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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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    Celiac disease markers in patients with liver diseases: A single center large scale screening study

    Pavel DrastichEva HonsováAlena LodererováMarcela Jare(s)ová...
    6255-6262页
    查看更多>>摘要：AIM:To study the coincidence of celiac disease,we tested its serological markers in patients with various liver diseases.METHODS:Large-scale screening of serum antibodies against tissue transglutaminase (tTG),and deamidated gliadin using enzyme-linked immunosorbent assay and serum antibodies against endomysium using immunohistochemistry,in patients with various liver diseases (n =962) and patients who underwent liver transplantation (OLTx,n =523) was performed.The expression of tTG in liver tissue samples of patients simultaneously suffering from celiac disease and from various liver diseases using immunohistochemistry was carried out.The final diagnosis of celiac disease was confirmed by histological analysis of small-intestinal biopsy.RESULTS:We found that 29 of 962 patients (3％) with liver diseases and 5 of 523 patients (0.8％) who underwent OLTx were seropositive for IgA and IgG anti-tTG antibodies.However,celiac disease was biopsy-diagnosed in 16 patients:4 with autoimmune hepatitis type Ⅰ,3 with Wilson's disease,3 with celiac hepatitis,2 with primary sclerosing cholangitis,1with primary biliary cirrhosis,1 with Budd-Chiari syndrome,1 with toxic hepatitis,and 1 with non-alcoholic steatohepatitis.Unexpectedly,the highest prevalence of celiac disease was found in patients with Wilson's disease (9.7％),with which it is only rarely associated.On the other hand,no OLTx patients were diagnosed with celiac disease in our study.A pilot study of the expression of tTG in liver tissue using immunohistochemistry documented the overexpression of this molecule in endothelial cells and periportal hepatocytes of patients simultaneously suffering from celiac disease and toxic hepatitis,primary sclerosing cholangitis or autoimmune hepatitis type Ⅰ.CONCLUSION:We suggest that screening for celiac disease may be beneficial not only in patients with associated liver diseases,but also in patients with Wilson's disease.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Clinicopathological characteristics of human epidermal growth factor receptor 2-positive Barrett's adenocarcinoma

    Takehiro TanakaAtsushi FujimuraKoichi IchimuraHiroyuki Yanai...
    6263-6268页
    查看更多>>摘要：AIM:To compare the clinicopathological characteristics of human epidermal growth factor receptor 2 (HER2)-positive and HER2-negative Barrett's adenocarcinoma in Japan.METHODS:We performed immunohistochemical analysis of HER2 in 30 samples taken from patients with Barrett's adenocarcinoma and dual color in situ hybridization in cases showing 2+ reactions.We compared the clinicopathological characteristics of HER2-positive and HER2-negative patients.RESULTS:HER2 positivity was identified in 8 (27％) carcinoma samples.We found that HER2 expression was associated with p53 overexpression (100％ vs 52.6％ in pT1 tumor; 100％ vs 54.5％ in all stage tumor,P ＜ 0.05) and protruding lesions at the early disease stage.There was no association between the mucin phenotype of the carcinomas and prognosis.HER2 expression and low clinical stage were unexpectedly different between Barrett's adenocarcinoma patients and gastric cancer patients,but the macroscopic features may be associated with earlier diagnosis in these patients.CONCLUSION:Our results suggest that HER2-positive Barrett's adenocarcinomas are associated with p53 overexpression and lesion protrusion at the early disease stage.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography

    Akihiro TateyamaYoshihiko FukukuraKoji TakumiToshikazu Shindo...
    6269-6276页
    查看更多>>摘要：AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT).METHODS:Twenty-six patients with 61 hepatic hemangiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed.Hemangioma appearances (presence of peripheral nodular enhancement,central nodular enhancement,diffuse homogenous enhancement,and arterioportal shunt during the arterial phase,fill-in enhancement during the portal venous phase,and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated.The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase.For quantitative analysis,the tumor-muscle signal intensity ratio (SIR),the liver-muscle SIR,and the attenuation value of the tumor and liver parenchyma were calculated.The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT.RESULTS:There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85％vs 82％),central nodular enhancement (3％ vs 3％),diffuse enhancement (11％ vs 16％),or arterioportal shunt (23％ vs 34％) during arterial phase,or fill-in enhancement (79％ vs 80％) during portal venous phase.Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52％ vs 100％,P ＜ 0.001).On visual inspection,there was significantly less contrast enhancement of the enhancing portion on GdEOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64,respectively,P ＜ 0.001),portal venous (3.72 ± 0.82 vs 4.36 ± 0.53,respectively,P ＜ 0.001),and equilibrium phases (2.01± 0.95 vs 4.04 ± 0.51,respectively,P ＜ 0.001).In the quantitative analysis,the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast,1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase,1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase,1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase,and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase,respectively.The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37precontrast,172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase,152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase,and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase,respectively.Hemangiomas demonstrated peak enhancement during the arterial phase,and both the SIR with GdEOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time.The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on GdEOB-DTPA-enhanced MRI.However,the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CONCLUSION:Prolonged enhancement during the equilibrium phase was observed less frequently on GdEOB-DTPA-enhanced MRI than enhanced CT,which may exacerbate differentiating between hemangiomas and malignant tumors.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Durability of viral response after off-treatment in HBeAg positive chronic hepatitis B

    Myeong Jun SongDo Seon SongHee Yeon KimSun Hong Yoo...
    6277-6283页
    查看更多>>摘要：AIM:To evaluate the durability in hepatitis B e antigen (HBeAg) positive chronic hepatitis B patients who discontinued antiviral treatment.METHODS:A total of 48 HBeAg positive chronic hepatitis B patients who were administered nucleoside analogues and maintained virological response for ≥6 mo [hepatitis B virus (HBV) DNA ＜ 300 copies/mL and HBeAg seroconversion] before cessation of treatment were enrolled between February 2007 and January 2010.The criteria for the cessation of the antiviral treatment were defined as follows:(1) achievement of virological response; and (2) duration of consolidation therapy (≥ 6 mo).After treatment cessation,the patients were followed up at 3-6 mo intervals.The primary endpoint was serologic and virologic recurrence rates after withdrawal of antiviral treatment.Serologic recurrence was defined as reappearance of HBeAg positivity after HBeAg seroconversion.Virologic recurrence was defined as an increase in HBV-DNA level ＞104 copies/mL after HBeAg seroconversion with previously undetectable HBV-DNA level.RESULTS:During the median follow-up period of 18.2 mo (range:5.1-47.5 mo) after cessation of antiviral treatment,the cumulative serological recurrence rate was 15 ％ at 12 mo.The median duration between the cessation of antiviral treatment and serologic recurrence was 7.2 mo (range:1.2-10.9 mo).Of the 48 patients with HBeAg positive chronic hepatitis,20 (41.6％)showed virological recurrence.The cumulative virologic recurrence rates at 12 mo after discontinuing the antiviral agent were 41％.The median duration between off-treatment and virologic recurrence was 7.6 mo (range:4.3-27.1 mo).The mean age of the virological recurrence group was older than that of the non-recurrence group (46.7 ± 12.1 years vs 38.8 ± 12.7 years,respectively; P =0.022).Age (＞ 40 years) and the duration of consolidation treatment (≥ 15 mo) were significant predictive factors for offtreatment durability in the multivariate analysis [P =0.049,relative risk (RR) 0.31,95％ CI (0.096-0.998) and P =0.005,RR 11.29,95％ CI (2.054-65.12),respectively].Patients with age (≤ 40 years) who received consolidation treatment (≥15 mo) significantly showed durability in HBeAg positive chronic hepatitis B patients (P =0.014).These results suggest that additional treatment for more than 15 mo after HBeAg seroconversion in patients who are ≤ 40 years old may be beneficial in providing a sustained virological response.CONCLUSION:Our data suggest that HBeAg seroconversion is an imperfect end point in antiviral treatment.Long-term consolidation treatment (≥ 15 mo)in younger patients is important for producing better prognosis in HBeAg positive chronic hepatitis B.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Bispectral index monitoring as an adjunct to nurse-administered combined sedation during endoscopic retrograde cholangiopancreatography

    Se Young JangHyun Gu ParkMin Kyu JungChang Min Cho...
    6284-6289页
    查看更多>>摘要：AIM:TO determine whether bispectral index (BIS)monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP).METHODS:Fifty-nine consecutive patients with a variety of reasons for ERCP who underwent the procedure at least twice between 1 July 2010 and 30 November 2010.This was a randomized cross-over study,in which each patient underwent ERCP twice,once with BIS monitoring and once with control monitoring.Whether BIS monitoring was done during the first or second ERCP procedure was random.Patients were intermittently administered a mixed regimen including midazolam,pethidine,and propofol by trained nurses.The nurse used a routine practice to monitor sedation using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale or the BIS monitoring.The total amount of midazolam and propofol used and serious side effects were compared between the BIS and control groups.RESULTS:The mean total propofol dose administered was 53.1 ± 32.2 mg in the BIS group and 54.9± 30.8 mg in the control group (P =0.673).The individual propofol dose received per minute during the ERCP procedure was 2.90 ± 1.83 mg/min in the BIS group and 3.44 ± 2.04 mg in the control group (P =0.103).The median value of the MOAA/S score during the maintenance phase of sedation was comparable for the two groups.The mean BIS values throughout the procedure (from insertion to removal of the endoscope) were 76.5 ± 8.7 for all 59 patients in using the BIS monitor.No significant differences in the frequency of ＜ 80％ oxygen saturation,hypotension (＜ 80 mmHg),or bradycardia (＜ 50 beats/min) were observed between the two study groups.Four cases of poor cooperation occurred,in which the procedure should be stopped to add the propofol dose.After adding the propofol,the procedure could be conducted successfully (one case in the BIS group,three cases in the control group).The endoscopist rated patient sedation as excellent for all patients in both groups.All patients in both groups rated their level of satisfaction as high (no discomfort).During the post-procedural follow-up in the recovery area,no cases of clinically significant hypoxic episodes were recorded in either group.No other postoperative side effects related to sedation were observed in either group.CONCLUSION:BIS monitoring trend to slighlty reduce the mean propofol dose.Nurse-administered propofol sedation under the supervision of a gastroenterologist may be considered an alternative under anesthesiologist.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Effects of telbivudine and entecavir for HBeAg-positive chronic hepatitis B: A meta-analysis

    Qi-Min SuXiao-Guang Ye
    6290-6301页
    查看更多>>摘要：AIM:To compare the effects of telbivudine (LDT) and entecavir (ETV) in treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B by meta-analysis.METHODS:We conducted a literature search using PubMed,MEDLINE,EMBASE,the China National Knowledge Infrastructure,the VIP database,the Wanfang database and the Cochrane Controlled Trial Register for all relevant articles published before April 1,2012.Randomized controlled trials (RCTs) comparing LDT with ETV for treatment of HBeAg-positive chronic hepatitis B were included.The data was analyzed with Review Manager Software 5.0.We used relative risk (RR) as an effect measure,and reported its 95％ CI.Meta-analysis was performed using either a fixedeffect or random-effect model,based on the absence or presence of significant heterogeneity.Two reviewers assessed the risk of bias and extracted data independently and in duplicate.The analysis was executed using the main outcome parameters including hepatitis B virus (HBV) DNA undetectability,alanine aminotransferase (ALT) normalization,HBeAg loss,HBeAg seroconversion,drug-resistance,and adverse reactions.Meta-analysis of the included trials and subgroup analyses were conducted to examine the association between pre-specified characteristics with the therapeutic effects of the two agents.RESULTS:Thirteen eligible trials (3925 patients in total) were included and evaluated for methodological quality and heterogeneity.In various treatment durations of 4 wk,8 wk,12 wk,24 wk,36 wk,48 wk,52 wk,60 wk and 72 wk,the rates of HBV DNA undetectability and ALT normalization in the two groups were similar,without statistical significance.At 4 wk and 8 wk of the treatment,no statistical differences were found in the rate of HBeAg loss between the two groups,while the rate in the LDT group was higher than in the ETV group at 12 wk,24 wk,48 wk and 52 wk,respectively (RR 2.28,95％ CI 1.16,7.03,P =0.02; RR 1.45,95％ CI 1.16,1.82,P =0.001; RR 1.45,95％ CI 1.11,1.89,P =0.006; and RR 1.86,95％ CI 1.04,3.32,P =0.04).At 4 wk,8 wk,60 wk and 72 wk of the treatment,there were no significant differences in the rate of HBeAg seroconversion between the two groups,while at 12 wk,24 wk,48 wk and 52 wk,the rate in the LDT group was higher than in the ETV group (RR 2.10,95％ CI 1.36,3.24,P =0.0008;RR 1.71,95％ CI 1.29,2.28,P =0.0002; RR 1.86,95％ CI 1.36,2.54,P ＜ 0.0001; and RR 1.87,95％ CI 1.21,2.90,P =0.005).The rate of drug-resistance was higher in the LDT group than in the ETV group (RR 3.76,95％ CI 1.28,11.01,P =0.02).In addition,no severe adverse drug reactions were observed in the two groups.And the rate of increased creatine kinase in the LDT group was higher than in the ETV group (RR 5.58,95％ CI 2.22,13.98,P =0.0002).CONCLUSION:LDT and ETV have similar virological and biomedical responses,and both are safe and well tolerated.However,LDT has better serological response and higher drug-resistance.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection

    Yi-Qi DuTun SuJian-Gao FanYu-Xia Lu...
    6302-6307页
    查看更多>>摘要：AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H.pylori) infection.METHODS:This open randomized trial recruited 234 H.pylori positive gastritis patients from seven local centers.The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid,clarithromycin 500 mg bid,and amoxicillin 1000 mg bid; OCA group,n =79); two weeks of pre-treatment with probiotics,containing 3 × 107 Lactobacillus acidophilus per day,prior to one week of triple therapy (POCA group,n =78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group,n =77).Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy.Patients were asked to report associated symptoms at baseline and during follow-up,and side effects related to therapy were recorded.Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods.RESULTS:PP analysis involved 228 patients,78 in the OCA,76 in the POCA and 74 in the OCAP group.Successful eradication was observed in 171 patients; by PP analysis,the eradication rates were significantly higher (P =0.007 each) in the POCA (62/76; 81.6％,95％CI 72.8％-90.4％) and OCAP (61/74; 82.4％,95％ CI 73.6％-91.2％) groups than in the OCA group (48/78;61.5％,95％ CI 50.6％-72.4％).ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5％,95％ CI 70.4％-88.6％)and OCAP (61/77; 79.2％,95％ CI 70％-88.4％)groups than in the OCA group (48/79; 60.8％,95％ CI 49.9％-71.7％),(P =0.014 and P =0.015).The symptom relieving rates in the POCA,OCAP and OCA groups were 85.5％,89.2％ and 87.2％,respectively.Only one of the 228 patients experienced an adverse reaction.CONCLUSION:Administration of probiotics before or after standard triple therapy may improve H.pylori eradication rates.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Effects of warm ischemia time on biliary injury in rat liver transplantation

    Xin-Hua ZhuJun-Ping PanYa-Fu WuYi-Tao Ding...
    6308-6314页
    查看更多>>摘要：AIM:To investigate the effect of different secondary warm ischemia time (SWIT) on bile duct injury in livertransplanted rats.METHODS:Forty-eight male inbred Sprague-Dawley rats were randomly assigned into four groups:a shamoperation group and three groups with secondary biliary warm ischemia time of 0 min,10 min and 20 min.A rat model of autologous liver transplantation under ether anesthesia was established,and six rats were killed in each group and blood samples and the median lobe of the liver were collected for assay at 6 h and 24 h after hepatic arterial reperfusion.RESULTS:With prolongation of biliary warm ischemia time,the level of vascular endothelial growth factor-A was significantly decreased,and the value at 24 h was higher than that at 6 h after hepatic arterial reperfusion,but with no significant difference.The extended biliary SWIT led to a significant increase in bile duct epithelial cell apoptosis,and a decrease in the number of blood vessels,the bile duct surrounding the blood vessels and bile duct epithelial cell proliferation in the early postoperative portal area.Pathologic examinations showed that inflammation of the rat portal area was aggravated,and biliary epithelial cell injury was significantly worsened.CONCLUSION:A prolonged biliary warm ischemia time results in aggravated injury of the bile duct and the surrounding vascular plexus in rat autologous orthotopic liver transplantation.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Does antecolic reconstruction for duodenojejunostomy improve delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? A systematic review and meta-analysis

    An-Ping SuShuang-Shuang CaoYi ZhangZhao-Da Zhang...
    6315-6323页
    查看更多>>摘要：AIM:To evaluate whether antecolic reconstruction for duodenojejunostomy (DJ) can decrease delayed gastric emptying (DGE) rate after pylorus-preserving pancreaticoduodenectomy (PPPD) through literature review and meta-analysis.METHODS:Articles published between January 1991 and April 2012 comparing antecolic and retrocolic reconstruction for DJ after PPPD were retrieved from the databases of MEDLINE (PublMled),EMBASE,OVID and Cochrane Library Central.The primary outcome of interest was DGE.Either fixed effects model or random effects model was used to assess the pooled effect based on the heterogeneity.RESULTS:Five articles were identified for inclusion:two randomized controlled trials and three non-randomized controlled trials.The meta-analysis revealed that antecolic reconstruction for DJ after PPPD was associated with a statistically significant decrease in the incidence of DGE [odds ratio (OR),0.06; 95％ CI,0.02-0.17; P ＜ 0.00 001] and intra-operative blood loss [mean difference (MD),-317.68; 95％ CI,-416.67to-218.70; P ＜ 0.00 001].There was no significant difference between the groups of antecolic and retrocolic reconstruction in operative time (MD,25.23; 95％CI,-14.37 to 64.83; P =0.21),postoperative mortality,overall morbidity (OR,0.54; 95％ CI,0.20-1.46; P =0.22) and length of postoperative hospital stay (MD,-9.08; 95％ CI,-21.28 to 3.11; P =0.14).CONCLUSION:Antecolic reconstruction for DJ can decrease the DGE rate after PPPD.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Granular cell tumor of the common bile duct: A Japanese case

    Junko SaitoMichiko KitagawaHiroshi KusanagiNobuyasu Kano...
    6324-6327页
    查看更多>>摘要：Granular cell tumor (GCT) of the biliary system is rare.It is reported that it occurs more commonly in young black women.We report here our seldom experience of a Japanese case in whom icterus was found as a first symptom just after a caesarean operation.A 36-year-old Japanese woman developed icterus after delivery by the Caesarean operation.A surgical operation was performed without can deny that there was a tumor-related change in a bile duct as a result of examination for various images.As a result of pathological evaluation,GCT was diagnosed.By the preoperative organization biomicroscopy result,it was not able to be attachd a right diagnosis.It was thought that this tumor,although rare,should be considered as one of the causes of biliary stenosis in the younger population.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普