture and biliary cancer in tissue remnant.
      原文链接:
    • NETL
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    Quality of ulcer healing in gastrointestinal tract: Its pathophysiology and clinical relevance

    Tetsuo ArakawaToshio WatanabeTetsuya TanigawaKazunari Tominaga...
    4811-4822页
    查看更多>>摘要：In this paper,we review the concept of quality of ulcer healing (QOUH) in the gastrointestinal tract and its role in the ulcer recurrence.In the past,peptic ulcer disease (PUD) has been a chronic disease with a cycle of repeated healing/remission and recurrence.The main etiological factor of PUD is Helicobacter pylori (H.pylori),which is also the cause of ulcer recurrence.However,H.pylori-negative ulcers are present in 12％-20％ of patients; they also recur and are on occasion intractable.QOUH focuses on the fact that mucosal and submucosal structures within ulcer scars are incompletely regenerated.Within the scars of healed ulcers,regenerated tissue is immature and with distorted architecture,suggesting poor QOUH.The abnormalities in mucosal regeneration can be the basis for ulcer recurrence.Our studies have shown that persistence of macrophages in the regenerated area plays a key role in ulcer recurrence.Our studies in a rat model of ulcer recurrence have indicated that proinflammatory cytokines trigger activation of macrophages,which in turn produce increased amounts of cytokines and chemokines,which attract neutrophils to the regenerated area.Neutrophils release proteolytic enzymes that destroy the tissue,resulting in ulcer recurrence.Another important factor in poor QOUH can be deficiency of endogenous prostaglandins and a deficiency and/or an imbalance of endogenous growth factors.Topically active mucosal protective and antiulcer drugs promote high QOUH and reduce inflammatory cell infiltration in the ulcer scar.In addition to PUD,the concept of QOUH is likely applicable to inflammatory bowel diseases including Crohn's disease and ulcerative colitis.
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    Use of the tumor necrosis factor-blockers for Crohn's disease

    Alan BR ThomsonMilli GuptaHugh J Freeman
    4823-4854页
    查看更多>>摘要：The use of anti-tumor necrosis factor-α therapy for inflammatory bowel disease represents the most important advance in the care of these patients since the publication of the National Co-operative Crohn's disease study thirty years ago.The recommendations of numerous consensus groups worldwide are now supported by a wealth of clinical trials and several meta-analyses.In general,it is suggested that tumor necrosis factor-α blockers (TNFBs) are indicated (1)for persons with moderately-severe Crohn's disease or ulcerative colitis (UC) who have failed two or more causes of glucocorticosteroids and an acceptably long cause (8 wk to 12 wk) of an immune modulator such as azathioprine or methotrexate; (2) non-responsive perianal disease; and (3) severe UC not responding to a 3-d to 5-d course of steroids.Once TNFBs have been introduced and the patient is responsive,therapy given by the IV and SC rate must be continued.It remains open to definitive evidence if concomitant immune modulators are required with TNFB maintenance therapy,and when or if TNFB may be weaned and discontinued.The supportive evidence from a single study on the role of early versus later introduction of TNFB in the course of a patient's illness needs to be confirmed.The risk/benefit profile of TNFB appears to be acceptable as long as the patient is immunized and tested for tuberculosis and viral hepatitis before the initiation of TNFB,and as long as the long-term adverse effects on the development of lymphoma and other tumors do not prone to be problematic.Because the rates of benefits to TNFB are modest from a population perspective and the cost of therapy is very high,the ultimate application of use of TNFBs will likely be established by cost/benefit studies.
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    Role for mycobacterial infection in pathogenesis of primary biliary cirrhosis?

    Daniel SmykEirini I RigopoulouYoh ZenRobin Daniel Abeles...
    4855-4865页
    查看更多>>摘要：Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterized by the immunemediated destruction of biliary epithelial cells in small intrahepatic bile ducts.The disease is characterized by circulating antimitochondrial antibodies (AMAs) as well as disease-specific antinuclear antibodies,cholestatic liver function tests,and characteristic histological features,including granulomas.A variety of organisms are involved in granuloma formation,of which mycobacteria are the most commonly associated.This has led to the hypothesis that mycobacteria may be involved in the pathogenesis of PBC,along with other infectious agents.Additionally,AMAs are found in a subgroup of patients with mycobacterial infections,such as leprosy and pulmonary tuberculosis.Antibodies against species-specific mycobacterial proteins have been reported in patients with PBC,but it is not clear whether these antibodies are specific for the disease.In addition,data in support of the involvement of the role of molecular mimicry between mycobacterial and human mitochondrial antigens as triggers of cross-reactive immune responses leading to the loss of immunological tolerance,and the induction of pathological features have been published.Thus,antibodies against mycobacterial heat shock protein appear to cross-recognize AMA-specific autoantigens,but it is not clear whether these autoantibodies are mycobacterium-species-specific,and whether they are pathogenic or incidental.The view that mycobacteria are infectious triggers of PBC is intriguing,but the data provided so far are not conclusive.
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    Indomethacin but not a selective cyclooxygenase-2 inhibitor inhibits esophageal adenocarcinogenesis in rats

    Paula EsquiviasAntonio MorandeiraAlfredo EscartínCarmelo Cebrián...
    4866-4874页
    查看更多>>摘要：AIM:To evaluate the effects of indomethacin [dual cyclooxygenase (COX)-1/COX-2 inhibitor] and 3-(3,4-difluorophenyl)-4-(4-(methylsulfonyl) phenyl)-2-(5H)-furanone (MF-tricyclic) (COX-2 selective inhibitor) in a rat experimental model of Barrett's esophagus and esophageal adenocarcinoma.METHODS:A total of 112 surviving post-surgery rats were randomly divided into three groups:the control group (n =48),which did not receive any treatment; the indomethacin group (n =32),which were given 2mg/kg per day of the COX-1/COX-2 inhibitor; and the MF-tricyclic group (n =32),which received 10 mg/kg per day of the selective COX-2 inhibitor.Randomly selected rats were killed either 8 wk or 16 wk after surgery.The timing of the deaths was in accordance with a previous study performed in our group.Only rats that were killed at the times designated by the protocol were included in the study.We then assessed the histology and prostaglandin E2 (PGE2) expression levels in the rat esophagi.An additional group of eight animals that did not undergo esophagojejunostomy were included in order to obtain normal esophageal tissue as a control.RESULTS:Compared to a control group with no treatment (vehicle-treated rats),indomethacin treatment was associated with decreases in ulcerated esophageal mucosa (16％ vs 35％ and 14％ vs 17％,2 mo and 4mo after surgery,respectively; P =0.021),length of intestinal metaplasia in continuity with anastomosis (2± 1.17 mm vs 2.29 ± 0.75 mm and 1.25 ± 0.42 mm vs 3.5 ± 1.54 mm,2 mo and 4 mo after surgery,respectively; P =0.007),presence of intestinal metaplasia beyond anastomosis (20％ vs 71.4％ and 0％ vs 60％,2 mo and 4 mo after surgery,respectively; P =0.009),severity of dysplasia (0％ vs 71.4％ and 20％ vs 85.7％high-grade dysplasia,2 mo and 4 mo after surgery,respectively; P =0.002),and adenocarcinoma incidence (0％ vs 57.1％ and 0％ vs 60％,2 mo and 4 mo after surgery,respectively; P ＜ 0.0001).Treatment with the selective COX-2 inhibitor,MF-tricyclic,did not prevent development of intestinal metaplasia or adenocarcinoma.In parallel,we observed a significant decrease in PGE2 levels in indomethacin-treated rats,but not in those treated with MF-tricyclic,at both 2 mo and 4 mo.Compared to control rats that did not undergo surgery (68 ± 8 ng/g,P =0.0022 Kruskal-Wallis test) there was a significant increase in PGE2 levels in the esophageal tissue of the rats that underwent surgery either 2 mo (1332 ± 656 ng/g) or 4 mo (1121 ± 1015 ng/g) after esophagojejunostomy.However,no differences were found when esophageal PGE2 levels were compared 2 mo vs 4 mo post-esophagojejunostomy.At both the 2-and 4-mo timepoints,we observed a significant decrease in PGE2 levels in indomethacin-treated rat esophagi compared to those in either the control or MF-tricyclic groups (P =0.049 and P =0.017,respectively).No differences in PGE2 levels were found when we compared levels in rats treated with MF-tricyclic to not-treated rats.CONCLUSION:In this rat model of gastrointestinal reflux,indomethacin was associated with a decrease in the severity of esophagitis and reduced development of esophageal intestinal metaplasia and adenocarcinoma.
      原文链接:
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    Effect of Tangweian Jianji on upper gastrointestinal remodeling in streptozotocin-induced diabetic rats

    Gui-Fang LiuJing-Bo ZhaoZhong ZhenHong Sha...
    4875-4884页
    查看更多>>摘要：AIM:To investigate the effect of Tangweian Jianji (TWAJJ) on the biomechanical and morphometrical remodeling of the upper gastrointestinal tract in diabetic METHODS:Diabetes was induced in 27 rats by injecting streptozotocin (40 mg/kg body weight),the animals were then divided into three groups (n =9 in each group),i.e.,diabetic control (DM); high dose (10g/kg,T1) and low dose (5 g/kg,T2).Another 10 rats acted as normal controls (Control).TWAJJ was administered by gavage once daily.Blood glucose and serum insulin levels were measured.Circumferential length,wall thickness and opening angle were measured from esophageal,duodenal,jejunal and ileal ring segments.The residual strain was calculated from the morphometric data.Step-wise distension was carried out on esophageal and jejunal segments.The obtained data on the length,diameter and pressure changes were then used to calculate the circumferential and longitudinal stresses and strains.Real-time reverse transcription polymerase chain reaction was used to detect the receptor of advanced glycation end-products (RAGE)mRNA level in jejunal tissues.RESULTS:At the end of the experiment,the blood glucose level was significantly higher and the serum insulin level was significantly lower in DM,T1 and T2groups than in the control group (Glucose:30.23 ± 0.41mmol/L,27.48 ± 0.27 mmol/L and 27.84 ± 0.29 mmol/L vs 5.05-0.04 mmol/L,P =1.65 × 10-16,p =5.89 ×10-19 and P =1.63 × 10-18,respectively; Insulin:1.47 ±0.32 μg/L,2.66 ± 0.44 μg/L,2.03 ± 0.29 μg/L and 4.17±0.54 μg/L,P =0.0001,P =0.029 and P =0.025,respectively).However,these levels did not differ among the DM,T1 and T2 groups.The wet weight per unit length,wall thickness and opening angle of esophageal and intestinal segments in the DM group were significantly higher than those in the control group (from P =0.009 to P =0.004).These parameters in the T1 group were significantly lower than those in the DM group (wet weight,duodenum:0.147 ± 0.003 g/cm vs 0.158 ± 0.001 g/cm,P =0.047; jejunum,0.127 ±0.003 g/cm vs 0.151 ± 0.002 g/cm,P =0.017; ileum,0.127 ± 0.004 g/cm vs 0.139 ± 0.003 g/cm,P =0.046;wall thickness,esophagus:0.84 ± 0.03 mm vs 0.94± 0.02 mm,P =0.014; duodenum:1.27 ± 0.06 mm vs 1.39 ± 0.05 mm,P =0.031; jejunum:1.19 ± 0.07mm vs 1.34 ± 0.04 mm,P =0.047; ileum:1.09 ± 0.04mm vs 1.15 ± 0.03 mm,P =0.049; opening angle,esophagus:112.2 ± 13.2° vs 134.7 ± 14.7°,P =0.027;duodenum:105.9 ± 12.3° vs 123.1 ± 13.1°,P =0.046;jejunum:90.1 ± 15.4° vs 115.5 ± 13.3°,P =0.044;ileum:112.9 ± 13.4° vs 136.1 ± 17.1°,P =0.035).In the esophageal and jejunal segments,the inner residual stain was significantly smaller and the outer residual strain was larger in the DM group than in the control group (P =0.022 and P =0.035).T1 treatment significantly restored this biomechanical alteration (P =0.011 and P =0.019),but T2 treatment did not.Furthermore,the circumferential and longitudinal stiffness of the esophageal and jejunal wall increased in the DM group compared with those in the control group.T1,but not T2 treatment,significantly decreased the circumferential wall stiffness in the jejunal segment (P =0.012) and longitudinal wall stiffness in the esophageal segment (P =0.023).The mRNA level of RAGE was significantly decreased in the T1 group compared to that in the DM group (P =0.0069).CONCLUSION:TMAJJ (high dose) treatment partly restored the morphometric and biomechanical remodeling of the upper gastrointestinal tract in diabetic rats.
      原文链接:
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    Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

    Fermín MearinJulio PonceMarta PonceAgustín Balboa...
    4885-4891页
    查看更多>>摘要：AIM:To investigate usefulness of adherence to gastroesophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology.METHODS:Prospective,observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice.Patients (aged ＞ 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms,such as dyspeptic symptoms and/or supraesophageal symptoms.Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.RESULTS:Endoscopy was indicated in 123 (41％)patients:50 with alarm symptoms,32 with age ＞ 50years without alarm symptom.Seventy-two patients (58.5％) had esophagitis (grade A,23,grade B,28,grade C,18,grade D,3).In the presence of alarm symptoms,endoscopy was indicated consistently with recommendations in 98％ of cases.However,in the absence of alarm symptoms,endoscopy was indicated in 33％ of patients ＞ 50 years (not recommended by the guideline).Adherence for proton pump inhibitors (PPIs) therapy was 80％,but doses prescribed were lower (half) in 5％ of cases and higher (double) in 15％.Adherence regarding duration of PPI therapy was 69％; duration was shorter than recommended in 1％ (4 wk in esophagitis grades C-D) or longer in 30％(8 wk in esophagitis grades A-B or in patients without endoscopy).Treatment response was higher when PPI doses were consistent with guidelines,although differences were not significant (95％ vs 85％).CONCLUSION:GERD guideline compliance was quite good although endoscopy was over indicated in patients ＞ 50 years without alarm symptoms; PPIs were prescribed at higher doses and longer duration.
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    IL28B polymorphism as a predictor of antiviral response in chronic hepatitis C

    Andrzej Cie(s)laMonika Bociaga-JasikIwona Sobczyk-KrupiarzMiko(l)aj K G(l)owacki...
    4892-4897页
    查看更多>>摘要：AIM:To evaluate the effect of single nucleotide polymorphisms of interleukin (IL)-28B,rs12979860 on progression and treatment response in chronic hepatitis C.METHODS:Patients (n =64; 37 men,27 women;mean age,44 ± 12 years) with chronic hepatitis C,genotype 1,received treatment with peg-interferon plus ribavirin.Genotyping of rs12979860 was performed on peripheral blood DNA.Histopathological assessment of necroinflammatory grade and fibrosis stage were scored using the METAVIR system on a liver biopsy sample before treatment.Serum viral load,aminotransferase activity,and insulin level were measured.Insulin resistance index,body mass index,waist/hip ratio,percentage of body fat and fibrosis progression rate were calculated.Applied dose of interferon and ribavirin,platelet and neutrophil count and hemoglobin level were measured.RESULTS:A sustained virological response (SVR) was significantly associated with IL28B polymorphism (CC vs TT allele:odds ratio (OR),25; CC vs CT allele:OR,5.4),inflammation activity (G ＜ 1 vs G ＞ 1:OR,3.9),fibrosis (F ＜ 1 vs F ＞ 1:OR,5.9),platelet count (＞ 200× 109/L vs ＜ 200 × 109/L:OR,4.7; OR in patients with genotype CT:12.8),fatty liver (absence vs presence of steatosis:OR,4.8),insulin resistance index (＜ 2.5 vs ＞2.5:OR,3.9),and baseline HCV viral load (＜ 106 IU/mL vs ＞ 106 IU/mL:OR,3.0).There was no association with age,sex,aminotransferases activity,body mass index,waist/hip ratio,or percentage body fat.There was borderline significance (P =0.064) of increased fibrosis in patients with the TT allele,and no differences in the insulin resistance index between groups of patients with CC,CT and TT alleles (P =0.12).Spearman's rank correlation coefficient between insulin resistance and stage of fibrosis and body mass index was r =0.618 and r =0.605,respectively (P ＜ 0.001).Significant differences were found in the insulin resistance index (P =0.01) between patients with and without steatosis.Patients with the CT allele and absence of a SVR had a higher incidence of requiring threshold dose reduction of interferon (P =0.07).CONCLUSION:IL28B variation is the strongest host factor not related to insulin resistance that determines outcome of antiviral therapy.Baseline platelet count predicts the outcome of antiviral therapy in CT allele patients.
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    Analysis of colonoscopic perforations at a local clinic and a tertiary hospital

    Toshihiko SagawaSatoru KakizakiHaruhisa IizukaYasuhiro Onozato...
    4898-4904页
    查看更多>>摘要：AIM:TO define the clinical characteristics,and to assess the management of colonoscopic complications at a local clinic.METHODS:A retrospective review of the medical records was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic between April 2006 and December 2010.Data obtained from a tertiary hospital in the same region were also analyzed.The underlying conditions,clinical presentations,perforation locations,treatment types (operative or conservative) and outcome data for patients at the local clinic and the tertiary hospital were compared.RESULTS:A total of 10 826 colonoscopies,and 2625 therapeutic procedures were performed at a local clinic and 32 148 colonoscopies,and 7787 therapeutic procedures were performed at the tertiary hospital.The clinic had no perforations during diagnostic colonoscopy and 8 (0.3％) perforations were determined to be related to therapeutic procedures.The perforation rates in each therapeutic procedure were 0.06％ (1/1609) in polypectomy,0.2％ (2/885) in endoscopic mucosal resection (EMR),and 3.8％ (5/131) in endoscopic submucosal dissection (ESD).Perforation rates for ESD were significantly higher than those for polypectomy or EMR (P ＜ 0.01).All of these patients were treated conservatively.On the other hand,three (0.01％) perforation cases were observed among the 24 361 diagnostic procedures performed,and these cases were treated with surgery in a tertiary hospital.Six perforations occurred with therapeutic endoscopy (perforation rate,0.08％; 1 per 1298 procedures).Perforation rates for specific procedure types were 0.02％ (1 per 5500) for polypectomy,0.17％ (1 per 561) for EMR,2.3％ (1 per 43) for ESD in the tertiary hospital.There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital.The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital.No procedure-related mortalities occurred.Performing closure with endoscopic clipping reduced the C-reactive protein (CRP) titers.The mean maximum CRP titer was 2.9 ± 1.6 mg/dL with clipping and 9.7 ± 6.2 mg/dL without clipping,respectively (P ＜0.05).An operation is indicated in the presence of a large perforation,and in the setting of generalized peritonitis or ongoing sepsis.Although we did not experience such case in the clinic,patients with large perforations should be immediately transferred to a tertiary hospital.Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained.CONCLUSION:It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.
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    High-risk esophageal varices in patients treated with Iocoregional therapy for hepatocellular carcinoma:Assessment with liver computed tomography

    Hyojin KimDongil ChoiJoon Hyeok LeeSoon Jin Lee...
    4905-4911页
    查看更多>>摘要：AIM:To assess the diagnostic performance of followup liver computed tomography (CT) for the detection of high-risk esophageal varices in patients treated with locoregional therapy for hepatocellular carcinoma (HCC).METHODS:We prospectively enrolled 100 patients with cirrhosis who underwent transcatheter arterial chemoembolization,radiofrequency ablation or both procedures for HCCs.All patients underwent upper endoscopy and subsequently liver CT.Three radiologists independently evaluated the presence of high-risk esophageal varices with transverse images alone and with three orthogonal multiplanar reformation (MPR)images,respectively.With endoscopic grading as the reference standard,diagnostic performance was assessed by using receiver operating characteristic (ROC)curve analysis.RESULTS:The diagnostic performances (areas under the ROC curve) of three observers with transverse images alone were 0.947 ± 0.031,0.969 ± 0.024,and 0.916 ± 0.038,respectively.The mean sensitivity,specificity,positive predicative value (PPV),and negative predicative value (NPV) with transverse images alone were 90.1％,86.39％,70.9％,and 95.9％,respectively.The diagnostic performances,mean sensitivity,specificity,PPV,and NPV with three orthogonal MPR images (0.965 ± 0.025,0.959 ± 0.027,0.938 ± 0.033,91.4％,89.5％,76.3％,and 96.6％,respectively) were not superior to corresponding values with transverse images alone (P ＞ 0.05),except for the mean specificity (P =0.039).CONCLUSION:Our results showed excellent diagnostic performance,sensitivity and NPV to detect high-risk esophageal varices on follow-up liver CT after locoregional therapy for HCC.
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