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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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    Pancreatic ductal adenocarcinoma screening: New perspectives

    Raffaele PezzilliDario FabbriAndrea Imbrogno
    4973-4977页
    查看更多>>摘要：Pancreatic ductal adenocarcinoma accounts for more than 90％ of all pancreatic cancers and its incidence has increased significantly worldwide.Patients with pancreatic ductal adenocarcinoma have a poor outcome and more than 95％ of the people affected die from the disease within 12 mo after diagnosis.Surgery is the first-line treatment in the case of resectable neoplasm,but only 20％ of patients are candidates for this approach.One of the reasons there are few candidates for surgery is that,during the early phases of the disease,the symptoms are poor or non-specific.Early diagnosis is of crucial importance to improve patient outcome; therefore,we are looking for a good screening test.The screening test must identify the disease in an early stage in order to be effective; having said this,a need exists to introduce the concept of "early" ductal adenocarcinoma.It has been reported that at least five additional years after the occurrence of the initiating mutation are required for the acquisition of metastatic ability of pancreatic adenocarcinoma and patients die an average of two years thereafter.We have reviewed the most recent literature in order to evaluate the present and future perspectives of screening programs of this deadly disease.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Hepatorenal syndrome

    Jan Lata
    4978-4984页
    查看更多>>摘要：Hepatorenal syndrome (HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension.This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys,where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration,which ultimately results in uraemia.The syndrome occurs almost exclusively in patients with ascites.Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output.Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure,but refractory ascites,and its impact on prognosis is less negative.Liver transplantation is the most appropriate therapeutic method,nevertheless,only a few patients can receive it.The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response.Renal function recovery can be achieved in less than 50％ of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term.Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Novel insight into mechanisms of cholestatic liver injury

    Benjamin L WoolbrightHartmut Jaeschke
    4985-4993页
    查看更多>>摘要：Cholestasis results in a buildup of bile acids in serum and in hepatocytes.Early studies into the mechanisms of cholestatic liver injury strongly implicated bile acidinduced apoptosis as the major cause of hepatocellular injury.Recent work has focused both on the role of bile acids in cell signaling as well as the role of sterile inflammation in the pathophysiology.Advances in modern analytical methodology have allowed for more accurate measuring of bile acid concentrations in serum,liver,and bile to very low levels of detection.Interestingly,toxic bile acid levels are seemingly far lower than previously hypothesized.The initial hypothesis has been based largely upon the exposure of μmol/L concentrations of toxic bile acids and bile salts to primary hepatocytes in cell culture,the possibility that in vivo bile acid concentrations may be far lower than the observed in vitro toxicity has far reaching implications in the mechanism of injury.This review will focus on both how different bile acids and different bile acid concentrations can affect hepatocytes during cholestasis,and additionally provide insight into how these data support recent hypotheses that cholestatic liver injury may not occur through direct bile acid-induced apoptosis,but may involve largely inflammatory cell-mediated liver cell necrosis.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (Part Ⅱ :Treatment)

    Antonio BoveMassimo BelliniEdda BattagliaRenato Bocchini...
    4994-5013页
    查看更多>>摘要：The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation.There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation.Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre.Osmotic laxatives may be effective in patients who do not respond to fibre supplements.Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives.Controlled trials have shown that serotoninergic enterokinetic agents,such as prucalopride,and prosecretory agents,such as lubiprostone,are effective in the treatment of patients with chronic constipation.Surgery is sometimes necessary.Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders,generalised motility disorders or psychological disorders.Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation.Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects,but none is considered to be the gold standard.Surgery should be reserved for selected patients with an impaired quality of life.Obstructed defecation is often associated with pelvic organ prolapse.Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse,but the efficacy and safety of such procedures have not yet been established.
      原文链接:
    • NETL
    • NSTL
    • 万方数据

    What we should know about portal vein thrombosis in cirrhotic patients: A changing perspective

    Francesca Romana PonzianiMaria Assunta ZoccoMatteo GarcovichFrancesca D'Aversa...
    5014-5020页
    查看更多>>摘要：Portal vein thrombosis (PVT) is one of the most common complications occurring during the natural course of liver cirrhosis.Even though PVT is often asymptomatic,the worsening of liver function,an unexpected episode of gastrointestinal bleeding or ascitic decompensation may be landmarks of PVT development.Beyond these clinical manifestations,it is debated whether PVT really has an impact on liver cirrhosis natural history or rather represents only one of its consequences.Probably PVT development should not only be considered as a matter of impaired blood flow or pro-coagulation tendency.On one hand,PVT seems a consequence of the worsening in portal vein outflow due to the increased hepatic resistance in cirrhotic livers.On the other hand,vascular microthrombosis secondary to necroinflammation may cause liver ischemia and infarction,with loss of hepatic tissue (parenchymal extinction) which is replaced by fibrotic tissue.Therefore,PVT might also be considered as the overt manifestation of the liver fibrosing process evolution and anticoagulant therapy may thus have microscopic indirect effects also on the progression of liver disease.At present,a connection between PVT development and the progression of liver fibrosis/cirrhosis has not yet been demonstrated.Nevertheless,it is not clear if PVT development may worsen cirrhotic patients' outcome by itself.Some authors tried to assess liver transplant benefit in PVT cirrhotic patients but data are contrasting.In this review,we will try to answer these questions,providing a critical analysis of data reported in literature.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer

    Sφren R RafaelsenChris Vagn-HansenTorben SφrensenJohn Plφen...
    5021-5026页
    查看更多>>摘要：AIM:To evaluate the agreement between transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) in classification of ≥ T3 rectal tumors.METHODS:From January 2010 to January 2012,86consecutive patients with ≥ T3 tumors were included in this study.The mean age of the patients was 66.4years (range:26-91 years).The tumors were all ≥T3 on TRUS.The sub-classification was defined by the penetration of the rectal wall:a:0 to 1 mm; b:1-5 mm; c:6-15; d:＞ 15 mm.Early tumors as ab (≤ 5 mm) and advanced tumors as cd (＞ 5 mm).All patients underwent TRUS using a 6.5 MHz transrectal transducer.The MRI was performed with a 1.5 T Philips unit.The TRUS findings were blinded to the radiologist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread.RESULTS:TRUS found 51 patients to have an early ≥T3 tumors and 35 to have an advanced tumor,whereas MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors.No patients with tumors classified as advanced by TRUS were found to be early on MRI.The kappa value in classifying early versus advanced T3 rectal tumors was 0.93 (95％ CI:0.85-1.00).We found a kappa value of 0.74 (95％ CI:0.63-0.86) for the total sub-classification between the two methods.The mean maximal tumor outgrowth measured by TRUS,5.5 mm ± 5.63 mm and on MRI,6.3 mm ± 6.18 mm,P =0.004.In 19 of the 86 patients the following CT scan or surgery revealed distant metastases; of the 51 patients in the ultrasound ab group three (5.9％)had metastases,whereas 16 (45.7％) of 35 in the cd group harbored distant metastases,P =0.00002.The odds ratio of having distant metastases in the ultrasound cd group compared to the ab group was 13.5(95％ CI:3.5-51.6),P =0.00002.The mean maximal ultrasound measured outgrowth was 4.3 mm (95％ CI:3.2-5.5 mm) in patients without distant metastases,while the mean maximal outgrowth was 9.5 mm (95％CI:6.2-12.8 mm) in the patients with metastases,P =0.00004.Using the MRI classification three (6.3％) of 48 in the MRI ab group had distant metastases,while 16 (42.1％) of the 38 in the MRI cd group,P =0.00004.The MRI odds ratio was 10.9 (95％ CI:2.9-41.4),P=0.00008.The mean maximal MRI measured outgrowth was 4.9 mm (95％ CI:3.7-6.1 mm) in patients without distant metastases,while the mean maximal outgrowth was 11.5 mm (95％ CI:7.8-15.2 mm) in the patients with metastases,P =0.000006.CONCLUSION:There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors.Distant metastases are more frequent in the advanced group.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Effect of psychological stress on gastric motility assessed by electrical bio-impedance

    María Raquel Huerta-FrancoMiquel Vargas-LunaJuana Berenice Montes-FraustoIsmael Morales-Mata...
    5027-5033页
    查看更多>>摘要：AIM:To evaluate gastric motility using electrical bioimpedance (EBI) and gastric changes as a result of stress induced by psychological tests.METHODS:A group of 57 healthy women,aged 40-60years,was recruited,and a clinical history and physical examination were performed.The women were free from severe anxiety,chronic or acute stress,severe depression,mental diseases and conditions that affect gastric activity.The women were evaluated under fasting conditions,and using a four-electrode configuration,the gastric signals were obtained through a BIOPAC MP-150system.The volunteers were evaluated using the following paradigm:basal state,recording during the Stroop Test,intermediate resting period,recording during the Raven Test,and a final resting period.We analyzed the relative areas of the frequency spectrum:A1 (1-2 cpm),A2 (2-4 cpm),A3 (4-8 cpm),and A4 (8-12 cpm),as well as the median of area A2 + A3.The data were analyzed by an autoregressive method using a Butterworth filter with MatLab and Origin.Analysis of variance (ANOVA)and Friedman ANOVA (for nonparametric variables) were performed; in addition,pairs of groups were compared using the Tdependent and Wilcoxon Ttests.RESULTS:The results of the main values of area A2 were not significantly different comparing the five steps of the experimental paradigm.Nevertheless,there was a tendency of this A2 region to decrease during the stress tests,with recuperation at the final resting step.When an extended gastric region was considered (1-4cpm),significant differences with the psychological stress tests were present (F =3.85,P =0.005).The A3 region also showed significant changes when the stress psychological tests were administered (F =7.25,P ＜0.001).These differences were influenced by the changes in the adjacent gastric region of A2.The parameter that we proposed in previous studies for the evaluation of gastric motility by electrical bio-impedance (EBI)was the median of the area under the region from 2 to 8 cpm (A2 + A3).The mean values of these frequencies (median of the A2 + A3 area) with the stress test showed significant changes (F =5.5,P ＜ 0.001).The results of the Wilcoxon Ttest for the A4 area parameter,which is influenced by the breathing response,changed significantly during the Raven stress test (P ＜ 0.05).CONCLUSION:We confirm that the gastric response to acute psychological stress can be evaluated by short-term EBI.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Interplay of neuropilin-1 and semaphorin 3A after partial hepatectomy in rats

    Ling FuTsuneo KitamuraKazuhisa IwabuchiSyozo Ichinose...
    5034-5041页
    查看更多>>摘要：AIM:To elucidate the role of neuropilin-1 (Nrp-1) and semaphorin 3A (Sema3A) in sinusoidal remodeling during liver regeneration in rats.METHODS:Male Wistar/ST rats at 7 wk of age,weighing about 200 g,were used for all animal experiments.In vivo,at 24,48,72,96,144 and 192 h after twothirds partial hepatectomy (PHx),the remnant livers were removed.Liver tissues were immunohistochemically stained for Nrp-1,Sema3A and SE-1,a liver sinusoidal endothelial cell (SEC) marker.Total RNA of the liver tissue was extracted and reversely transcribed into cDNA.The mRNA expression of Sema3A was analyzed by quantitative real-time polymerase chain reaction and normalized to that of ribosomal protein S18.In vitro,SECs were isolated from rat liver and cultured in endothelial growth medium containing 20 ng/mL vascular endothelial cell growth factor.Migration of SECs in primary culture was assessed by cell transwell assay with or without recombinant Sema3A.Apoptotic cells were determined by a terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling method.RESULTS:In vitro,immunohistochemistry study revealed that Sema3A and Nrp-1 were constitutively expressed in hepatocytes and SECs,respectively,in normal rat liver tissues.Nrp-1 expression in SECs was quantified by the percentage of immunostained area with antiNrp-1 antibody in relation to the area stained with SE-1.Between 24 h and 96 h following resection of liver,Nrp-1 expression in SECs was transiently increased.Compared with the baseline (5.2％ ± 0.1％),Nrp-1 expression in SECs significantly increased at 24 h (17.3％ ± 0.7％,P ＜ 0.05),48 h (39.1％ ± 0.6％,P ＜ 0.01),72 h (46.9％ ± 4.5％,P ＜ 0.01) and 96 h (29.9％ ± 3.8％,P ＜ 0.01) after PHx,then returned to the basal level at termination of liver regeneration.Interestingly,the expression of Sema3A was inversely associated with that of Nrp-1 in liver after PHx.Sema3A mRNA expression was significantly reduced by about 75％ over the period 24-144 h after PHx (P ＜ 0.05),and returned to basal levels at 192 h after PHx.In vitro,SECs isolated from rats after PHx (PHx-SECs) were observed to migrate to the lower chamber of the cell transwell system after incubation for 24 h,but not cells from normal rats (CONT-SECs),indicating that mobility of PHx-SECs increases as compared with that of CONT-SECs.Moreover,recombinant Sema3A significantly attenuated migration in PHx-SECs in primary culture (vehicle-treated100％ ± 7.9％ vs Sema3A-treated 42.6％ ± 5.4％,P＜ 0.01),but not in CONT-SECs.Compared with CONT-SECs,the apoptotic rate of PHx-SECs decreased by 78.3％ (P ＜ 0.05).There was no difference in apoptosis between CONT-SECs that were treated with vehicle and Sema3A.However,in PHx-SECs,apoptosis was induced by the presence of 5 nmol Sema3A for 24 h (vehicle-treated 21.7％ ± 7.6％ vs Sema3A-treated 104.3％ ± 8.9％,P ＜ 0.05).In addition,immunohistochemistry confirmed the increased expression of Nrp-1 in PHx-SECs,while it was noted to a lesser extent in CONT-SECs.CONCLUSION:The interplay of Nrp-1 and Sema3A shown in our results may lead to a better understanding of interaction between sinusoidal remodeling and SECs during liver regeneration.
      原文链接:
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    • NSTL
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    • 维普

    Tumor necrosis factor alpha increases intestinal permeability in mice with fulminant hepatic failure

    Guo-Zhen LiZhao-Han WangWei CuiJin-Long Fu...
    5042-5050页
    查看更多>>摘要：AIM:To determine the effect of tumor necrosis factor alpha (TNF-α） on intestinal permeability (IP) in mice with fulminant hepatic failure (FHF),and the expression of tight junction proteins.METHODS:We selected D-lactate as an index of IP,induced FHF using D-galactosamine/lipopolysaccharide and D-galactosamine/TNF-α,assessed the results using an enzymatic-spectrophotometric method,transmission electron microscopy,immunohistochemistry,Western blotting and real-time quantitative polymerase chain reaction.The effect of the administration of antiTNF-α immunoglobulin G (IgG) antibody,before the administration of D-galactosamine/lipopolysaccharide,on TNF-α was also assessed.RESULTS:IP was significantly increased in the mouse model of FHF 6 h after injection (13.57 ± 1.70 mg/L,13.02 ± 1.97 mg/L vs 3.76 ± 0.67 mg/L,P =0.001).Electron microscopic analysis revealed tight junction (TJ) disruptions,epithelial cell swelling,and atrophy of intestinal villi.Expression of occludin and claudin-1 mRNA was significantly decreased in both FHF models (occludin:0.57 ± 0.159 fold vs baseline,P =0.000;claudin-1:0.3067±0.1291 fold vs baseline,P =0.003),as were the distribution density of proteins in the intestinal mucosa and the levels of occludin and claudin-1 protein (occludin:0.61 ± 0.0473 fold vs baseline,P =0.000; claudin-1:0.6633 ± 0.0328 fold vs baseline,P =0.000).Prophylactic treatment with antiTNF-α IgG antibody prevented changes in IP (4.50 ±0.97 mg/L vs 3.76 ± 0.67 mg/L,P =0.791),intestinal tissue ultrastructure,and the mRNA levels of occludin and claudin-1 expression (occludin:0.8865 ± 0.0274fold vs baseline,P =0.505; claudin-1:0.85 ± 0.1437fold vs baseline,P =0.1),and in the protein levels (occludin:0.9467 ± 0.0285 fold vs baseline,P ＞ 0.05;claudin-1:0.9533 ± 0.0186 fold vs baseline,P =0.148).CONCLUSION:Increased in IP stemmed from the downregulation of the TJ proteins occludin and claudin-1,and destruction of the TJ in the colon,which were induced by TNF-α in FHF mice.
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    • NETL
    • NSTL
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    • 维普

    Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations

    Cemal YaziciJohn LosurdoMichael D BrownScott Oosterveen...
    5051-5057页
    查看更多>>摘要：AIM:To examine the predictive factors of capsule endoscopy (CE) completion rate (CECR) including the effect of inpatient and outpatient status.METHODS:We identified 355 consecutive patients who completed CE at Rush University Medical Center between March 2003 and October 2005.Subjects for CE had either nothing by mouth or clear liquids for the afternoon and evening of the day before the procedure.CE exams were reviewed by two physicians who were unaware of the study hypotheses.After retrospective analysis,21 cases were excluded due to capsule malfunction,prior gastric surgery,endoscopic capsule placement or insufficient data.Of the remaining 334 exams [264 out-patient (OP),70 in-patient (IP)],CE indications,findings,location of the patients [IP vs OP and intensive care unit (ICU) vs general medical floor (GMF)] and gastrointestinal transit times were analyzed.Statistical analysis was completed using SPSS version 17 (Chicago,IL).Chi-square,t test or fisher exact-tests were used as appropriate.Multivariate logistic regression analysis was used to identify variables associated with incomplete CE exams.RESULTS:The mean age for the entire study population was 54.7 years.Sixty-one percent of the study population was female,and gender was not different between IPs vs OPs (P =0.07).The overall incomplete CECR was 14％ in our study.Overt obscure gastrointestinal bleeding (OGB) was significantly more common for the IP CE (P =0.0001),while abdominal pain and assessment of IBD were more frequent indications for the OP CE exams (P =0.002 and P =0.01,respectively).Occult OGB was the most common indication and arteriovenous malformations were the most common finding both in the IPs and OPs.The capsule did not enter the small bowel (SB) in 6/70 IPs and 8/264OPs (P =0.04).The capsule never reached the cecum in 31.4％ (22/70) of IP vs 9.5％ (25/ 264) of OP examinations (P ＜ 0.001).The mean gastric transit time (GTT) was delayed in IPs compared to OPs,98.5 ±139.5 min vs 60.4 ± 92.6 min (P =0.008).Minimal SB transit time was significantly prolonged in the IP compared to the OP setting [IP =275.1 ± 111.6 min vs OP Yazici C et al.Capsule endoscopy and hospitalization status =244.0 ± 104.3 min (P =0.037)].CECR was also significantly higher in the subgroup of patients with OGB who had OP vs TP exams (95％ vs 80％ respectively,P =0.001).The proportion of patients with incomplete exams was higher in the ICU (n =7/13,54％) as compared to the GMF (n =15/57,26％) (P =0.05).There was only a single permanent SB retention case which was secondary to a previously unknown SB stricture,and the remaining incomplete SB exams were due to slow transit.Medications which affect gastrointestinal system motility were tested both individually and also in aggregate in univariate analysis in hospitalized patients (ICU and GMF) and were not predictive of incomplete capsule passage (P ＞ 0.05).Patient location (IP vs OP) and GTT were independent predictors of incomplete CE exams (P ＜ 0.001 and P =0.008,respectively).CONCLUSION:Incomplete CE is a multifactorial problem.Patient location and related factors such as severity of illness and sedentary status may contribute to incomplete exams.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普