期刊,世界胃肠病学杂志（英文版） 2012年卷44期_国家学术搜索

期刊信息/Journal information

世界胃肠病学杂志（英文版）

主　　编：潘伯荣

出版周期：周刊

国际刊号：1007-9327

电子邮箱：wjg@wjgnet.com

电　　话：010-85381901-628

邮政编码：100025

地　　址：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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收录年代

Human epidermal growth factor receptor-2 in oesophageal cancers: An observational study

Hazem Al-MomaniRachel BarnesAhmed El-HadiRachit Shah...

6447-6451页

查看更多>>摘要：AIM:To determine the incidence of human epidermal growth factor receptor 2 (HER2) over expression in oesophageal cancers.METHODS:A retrospective study,of one hundred consecutive cases of endoscopic histological samples of oesophageal cancers from a single British cancer network were included.Cancer cases were diagnosed between April 2007 and June 2010.HER2 over expression was assessed using immunohistochemistry,those that scored "0" and "+1" were considered "negative"for HER2; those that scored "+3" were considered "Positive".Cases that were scored "+2" on immunohistochemistry further went on to have HER2 gene analysis using the Ventana HER brightfield dual-colour in situ hybridisations (HER B DISH) assay and either came back to be positive or negative for HER2 over expression.Overall survival was measured from date of histological diagnosis until date of death.93％ of the cases were followed up till five years or death,and all were followed up till two years.Cases of gastro-oesophageal junctional tumours were excluded.RESULTS:The median age of our sample was 66years (range:38-91 years).Eighty one were male and 19 female.Ninety-one of the cases were adenocarcinoma of the oesophagus and the rest were cases of squamous cell carcinoma.The anatomical distribution of the tumours was; upper oesophagus 2,middle oesophagus 11,and 87 were in the lower oesophagus.Operative resection was completed in 15 cases; seven cases had attempted surgical resections,i.e.,open and close,33 patients received definitive chemo-radiation and 52 had palliative treatment.Twenty-five of the cancers showed evidence of HER2 over expression,all were adenocarcinomas.Of the 25 cases that showed evidence of HER2 over expression,21 (84％) were located in the lower third of the oesophagus.On staging,24 out of the 25 HER2 positive cases were at stage 3or more (13 at stage 3 and 11 at stage 4),For HER2 negative cases 37 were at stage 3 and 32 were staged as stage 4.Seventeen out of twenty five cases (68％)with HER2 over expression received palliative therapy,in comparison to thirty five out of seventy five (46.7％)in tumours not expressing HER2.No significant difference in overall survival was demonstrated between patients whose cancers showed evidence of HER2 over expression and those who did not; median overall sup vival for HER2 positive tumours was 15 mo (95％CI,11-19 mo) compared to 13 mo (95％CI,9-17 mo) for HER2 negative ones.Two years cumulative survival for cases with HER2 over expression was 33.7％ compared to 31.6％ in cases without HER2 over expression (P =0.576).Only cancer's stage significantly affected overall survival on both univariant and multivariable analysis (P =0.034 and P =0.009 respectively).None of the patients included in this study received Trastuzumab.CONCLUSION:Twenty-seven point five percent of oesophageal adenocarcinomas showed evidence of HER2 over expression.Routine testing for human HER2 in oesophageal adenocarcinomas can have significant implication on treatments offered to patients that may

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Effectiveness of Saccharomyces boulardii in a rat model of colitis

Mujde SoyturkSaba Mukaddes SaygiliHuseyin BaskinOzgul Sagol...

6452-6460页

查看更多>>摘要：AIM:To investigate the effects of Saccharomyces boulardii (S.boulardii） in an experimental rat model of trinitrobenzene sulfonic acid (TNBS)-induced colitis.METHODS:Thirty-two Wistar albino female rats were categorized into five groups.On the first day of the study,50 mg TNBS was administered via a rectal catheter in order to induce colitis in all rats,except those in the control group.For 14 d,the rats were fed a standard diet,without the administration of any additional supplements to either the control or TNBS groups,in addition to 1 mg/kg per day S.boulardii to the S.boulardii group,1 mg/kg per day methyl prednisolone (MP)to the MP group.The animals in the S.boulardii + MP group were coadministered these doses of S.boulardii and MP.During the study,weight loss,stool consistency,and the presence of obvious blood in the stool were evaluated,and the disease activity index (DAI) for colitis was recorded.The intestines were examined and colitis was macro-and microscopically scored.The serum and tissue levels of tumor necrosis factor-α (TNF-α)and nitric oxide (NO) were determined,and fungemia was evaluated in the blood samples.RESULTS:The mean DAI scores for the MP and S.boulardii + MP groups was significantly lower than the TNBS group (3.69 ± 0.61 vs 4.46 ± 0.34,P =0.018and 3.77 ± 0.73 vs 4.46 ± 0.34,P =0.025,respectively).While no significant differences between the TNBS and the S.boulardii or MP groups could be determined in terms of serum NO levels,the level of serum NO in the S.boulardii + MP group was significantly higher than in the TNBS and S.boulardii groups (8.12 ± 4.25μmol/L vs 3.18 ± 1.19 μmol/L,P =0.013; 8.12 ± 4.25μmol/L vs 3.47 ± 1.66 μmol/L,P =0.012,respectively).The tissue NO levels in the S.boulardii,MP and S.boulardii + MP groups were significantly lower than the TNBS group (16.62 ± 2.27 iμmol/L vs 29.72 ± 6.10μmol/L,P =0.002; 14.66 ± 5.18 μmol/L vs 29.72 ± 6.10μmol/L,P =0.003; 11.95 ± 2.34 μmol/L vs 29.72 ± 6.10μmol/L,P =0.002,respectively).The tissue NO levels in the S.boulardii,MP and S.boulardii + MP groups were similar.The mean serum and tissue TNF-α levels were determined to be 12.97 ± 18.90 pg/mL and 21.75± 15.04 pg/mL in the control group,18.25 ± 15.44pg/mL and 25.27 ± 11.95 pg/mL in the TNBS group,20.59 ± 16.15 pg/mL and 24.39 ± 13.06 pcg/mL in theS.boulardii group,9.05 ± 5.13 pg/mL and 24.46 ± 10.85pg/mL in the MP group,and 13.95 ± 10.17 pg/mL and 24.26 ± 10.37 pg/mL in the S.boulardii + MP group.Significant differences in terms of the levels of serum and tissue TNF-α and the macroscopic and microscopic scores were not found between the groups.S.boulardii fungemia was not observed in any of the rats.However,Candida fungemia was detected in one rat (14％) in the TNBS group,two rats (28％) in the S.boulardii group,three rats (50％) in the MP group,and three rats (42％)in S.boulardii + NP group.CONCLUSION:S.boulardii does not demonstrate considerable effects on the DAI,pathological scores,or cytokine levels but does decrease the tissue NO levels.

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Nutritional support teams increase percutaneous endoscopic gastrostomy uptake in motor neuron disease

Lin ZhangLeanne SandersRobert JL Fraser

6461-6467页

查看更多>>摘要：AIM:To examine factors influencing percutaneous endoscopic gastrostomy (PEG) uptake and outcomes in motor neuron disease (MND) in a tertiary care centre.METHODS:Case notes from all patients with a confirmed diagnosis of MND who had attended the clinic at the Repatriation General Hospital between January 2007and January 2011 and who had since died,were audited.Data were extracted for demographics (age and gender),disease characteristics (date of onset,bulbar or peripheral predominance,complications),date and nature of discussion of gastrostomy insertion,nutritional status [weight measurements,body mass index (BMI)],date of gastrostomy insertion and subsequent progress (duration of survival) and quality of life (QoL) [Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R)].In addition,the type of dinician initiating the discussion regarding gastrostomy was recorded as Nutritional Support Team (involved in providing nutrition input viz Gastroenterologist,Speech Pathologist,Dietitian) and other (involved in non-nutritional aspects of patient care).Factors affecting placement and outcomes including length of survival,change in weight and QoL were determined.RESULTS:Case records were available for all 86 patients (49 men,mean age at diagnosis 66.4 years).Thirty-eight patients had bulbar symptoms and 48 had peripheral disease as their presenting feature.Sixty-six patients reported dysphagia.Thirty-one patients had undergone gastrostomy insertion.The major indications for PEG placement were dysphagia and weight loss.Nine patients required immediate full feeding,whereas 17 patients initially used the gastrostomy to supplement oral intake,4 for medication administration and 1 for hydration.Initially the PEG regime met 73％ ± 31％ of the estimated total energy requirements,increasing to 87％ ± 32％ prior to death.There was stabilization of weight in patients undergoing gastrostomy [BMI at 3mo (22.6 ± 2.2 kg/m2) and 6 mo (22.5 ± 2.0 kg/m2)after PEG placement compared to weight at the time of the procedure (22.5 ± 3.0 kg/m2)].However,weight loss recurred in the terminal stages of the illness.There was a strong trend for longer survival from diagnosis among MND in PEG recipients with limb onset presentation compared to similar patients who did not undergo the procedure (P =0.063).Initial discussions regarding PEG insertion occurred earlier after diagnosis when seen by nutrition support team (NST) clinicians compared to other dinicians.(5.4 ± 7.0 mo vs 11.9 ± 13.4 mo,P =0.028).There was a significant increase in PEG uptake (56％ vs 24％,P =0.011) if PEG discussions were initiated by the NST staff compared to other clinicians.There was no change in the ALSFRS-R score in patients who underwent PEG (pre 34.1 ±-8.6 vs post 34.8 ±7.4),although in non-PEG recipients there was a nonsignificant fall in this score (33.7 ± 7.9 vs 31.6 ± 8.8).Four patients died within one month of the procedure,4 developed bacterial site infection requiring antibiotics and 1 required endoscopic therapy for gastric bleeding.Less serious complications attributed to the procedure included persistent gastrostomy site discomfort,poor appetite,altered bowel function and bloating.CONCLUSION:Initial discussion with NST clinicians increases PEG uptake in MND.Gastrostomy stabilizes patient weight but weight loss recurs with advancing disease.

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Clinicopathological features of minute pharyngeal lesions diagnosed by narrow-band imaging endoscopy and biopsy

Takashi KumamotoKazuhiro SentaniShiro OkaShinji Tanaka...

6468-6474页

查看更多>>摘要：AIM:To evaluate the utility of magnified narrow-band imaging (NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first author.A magnification hood was attached to the tip of the endoscope for quick focusing.Most of the examinations were performed under sedation.Magnified NBI examinations were performed for all of the pharyngeal lesions that had noticeable brownish areas under unmagnified NBI observation,and an intrapapillary capillary loop (IPCL)classification was made.A total of 93 consecutive pharyngeal lesions were diagnosed as IPCL type ⅣV and were suspected to represent dysplasia.Sixty-two lesions of approximately 1 mm in diameter were biopsied in the clinic,and 17 lesions with larger diameters were resected by endoscopic submucosal dissection (ESD)at the Hiroshima University Hospital.In addition to the histological diagnoses,the lesion diameters were microscopically measured in 45 of the 62 biopsies.Thirtyfour of the 62 biopsied patients received endoscopic follow up.RESULTS:Minute pharyngeal lesions were diagnosed in 93 of approximately 3000 patients receiving magnified NBI examinations at the clinic.Of the 93 patients with IPCL type Ⅳ lesions,80 were men,and 13 were women.Fifty-six were drinkers,and 57 were smokers.Two had esophageal cancer.Twenty-one lesions were located on the posterior hypopharyngeal wall,and 72lesions were located on the posterior oropharyngeal wall.All 93 lesions were fiat and showed similar findings in the magnified and unmagnified NBI examinations.Although almost all of the IPCL type Ⅳ lesions showed faint redness when examined under white light,it was difficult to diagnose the lesions using only this technique because the contrast was weaker than that achieved in the NBI examinations.Of the 93 lesions,only 3 had diameters greater than 2.1 mm.Sixty-two lesions of approximately 1 mm were biopsied in the clinic,whereas 17 larger lesions were treated by ESD at the Hiroshima University Hospital.Of the 79 pharyngeal lesions that were biopsied or resected by ESD,5 were histologically diagnosed as high-grade dysplasia,39were diagnosed as low-grade dysplasia,and 39 were determined to be non-dysplastic lesions.There were no cancerous lesions.Histologically,abnormal cell size variations and increased nuclear size were observed in all of the high-grade dysplasia lesions,while the incidence of these findings in the low-grade dysplasia lesions was low.Of the 62 biopsied lesions,45 were microscopically measurable.The measured diameters ranged from 0.1to 2.0 mm.The dysplasia ratios increased with the diameters.A follow-up endoscopic examination of the 34biopsied patients found the rate of complete resection by biopsy to be 79％.The largest lesion in which complete resection was expected was a low-grade dysplasia of 1.9 mm in diameter.CONCLUSION:Minute pharyngeal lesions suspected to be dysplasia that are identified by NBI magnifying endoscopy should be biopsied to determine the diagnosis and further treatment.

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Rome Ⅲ survey of irritable bowel syndrome among ethnic Malays

Yeong Yeh LeeAnuar WaidHuck Joo TanAndrew Seng Boon Chua...

6475-6480页

查看更多>>摘要：AIM:To survey irritable bowel syndrome (IBS) using Rome Ⅲ criteria among Malays from the north-eastern region of Peninsular Malaysia.METHODS:A previously validated Malay language Rome Ⅲ IBS diagnostic questionnaire was used in the current study.A prospective sample of 232 Malay subjects (80％ power) was initially screened.Using a stratified random sampling strategy,a total of 221 Malay subjects (112 subjects in a "full time job" and 109subjects in "no full time job"） were recruited.Subjects were visitors (friends and relatives) within the hospital compound and were representative of the local community.Red flags and psychosocial alarm symptoms were also assessed in the current study using previously translated and validated questionnaires.Subjects with IBS were sub-typed into constipation-predominant,diarrhea-predominant,mixed type and un-subtyped.Univariable and multivariable analyses were used to test for association between socioeconomic factors and presence of red flags and psychosocial alarm features among the Malays with IBS.RESULTS:IBS was present in 10.9％ (24/221),red flags in 22.2％ (49/221) and psychosocial alarm features in 9.0％ (20/221).Red flags were more commonly reported in subjects with IBS (83.3％) than psychosocial alarm features (20.8％,P ＜ 0.001).Subjects with IBS were older (mean age 41.4 years vs 36.9 years,P =0.08),but no difference in gender was noted (P =0.4).Using univariable analysis,IBS was significantly associated with a tertiary education,high individual income above RM1000,married status,exsmoker and the presence of red flags (all P ＜ 0.05).In multiple logistic regression analysis,only the presence of red flags was significantly associated with IBS (odds ratio:0.02,95％CI:0.004-0.1,P ＜ 0.001).The commonest IBS sub-type was mixed type (58.3％),followed by constipation-predominant (20.8％),diarrheapredominant (16.7％) and un-subtyped (4.2％).Four of 13 Malay females (30.8％) with IBS also had menstrual pain.Most subjects with IBS had at least one red flag (70.8％),12.5％ had two red flags and 16.7％ with no red flags.The commonest red flag was a bowel habit change in subjects ＞ 50 years old and this was reported by 16.7％ of subjects with IBS.CONCLUSION:Using the Rome Ⅲ criteria,IBS was common among ethnic Malays from the north-eastern region of Peninsular Malaysia.

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Novel biosensor-based microarray assay for detecting rs8099917 and rs12979860 genotypes

Pei-Yuan LiXiao-Jun ZhouLan YaoXin-Hua Fang...

6481-6488页

查看更多>>摘要：AIM:To evaluate a novel biosensor-based microarray (BBM) assay for detecting rs12979860 and rs8099917genotypes.METHODS:Four probes specific for rs8099917C/T or rs12979860G/T detection and three sets of quality control probes were designed,constructed and arrayed on an optical biosensor to develop a microarray assay.Two sets of primers were used in a one tube polymerase chain reaction (PCR) system to amplify two target fragments simultaneously.The biosensor microarray contained probes that had been sequenced to confirm that they included the rsS099917C/T or rs12979860G/T alleles of interest and could serve as the specific assay standards.In addition to rehybridization of four probes of known sequence,a total of 40 clinical samples collected from hepatitis C seropositive patients were also tested.The target fragments of all 40 samples were amplified in a 50 μL PCR system.Ten μL of each amplicon was tested by BBM assay,and another 40 μL was used for sequencing.The agreement of the results obtained by the two methods was tested statistically using the kappa coefficient.The sensitivity of the BBM assay was evaluated using serial dilutions of ten clinical blood samples containing 103-104 white cells/lμL.RESULTS:As shown by polyacrylamide gel electrophoresis,two target segments of the interleukin 28B-associated polymorphisms (SNPs) were successfully amplified in the one-tube PCR system.The lengths of the two amplified fragments were consistent with the known length of the target sequences,137 and 159bps.After hybridization of the PCR amplicons with the probes located on the BBM array,the signals of each allele of both the rs8099917 SNPs and rs12979860 SNPs were observed simultaneously and were clearly visible by the unaided eye.The signals were distinct from each other,could be interpreted visually,and accurately recorded using an ordinary digital camera.To evaluate the specificity of the assay,both the plasmids and clinical samples were applied to the microarray.First,30PCR amplicons of the various SNP alleles were hybridized on the BBM microarray.Full agreement between plasmids and the BBM assay was observed,with 30/30correct matches (100％).The kappa value for the BBM assay with plasmids was 1.00 (P ＜ 0.05).For the 40clinical blood samples,the BBM assay hybridization and direct sequencing results were compared for each amplicon.For patient blood samples,agreement was 28/28 for rs8099917T/T,9/11 for rs809991Tl-/G,1/1for rs8099917G/G,24/24 for rs12979860C/C,11/14 for rs12979860c/-r,and 2/2 for rs12979860T/T.Only five clinical samples of amplicon assay and direct sequencing results were discordant and heterozygotes:2/11rs809991TF/G and 3/14 rs12979860C/T-.The agreement of outcomes between BBM assay and direct sequencing for the detection of rs8099917 and rs12979860 was 95％ and 92.5％,respectively; and the corresponding kappa values were 0.88 and 0.85 (A kappa value ＞ 0.75was defined as substantial agreement).The BBM assay and sequencing had similar specificities for detection and identification of the two SNPs and their alleles.The sensitivity evaluation showed that the BBM assay could detect and identify SNP sequences present in blood samples containing as few as 102 white blood cells/μL.CONCLUSION:This biosensor microarray assay was highly specific,sensitive,rapid and easy to perform.It is compatible with clinical practice for detection of rs8099917 and rs12979860.

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Risk clinicopathological factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on laparoscopic wedge resection

Zhi-Bin HuoShu-Bo ChenJing ZhangHua Li...

6489-6493页

查看更多>>摘要：AIM:To investigate the predictive factors of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC),and enlarge the possibility of using laparoscopic wedge resection (LWR).METHODS:We retrospectively analyzed 85 patients with poorly differentiated EGC who underwent surgical resection between January 1992 and December 2010.The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Odds ratios (OR) with 95％CI were calculated.We further examined the relationship between the positive number of the three significant predictive factors and the LNM rate.RESULTS:In the univariate analysis,tumor size (P =0.011),depth of invasion (P =0.007) and lymphatic vessel involvement (P ＜ 0.001) were significantly associated with a higher rate of LNM.In the multivariate model,tumor size (OR =7.125,95％CI:1.251-38.218,P =0.041),depth of invasion (OR =16.624,95％CI:1.571-82.134,P =0.036) and lymphatic vessel involvement (OR =39.112,95％CI:1.745-123.671,P =0.011)were found to be independently risk clinicopathological factors for LNM.Of the 85 patients diagnosed with poorly differentiated EGC,12 (14.1％) had LNM.The LNM rates were 5.7％,42.9％ and 57.1％,respectively in cases with one,two and three of the risk factors respectively in poorly differentiated EGC.There was no LNM in 29 patients without the three risk clinicopathological factors.CONCLUSION:LWR alone may be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size,and when lymphatic vessel involvement is absent at postoperative histological examination.

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Small intestine bleeding due to multifocal angiosarcoma

Luisa Zacarias F(o)ohrdingArne MacherStefan BraunsteinWolfram Trudo Knoefel...

6494-6500页

查看更多>>摘要：We report a case of an 84-year-old male patient with primary small intestinal angiosarcoma.The patient initially presented with anemia and melena.Consecutive endoscopy revealed no signs of upper or lower active gastrointestinal bleeding.The patient had been diagnosed 3 years previously with an aortic dilation,which was treated with a stent.Computed tomography suggested an aorto-intestinal fistula as the cause of the in-testinal bleeding,leading to operative stent explantation and aortic replacement.However,an aorto-intestinal fistula was not found,and the intestinal bleeding did not arrest postoperatively.The constant need for blood transfusions made an exploratory laparotomy imperative,which showed multiple bleeding sites,predominately in the jejunal wall.A distal loop jejunostomy was conducted to contain the small intestinal bleeding and a segmental resection for histological evaluation was performed.The histological analysis revealed a lessdifferentiated tumor with characteristic CD31,cytokeratin,and vimentin expression,which led to the diagnosis of small intestinal angiosarcoma.Consequently,the infiltrated part of the jejunum was successfully resected in a subsequent operation,and adjuvant chemotherapy with paclitaxel was planned.Angiosarcoma of the small intestine is an extremely rare malignant neoplasm that presents with bleeding and high mortality.Early diagnosis and treatment are essential to improve outcome.A small intestinal angiosarcoma is a challenging diagnosis to make because of its rarity,nonspecific symptoms of altered intestinal function,nonspecific abdominal pain,severe melena,and acute abdominal signs.Therefore,a quick clinical and histological diagnosis and decisive measures including surgery and adjuvant chemotherapy should be the aim.

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Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis

Ling NieXue-Feng LuoXiao Li

6501-6503页

查看更多>>摘要：An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries.The clinical symptoms associated with APFs may include abdominal pain,gastrointestinal bleeding,ascites,nausea,vomiting,diarrhea,or even congestive heart failure.We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis.The endovascular embolization of APF was accomplished successfully,and symptoms of portal hypertension resolved immediately after intervention.Unfortunately,the patient did not respond well to anticoagulation therapy with warfarin.Therefore,the patient underwent implantation of a transjugular intrahepatic portosystemic shunt,and the complications of portal hypertension resolved.In conclusion,the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.

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Novel A TPSB1 mutation in an adult male with progressive familial intrahepatic cholestasis

Bao-Cheng DengSa LvWei CuiRui Zhao...

6504-6509页

查看更多>>摘要：Progressive familial intrahepatic cholestasis type 1 is a rare disease that is characterized by low serum γ-glutamyltransferase levels due to mutation in ATP8B1.We present a 23-year-old male who experienced persistent marked pruritus for eighteen years and recurrent jaundice for thirteen years,in addition to cholestasis that eventually became fatal.Genetic sequencing studies of the entire coding (exon) sequences of ATP8B1 and ABCB11 uncovered a novel heterozygous missense 3035G＞T mutation (S1012I) and a synonymous 696T＞C mutation in ATP8B1.The patient's progression was associated with not only impaired familial intrahepatic cholestasis 1 (FIC1) function but also impaired bile salt export pump expression due to the impaired FIC1 function.Our findings show that patients with intermittent cholestasis can develop progressive liver disease even after several decades and require regular follow up.

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