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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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    Crohn's disease genotypes of patients in remission vs relapses after infliximab discontinuation

    Cathy LuAlistair WaughRobert J BaileyRaeleen Cherry...
    5058-5064页
    查看更多>>摘要：AIM:To investigate genetic differences between Crohn's disease (CD) patients with a sustained remission vs relapsers after discontinuing infliximab while in corticosteroid-free remission.METHODS:Forty-eight CD patients received infliximab and were in full corticosteroid-free clinical remission but then discontinued infliximab for reasons other than a loss of response,were identified by review of an electronic database and charts.Infliximab-associated remission was defined as corticosteroid-free plus normalization of clinical disease activity [CD activity index (CDAI)＜ 150] during follow-up visits based on physician global assessments.A CD relapse (loss of infliximab-induced remission) was clinically defined as a physician visit for symptoms of disease activity (CDAI ＞ 220) and a therapeutic intervention with CD medication(s),or a hospitalization with complications related to active CD.Genetic analyses were performed on samples from 14 patients (n =6 who had a sustained long term remission after stopping infliximab,n =8 who rapidly relapsed after stopping infliximab).Nucleotide-binding oligomerization domain 2 (NOD2)/caspase activation recruitment domain 15 (CARD15) polymorphisms (R702W,G908R and L1007fs) and the inflammatory bowel disease 5 (IBD5)polymorphisms (IGR2060a1 and IGR3081a1) were analyzed in each group.RESULTS:Five single nucleotide polymorphisms of IBD5 and NOD2/CARD15 genes were successfully analyzed for all 14 subjects.There was no significant increase in frequency of the NOD2/CARD15 polymorphisms (R702W,G908R and L1007fs) and the IBD5 polymorphisms (IGR2060a1 and IGR3081a1) in either group of patients; those whose disease relapsed rapidly or those who remained in sustained long term remission following the discontinuation of infliximab.Nearly a third of patients in full clinical remission who stopped infliximab for reasons other than loss of response remained in sustained clinical remission,while two-thirds relapsed rapidly.There was a marked difference in the duration of clinical remission following discontinuance of infliximab between the two groups.The patients who lost remission did so after 1.0 years ± 0.6 years,while those still in remission were at the time of this study,8.1 years ± 2.6 years post-discontinuation of infliximab,P ＜ 0.001.The 8 patients who had lost remission after discontinuing infliximab had a mean number of 5 infusions (range 3-7),with a mean treatment time of 7.2 mo (range 1.5 mo-15 mo).The mean duration of time from the last infusion of infliximab to the time of loss of remission was 382 d (range 20 d-701 d).The 6 patients who remained in remission after discontinuing infliximab had a mean number of 6infusions (range 3-12),with a mean treatment duration of 12 mo (range 3.6 mo-32 mo) (P =0.45 relative to those who lost remission).
      原文链接:
    • NETL
    • NSTL
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    • 维普

    Propionyl-L-carnitine hydrochloride for treatment of mild to moderate colonic inflammatory bowel diseases

    Giuseppe MerraGiovanni GasbarriniLucrezia LaterzaMarco Pizzoferrato...
    5065-5071页
    查看更多>>摘要：AIM:To assess clinical and endoscopic response to propionyl-L-carnitine hydrochloride (PLC) in colonic inflammatory bowel disease.METHODS:Patients suffering from mild to moderate ulcerative colitis (UC) or Crohn's disease (CD) colitis,with disease activity index (DAI) between 3 and 10 and under stable therapy with oral aminosalicylates,mercaptopurine or azathioprine,for at least 8 wk prior to baseline assessments,were considered suitable for enrollment.Fourteen patients were enrolled to assume PLC 2 g/d (two active tablets twice daily) orally.Clinical-endoscopic and histological activity were assessed by DAI and histological index (HI),respectively,following a colonoscopy performed immediately before and after 4 wk treatment.Clinical response was defined as a lowering of at least 3 points in DAI and clinical remission as a DAI score ≤ 2.Histological response was defined as an improvement of HI of at least 1 point.We used median values for the analysis.Differences pre-and post-treatment were analyzed by Wilcoxon signed rank test.RESULTS:All patients enrolled completed the study.One patient,despite medical advice,took deflazacort 5 d before follow-up colonoscopy examination.No side effects were reported by patients during the trial.After treatment,71％ (SE 12％) of patients achieved clinical response,while 64％ (SE 13％) obtained remission.Separating UC from CD patients,we observed a clinical response in 60％ (SE 16％) and 100％,respectively.Furthermore 60％ (SE 16％) of UC patients and 75％ (SE 25％) of CD patients were in clinical remission after therapy.The median DAI was 7 [interquartile range (IQR):4-8] before treatment and decreased to 2 (IQR:1-3) (P ＜ 0.01) after treatment.Only patients with UC showed a significant reduction of DAI,from a median 6.5 (IQR:4-9) before treatment to 2(IQR:1-3) after treatment (P ＜ 0.01).Conversely,in CD patients,although displaying a clear reduction of DAI from 7 (IQR:5.5-7.5) before therapy to 1.5 (IQR:0.5-2.5) after therapy,differences observed were not significant (P =0.06).Seventy-nine percent (SE 11％)of patients showed improvement of HI of at least 1 point,while only one CD and two UC patients showed HI stability; none showed HI worsening.Median HI decreased from 1 (IQR:1-2),to 0.5 (IQR:0-1) at the endoscopic control in the whole population (P ＜ 0.01),while it changed from 1 (IQR:1-2) to 0.5 (IQR:0-1)in UC patients (P ＜ 0.01) and from 1.5 (IQR:1-2) to 0.5 (IQR:0-1) in CD patients (P =not significant).The two sample tests of proportions showed no significant differences in clinical and histological response or in clinical remission between UC and CD patients.No side effects were reported during treatment or at 4 wk follow-up visit.CONCLUSION:PLC improves endoscopic and histological activity of mild to moderate UC.Further studies are required to evaluate PLC efficacy in colonic CD patients.
      原文链接:
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    • NSTL
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    • 维普

    Prognostic value of 18-fluorodeoxyglucose positron emission tomography-computed tomography in resectable colorectal cancer

    Jang Eun LeeSang Woo KimJin Su KimKyu Yong Choi...
    5072-5077页
    查看更多>>摘要：AIM:To assess the prognostic value of preoperative 18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) in patients with resectable colorectal cancer.METHODS:One hundred sixty-three patients with resectable colorectal cancer who underwent FDG-PET/CT before surgery were included.Patient data including pathologic stage at presentation,histology,treatment,disease-free survival and the maximum standardized uptake value (SUVmax) of the primary tumor on FDGPET/CT were retrospectively analyzed.Median follow up duration was 756 (range,419-1355).The primary end point was disease-free survival.RESULTS:Twenty-five of 163 patients (15.3％) had recurrences.The median SUVmax values of the recurrence and no-recurrence groups were 8.9 (range,5-24) and 8.2 (range,0-23,P =0.998).Receiver operating characteristic (ROC) curve analysis showed no significant association between SUVmax and recurrence (area under the curve =0.5,P =0.998,95％CI:0.389-0.611).Because a statistically significant value was not found,SUVmax was dichotomized at its median of 8.6.The disease-free survival curve was analyzed using the median SUVmax (8.6) as the cut off.Univariate and multivariate analysis did not provide evidence that disease-free survival rates for the subgroups defined by the median SUVmax were significantly different (P =0.52,P =0.25).CONCLUSION:Our study suggests that the high FDG uptake of primary mass in resectable colorectal cancer doesn't have a significant relationship with tumor recurrence and disease-free survival.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

    Hsiu-Lung FanPo-Sheng YangHui-Wei ChenTeng-Wei Chen...
    5078-5083页
    查看更多>>摘要：AIM:TO identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients.METHODS:We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus (ACLF-HBV) and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy.Their demographic,clinical,and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test,Fisher's exact test,and a multiple logistic regression analysis.RESULTS:The study included 113 patients (87 men and 26 women) with a mean age of 49.84 years.Fiftytwo patients survived,and 61 patients died.Liver failure (85.2％),sepsis (34.4％),and multiple organ failure (39.3％) were the main causes of death.Multivariate analyses showed that Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores ≥ 12[odds ratio (OR) =7.160,95％ CI:2.834-18.092,P ＜0.001] and positive blood culture (OR =13.520,95％CI:2.740-66.721,P =0.001) on the day of diagnosis and model for end-stage liver disease (MELD) scores ≥ 28 (OR =8.182,95％ CI:1.884-35.527,P =0.005)after the first week of treatment were independent predictors of mortality.CONCLUSION:APACHE Ⅱ scores on the day of diagnosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF-HBV patients.
      原文链接:
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    • NSTL
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    Decreased mitochondrial deoxyribonucleic acid and increased oxidative damage in chronic hepatitis C

    Hsu-Heng YenKai-Lun ShihTa-Tsung LinWei-Wen Su...
    5084-5089页
    查看更多>>摘要：AIM:To determine whether alteration of the mitochondria DNA (mtDNA) copy number and its oxidative damage index (mtDNA△CT) can be detected by analysis of peripheral blood cells in hepatitis C virus (HCV)-infected patients.METHODS:This study enrolled two groups of patients aged 40-60 years:a control group and an HCV-infected group in Department of Gastroenterology and Hepatology in Changhua Christian Hospital.Patients with co-infection with hepatitis B virus or human immunodeficiency virus,autoimmune disease,malignant neoplasia,pregnancy,thyroid disease,or alcohol consumption ＞ 40 g/d were excluded.HCV-infected patients who met the following criteria were included:(1)positive HCV antibodies for ＞ 6 mo; (2) alanine aminotransferase (ALT) levels more than twice the upper limit of normal on at least two occasions during the past 6 mo; and (3) histological fibrosis stage higher than F1.The mtDNA copy number and oxidative damage index of HCV mtDNA (mtDNA△CT) were measured in peripheral blood leukocytes.The association between mtDNA copy number and mtDNA△Cr was further analyzed using clinical data.RESULTS:Forty-seven normal controls (male/female:26/21,mean age 50.51 ± 6.15 years) and 132 HCV-infected patients (male/female:76/61,mean age 51.65± 5.50 years) were included in the study.The genotypes of HCV-infected patients include type 1a (n =3),type 1b (n =83),type 2a (n =32),and type 2b (n =14).Liver fibrosis stages were distributed as follows:F1/F2/F3/F4 =1/61/45/25 and activity scores were A0/A1/A2/A3 =7/45/55/25.There were no age or genderdifferences between the two groups.HCV-infected patients had higher hepatitis activity (aspartate transaminase levels 108.77 ± 60.73 vs 23.19 ± 5.47,P ＜ 0.01;ALT levels 168.69 ± 93.12 vs 23.15 ± 9.45,P ＜ 0.01)and lower platelet count (170.40 ± 58.00 vs 251.24 ±63.42,P ＜ 0.01) than controls.The mtDNA copy number was lower in HCV-infected patients than in controls (173.49 vs 247.93,P ＜ 0.05).The mtDNA△CT was higher in HCV-infected patients than in controls (2.92 vs 0.64,P ＜ 0.05).To clarify the clinical significance of these results in HCV-infected patients,their association with different clinical parameters among HCV-infected patients was analyzed.A negative association was found between mtDNA copy number and elevated aspartate transaminase levels (r =-0.17,P ＜ 0.05).Changes in mtDNA copy number were not associated with HCV RNA levels,HCV genotypes,liver fibrosis severity,or inflammatory activity in the liver biopsy specimen.However,a correlation was observed between mtDNA△Cr and platelet count (r =-0.22,P ＜ 0.01),HCV RNA level (r =0.36,P ＜ 0.01),and hepatitis activity (r =0.20,P =0.02).However,no difference in the change in mtDNA△Crwas observed between different fibrosis stages or HCV CONCLUSION:Oxidative stress and mtDNA damage are detectable in patient's peripheral leukocytes.Increased leukocyte mtDNA△CT correlates with higher HCV viremia,increased hepatitis activity,and lower platelet count.
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    • NSTL
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    • 维普

    Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease

    Shou-Wu LeeHan-Chung LienChi-Sen ChangYen-Chun Peng...
    5090-5095页
    查看更多>>摘要：AIM:To investigate the symptom presentation and quality of life in obese Chinese patients with gastroesophageal reflux disease (GERD).METHODS:Data from patients diagnosed with GERD according to the Montreal definition,were collected between January 2009 to March 2010.The enrolled patients were assigned to the normal [body mass index (BMI) ＜ 25 kg/m2],overweight (25-30 kg/m2),and obese (BMI ＞ 30 kg/m2) groups.General demographic data,endoscopic findings,and quality of life of the three groups of patients were analyzed and compared.RESULTS:Among the 173 enrolled patients,102,56and 15 patients were classified in the normal,overweight,and obese,respectively.There was significantly more erosive esophagitis (73.3％ vs 64.3％ vs 39.2％,P =0.002),hiatal hernia (60％ vs 33.9％ vs 16.7％,P=0.001),and males (73.3％ vs 73.2％ vs 32.4％,P =0.001) in the obese cases.The severity and frequency of heartburn,not acid regurgitation,was positively correlated with BMI,with a significant association in men,but not in women.Obese patients were prone to have low quality of life scores,with obese women having the lowest scores for mental health.CONCLUSION:In patients with GERD,obese men had the most severe endoscopic and clinical presentation.Obese women had the poorest mental health.
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    • NETL
    • NSTL
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    • 维普

    Influence of Helicobacter pylori infection on ghrelin levels in children

    Zhao-Hui DengBo ChuYa-Zhen XuBin Zhang...
    5096-5100页
    查看更多>>摘要：AIM:To compare ghrelin levels in plasma and gastric mucosa before and after Helicobacter pylori (H.pylori)treatment in children with H.pylori-associated functional dyspepsia.METHODS:Children with H.pylori-associated functional dyspepsia were enrolled in this study.H.pylori infection was confirmed by positive bacterial culture results.All of the children received triple H.pylori eradication therapy (a 2 wk course of omeprazole,amoxicillin,and clarithromycin).The children were divided into two groups based on the success of the H.pylori treatment:group 1 (eradicated)-patients who had a negative 13C-urea breath test 2 mo after the end of therapy; and group 2 (non-eradicated)-patients who had a positive 13C-urea breath test.Plasma ghrelin,gastric ghrelin mRNA,and the body mass index were evaluated in both groups before and after the H.pylori treatment.The plasma ghrelin levels were measured by a radioimmunoassay.The expression of gastric gnrelin mRNA was determined by real-time reverse transcription polymerase chain reaction.RESULTS:A total of 50 children with H.pylori-associated functional dyspepsia were treated with triple H.pylori eradication therapy.The mean age of the children was 5.52 ± 0.83 years,and there were 28 males and 22 females.Among the 50H.pylori-positive children,30 successfully achieved eradication,and 20 did not.The mean plasma ghrelin levels of group 1 were 22.17 ± 1.73 ng/L and 26.59 ± 2.05 ng/L before and after the treatment,respectively,which was a significant increase (P =0.001).However,the mean plasma ghrelin level of group 2 before and after the H.pylori treatment was 21.34 ± 2.40 ng/L and 22.24 ± 2.10ng/L (P =0.785).The plasma ghrelin levels increased substantially after treatment in group 1 but showed only minor changes in group 2.Similarly,the gastric ghrelin mRNA expression in group 1 before treatment was 2.84 ± 0.08.After treatment,the level was 3.11± 0.65,which was significantly different (P =0.023).The gastric ghrelin mRNA expression in group 2 did not change significantly during the treatment (2.82 ±0.44 vs 2.79 ± 0.31,P =0.875).The plasma ghrelin and gastric ghrelin mRNA levels in group 1 increased substantially after the treatment but did not do so in group 2.In addition,the body mass index the two groups did not differ significantly 2 mo before and after the H.pylori treatment.CONCLUSION:H.pylori eradication increases the plasma and tissue ghrelin levels in children with H.pylori-associated functional dyspepsia.
      原文链接:
    • NETL
    • NSTL
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    Predictive value of neutrophil infiltration as a marker of Helicobacter pylori infection

    Xiao-Qing XuZhen-Hua WangJing-Xian LiaoXiao-Yu Chen...
    5101-5105页
    查看更多>>摘要：AIM:To evaluate the predictive value of neutrophil infiltration as a marker of Helicobacter pylori (H.pylori)infection.METHODS:A total of 315 patients with dyspepsia symptoms who underwent upper gastrointestinal endoscopy were enrolled in this study.Biopsies were evaluated using the updated Sydney system.The medication history of all patients in the preceding 4 wk was recorded.The diagnosis of H.pylori infection was based on 13C-urea breath test at least 4 wk after withdrawal of antisecretory drugs,antibiotics and related drugs.For the patients with subtotal gastrectomy,the diagnosis of H.pylori infection was based on anti-H.pylori immunoglobulin G (IgG) antibody.Serum anti-H.pylori IgG antibody was measured by enzyme-linked immunosorbent assays (Biohit,Finland).RESULTS:The sensitivity,specificity,positive predictive value and negative predictive value of neutrophil infiltration in the diagnosis of H.pylori infection were 92.3％,83.5％,77.4％ and 94.7％,respectively.Neutrophil infiltration of gastric mucosa in the histological analysis was strongly associated with H.pylori infection (77.4％ vs 5.3％ in the neutrophil infiltration negative group,P =0.000).Moderate neutrophil infiltration was more frequent in H.pylori infection when compared to mild infiltration (81.8％ and 75％,respectively),but did not reach statistical significance.For those patients with negative rapid urease test,H.pylori was detected in 73.2％ of patients with positive neutrophil infiltration on histology.In patients with subtotal gastrectomy,the diagnostic accuracy of neutrophil infiltration in H.pylori infection was 50％.CONCLUSION:Neutrophil infiltration is closely associated with H.pylori and may be recognized as a sign of this infection.
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    • NSTL
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    Quality of life after three kinds of esophagectomy for cancer

    Jian ZengJin-Shi Liu
    5106-5113页
    查看更多>>摘要：AIM:To evaluate quality of life (QOL) following Ivor Lewis,left transthoracic,and combined thoracoscopic/laparoscopic esophagectomy in patients with esophageal cancer.METHODS:Ninety patients with esophageal cancer were assigned to Ivor Lewis (n =30),combined thoracoscopic/laparoscopic (n =30),and left transthoracic (n =30) esophagectomy groups.The QOL-core 30questionnaire and the supplemental QOL-esophageal module 18 questionnaire for patients with esophageal cancer,both developed by the European Organization for Research and Treatment of Cancer,were used to evaluate patients' QOL from 1 wk before to 24 wk after surgery.RESULTS:A total of 324 questionnaires were collected from 90 patients; 36 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits.QOL declined markedly in all patients at 1 wk postoperatively:preoperative and 1-wk postoperative global QOL scores in the Ivor Lewis,combined thoracoscopic/laparoscopic,and left transthoracic groups were 80.8 ± 9.3 vs 32.0 ± 16.1 (P ＜ 0.001),81.1 ± 9.0 vs 53.3 ± 11.5 (P ＜ 0.001),and 83.6 ± 11.2 vs 46.4 ± 11.3 (P ＜ 0.001),respectively.Thereafter,QOL recovered gradually in all patients.Patients who underwent Ivor Lewis esophagectomy showed the most pronounced decline in QOL; global scores were lower in this group than in the combined thoracoscopic/laparoscopic (P ＜ 0.001) and left transthoracic (P ＜ 0.001) groups at 1 wk postoperatively and was not restored to the preoperative level at 24 wk postoperatively.QOL declined least in patients undergoing combined thoracoscopic/laparoscopic esophagectomy,and most indices had recovered to preoperative levels at 24 wk postoperatively.In the Ivor Lewis and combined thoracoscopic/laparoscopic groups,pain and physical function scores were 78.9 ± 18.5 vs 57.8± 19.9 (P ＜ 0.001) and 59.3 ± 16.1 vs 70.2 ± 19.2 (P =0.02),respectively,at 1 wk postoperatively and 26.1± 28.6 vs 9.5 ± 15.6 (P =0.007) and 88.4 ± 10.5 vs 95.8 ± 7.3 (P =0.003),respectively,at 24 wk postoperatively.Scores in the left transthoracic esophagectomy group fell between those of the other two groups.CONCLUSION:Compared with Ivor Lewis and left transthoracic esophagectomies,combined thoracoscopic/laparoscopic esophagectomy enables higher postoperative QOL,making it a preferable surgical approach for esophageal cancer.
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    Health-related quality of life of 256 recipients after liver transplantation

    Pei-Xian ChenLu-Nan YanWen-Tao Wang
    5114-5121页
    查看更多>>摘要：AIM:To investigate health-related quality of life (HRQoL)and psychological outcomes in 256 adults who had undergone liver transplantation (LT).METHODS:A stratified random sampling method was used in this follow-up multicenter study to select a representative sample of recipients undergoing either living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT).HRQoL was measured by using the Chinese version of Medical Outcome Study Short Form-36 (SF-36),and psychological outcomes by using the beck anxiety inventory (BAI)and the self-rating depression scale (SDS).Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaires.RESULTS:A total of 256 patients were sampled,including 66 (25.8％) receiving LDLT and 190 (74.2％)undergoing DDLT; 15 (5.9％) recipients had anxiety and four (1.6％) developed severe depression after the operation.Compared with LDLT recipients,DDLT patients had higher scores in general health (60.33± 16.97 vs 66.86 ± 18.42,P =0.012),role-physical (63.64 ± 42.55 vs 74.47 ± 36.46,P =0.048),roleemotional (61.11 ± 44.37 vs 78.95 ± 34.31,P =0.001),social functioning (78.60 ± 22.76 vs 88.16 ± 21.85,P =0.003),vitality (70.30 ± 15.76 vs 75.95 ± 16.40,P =0.016),mental health (65.88 ± 12.94 vs 71.85 ±15.45,P =0.005),physical component summary scale (PCS,60.07 ± 7.36 vs 62.58 ± 6.88,P =0.013) and mental component summary scale (MCS,52.65 ± 7.66vs 55.95 ± 10.14,P =0.016).Recipients ＞ 45 years old at the time of transplant scored higher in vitality (77.33 ± 15.64 vs 72.52 ± 16.66,P =0.020),mental health (73.64 ± 15.06 vs 68.00 ± 14.65,P =0.003)and MCS (56.61 ± 10.00 vs 54.05 ± 9.30,P =0.037)than those aged ≤ 45 years.MCS was poorer in recipients with than in those without complications (52.92± 12.21 vs 56.06 ± 8.16,P =0.017).Regarding MCS (55.10 ± 9.66 vs 50.0 ± 10.0,P ＜ 0.05) and PCS (61.93± 7.08 vs 50.0 ± 10.0,P ＜ 0.05),recipients scored better than the Sichuan general and had improved overall QoL compared to patients with chronic diseases.MCS and PCS significantly correlated with scores of the BAI (P ＜ 0.001) and the SDS (P ＜ 0.001).CONCLUSION:Age ＞ 45 years at time of transplant,DDLT,full-time working,no complications,anxiety and depression were possible factors influencing postoperative HRQoL in liver recipients.
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    • 维普