Clinical and Experimental Gastroenterology最新文献

{"title":"Magnetic Resonance Enterography Assessment of Transmural Healing with Vedolizumab in Moderate to Severe Crohn's Disease: Feasibility in the VERSIFY Phase 3 Clinical Trial.","authors":"Jordi Rimola, Jean-Frédéric Colombel, Brian Bressler, Shashi Adsul, Jenifer Siegelman, Patricia E Cole, Dirk Lindner, Silvio Danese","doi":"10.2147/CEG.S429039","DOIUrl":"10.2147/CEG.S429039","url":null,"abstract":"<p><strong>Purpose: </strong>The VERSIFY phase 3 trial in patients with Crohn's disease (CD) treated with vedolizumab was the first to include a substudy that used a standardized magnetic resonance enterography (MRE) protocol to assess features of transmural inflammation (bowel edema and wall thickness) and extramural disease activity (enlarged lymph nodes).</p><p><strong>Patients and methods: </strong>Patients received intravenous vedolizumab (300 mg) at weeks 0 (baseline), 2, and 6, and then every 8 weeks for 26 or 52 weeks. Post hoc analyses included a subpopulation with a Magnetic Resonance Index of Activity score of ≥7 in at least one bowel segment at baseline and at least one postbaseline MRE assessment. Changes in transmural inflammation, including intramural bowel edema and wall thickness, were evaluated. Patient-level and segment-level analyses were performed.</p><p><strong>Results: </strong>MRE images were evaluated in 27 patients with 83 evaluable bowel segments at baseline and week 26, and 13 patients with 38 evaluable segments at baseline, week 26, and week 52. At baseline, all patients had bowel wall edema and wall thickness of >3 mm in at least one bowel segment. The proportion of patients with edema decreased at weeks 26 (17/27 [63.0%]) and 52 (4/13 [30.8%]) and the proportion with bowel wall thickness of >3 mm decreased at weeks 26 (25/27 [92.6%]) and 52 (10/13 [76.9%]).</p><p><strong>Conclusion: </strong>In patients with CD treated with vedolizumab for 26 and 52 weeks, the number of patients, and bowel segments, with MRE-detected transmural inflammation was reduced. These results highlight the impact of vedolizumab on components of transmural inflammation in CD and demonstrate that using MRE in CD multicenter clinical trials is feasible.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT02425111, April 23, 2015, http://www.clinicaltrials.gov NCT02425111; EU Clinical Trials Register EudraCT 2014-003509-13, https://www.clinicaltrialsregister.eu.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"17 ","pages":"9-23"},"PeriodicalIF":2.5,"publicationDate":"2024-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10829592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstacles to Early Diagnosis of Acute Hepatic Porphyria: Current Perspectives on Improving Early Diagnosis and Clinical Management","authors":"Manish Thapar, Akash Singh, Kevin Robinson, Herbert Bonkovsky","doi":"10.2147/ceg.s348507","DOIUrl":"https://doi.org/10.2147/ceg.s348507","url":null,"abstract":"","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"27 17","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139394226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized Treatment for Crohn's Disease: Current Approaches and Future Directions.","authors":"Joseph William Clinton, Raymond Keith Cross","doi":"10.2147/CEG.S360248","DOIUrl":"https://doi.org/10.2147/CEG.S360248","url":null,"abstract":"<p><p>Crohn's disease is a complex, relapsing and remitting inflammatory disorder of the gastrointestinal tract with a variable disease course. While the treatment options for Crohn's disease have dramatically increased over the past two decades, predicting individual patient response to treatment remains a challenge. As a result, patients often cycle through multiple different therapies before finding an effective treatment which can lead to disease complications, increased costs, and decreased quality of life. Recently, there has been increased emphasis on personalized medicine in Crohn's disease to identify individual patients who require early advanced therapy to prevent complications of their disease. In this review, we summarize our current approach to management of Crohn's disease by identifying risk factors for severe or disabling disease and tailoring individual treatments to patient-specific goals. Lastly, we outline our knowledge gaps in implementing personalized Crohn's disease treatment and describe the future directions in precision medicine.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"16 ","pages":"249-276"},"PeriodicalIF":2.4,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10726957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Pharmacokinetic Model That Accounts for the Plasma Concentrations of Conjugated and Unconjugated Bilirubin Observed in a Variety of Disease States","authors":"David Levitt, Michael D Levitt","doi":"10.2147/ceg.s438140","DOIUrl":"https://doi.org/10.2147/ceg.s438140","url":null,"abstract":"","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"334 ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138989707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PSMA-Targeted PET Radiotracer [18F]DCFPyL as an Imaging Biomarker in Inflammatory Bowel Disease","authors":"Mohamed Saleh Ismail, Diane E Peters, Steven P Rowe, Ali Salavati, Sowmya Sharma, Robert Anders, M. Pomper, Barbara S Slusher, Florin M Selaru","doi":"10.2147/CEG.S404009","DOIUrl":"https://doi.org/10.2147/CEG.S404009","url":null,"abstract":"Background Prostate-specific membrane antigen (PSMA) is highly and specifically upregulated in active-inflamed mucosa of patients with inflammatory bowel disease (IBD). We hypothesized that this upregulation would be detectable using a PSMA-targeted positron emission tomography/computed tomography (PET/CT) imaging agent, [18F]DCFPyL, enabling non-invasive visualization of inflammation. A noninvasive means of detecting active inflammation would have high clinical value in localization and management of IBD. Study We performed [18F]DCFPyL imaging in three IBD patients with active disease. Abnormally increased gastrointestinal [18F]DCFPyL uptake was observed in areas with endoscopic, histologic, and immunohistochemical inflammation, demonstrating partial overlap of segments of bowel with abnormal [18F]DCFPyL uptake and active inflammation. Conclusion This study demonstrates that PSMA-targeted [18F]DCFPyL PET can effectively detect regions of inflamed mucosa in patients with IBD, suggesting its utility as a non-invasive imaging agent to assess location, extent, and disease activity in IBD.","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" 966","pages":"237 - 247"},"PeriodicalIF":2.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gardenia Iridoid Glucosides Protect Against α-Naphthalene Isothiocya-Nate-Induced Cholestatic Rats Through Activation of the FXR-SHP Signaling Pathway","authors":"Meng Xu, Ke Che, Cong Wang, Ya-Ru Chen, Meng-Yuan Chen, Guang-Lei Zhang, Hao Yu, Hao-Nan Xu, Ya-Bao Li, Ping Sheng, Hao Chen","doi":"10.2147/CEG.S438234","DOIUrl":"https://doi.org/10.2147/CEG.S438234","url":null,"abstract":"Introduction Cholestasis is a common liver disorder that currently has limited treatment options. Gardenia Iridoid Glucosides (GIG) have been found to possess various physiological activities, such as cholagogic, hypoglycemic, antibacterial, and anti-inflammatory effects. The objective of this study was to investigate the effects of GIG on bile acid enterohepatic circulation and explore the underlying mechanism in cholestatic rats. Methods In order to identify key pathways associated with cholestasis, we conducted Gene Ontology (GO) Enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. In vivo experiments were then performed on alpha-naphthylisothiocyanate (ANIT)-treated rats to assess the impact of GIG. We measured bile flow and various biomarkers including total bilirubin (TB), total bile acids (TBA), total cholesterol (TC), malondialdehyde (MDA), glutamic-pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), and total superoxide dismutase (T-SOD) in the serum. We also examined the expression levels of bile salt export pump (BSEP), ATP-binding cassette subfamily B member 4 (ABCB4), far-nesoid X receptor (FXR), small heterodimer partner (SHP), cholesterol 7α-hydroxylase (CYP7A1), and sodium taurocholate cotransporting polypeptide (NTCP) in liver tissue. In vitro experiments were conducted on primary hepatocytes to further investigate the mechanism of action of GIG on the expression of SHP, CYP7A1, NTCP, and FXR. Results Our in vivo experiments demonstrated that GIG significantly increased bile flow and reduced the levels of TB, TBA, TC, MDA, GPT, and GOT, while increasing T-SOD levels in ANIT-treated rats. Addi-tionally, GIG ameliorated liver tissue damage induced by ANIT, upregulated the expression of BSEP and ABCB4, and modulated the protein expression of FXR, SHP, CYP7A1, and NTCP in model rats. In vitro experiments further revealed that GIG inhibited the expression of SHP, CYP7A1, and NTCP by suppressing the expression of FXR. Conclusion This study provides new insights into the therapeutic potential of GIG for the treatment of cholestasis. GIG demonstrated beneficial effects on bile acid enterohepatic circulation and liver biomarkers in cholestatic rats. The modulation of FXR and its downstream targets may contribute to the mechanism of action of GIG. These findings highlight the potential of GIG as a therapeutic intervention for cholangitis.","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" 47","pages":"225 - 236"},"PeriodicalIF":2.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138618489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dumping Syndrome: Pragmatic Treatment Options and Experimental Approaches for Improving Clinical Outcomes.","authors":"Gwen M C Masclee, Ad A M Masclee","doi":"10.2147/CEG.S392265","DOIUrl":"10.2147/CEG.S392265","url":null,"abstract":"<p><p>Dumping syndrome is a common complication after esophageal, gastric and bariatric surgery and has a significant negative impact on the quality of life of patients. This narrative review describes the clinical syndrome, pathophysiology, diagnosis and reports on standard and pragmatic therapeutical treatment options in order to improve the clinical outcome of patients with dumping syndrome. Dumping syndrome consists of early and late dumping symptoms and can be diagnosed using clinical parameters with the help of the Sigstad's score, questionnaires or by provocative testing. The prevalence of dumping syndrome varies depending on the employed definition of dumping syndrome. Overall, dumping syndrome is more frequent nowadays due to increasing numbers of upper gastrointestinal and bariatric surgeries being performed. First treatment step includes dietary adjustment and dietary supplements, which are often sufficient to manage symptoms for the majority of patients. Next step of therapy includes acarbose, which is effective for late dumping symptoms, but the use is limited due to side effects. Somatostatin analogues are indicated after these two steps have failed. Somatostatin analogues are very effective for controlling early and late dumping, also in the long term. Glucagon like peptide-1 receptor agonists, endoscopic and surgical (re)interventions are reported as treatment options for refractory dumping syndrome; however, their use is not recommended in clinical practice due to the limited evidence on and uncertainty of outcomes. These alternatives should be considered only as last resort options in patients with otherwise refractory and invalidating dumping syndrome.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"16 ","pages":"197-211"},"PeriodicalIF":2.4,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89717151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Mass Index Profile of Adult Patients with Inflammatory Bowel Disease in a Multicenter Study in Northeastern Brazil","authors":"Jones Lima, Carlos Brito, Lívia Celani, Marcelo Vicente Araújo, Maurilio Lucena, Graciana Vasconcelos, Gustavo Lima, Fernando Nóbrega, George Diniz, Norma Lucena-Silva, Regiane Maio, Valéria Martinelli","doi":"10.2147/ceg.s436699","DOIUrl":"https://doi.org/10.2147/ceg.s436699","url":null,"abstract":"Purpose: Inflammatory bowel disease (IBD) is a disease of increasing prevalence in developing countries. Obesity has emerged as a potential risk for IBD; however, the data in the literature are conflicting, and relevant studies in Brazil are limited. Here, we report body mass index profile (BMI) of patients with IBD treated at reference centers in three states of northeastern Brazil. Patients and Methods: Observational descriptive study conducted from January 2021 through December 2021 in patient with IBD. Results: Of 470 patients with IBD, 194 (41%) were classified as normal weight, 42 (9%) as underweight, 155 (33%) as overweight, and 79 (17%) as obese; CD patients were significantly more likely to be underweight than UC patients ( p =0.031)Overweight patients were older (median age: 47 years) than normal-weight and underweight patients at diagnosis (38.5 and 35.5 years, respectively [ p < 0.0001]). IBD onset and diagnosis among overweight and obese individuals were associated with older age. More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD, irrespective of nutritional status. There was a higher frequency of compatible symptoms with axial joint inflammation among obese patients ( p =0.005) and a lower frequency of compatible symptoms with peripheral joint inflammation in underweight patients ( p =0.044) than in patients of normal weight. No significant difference in the frequency of different drug or surgical treatments was observed among the groups. Conclusion: Despite the predominance of overweight and obesity in patients with IBD, no differences in the patterns of disease were seen between the overweight and normal-weight groups; however, obesity was associated with IBD onset in older adults and a higher frequency compatible symptom with axial joint inflammation. These data reinforce the importance of monitoring the nutritional status of IBD patients and the need for a multidisciplinary approach, as recommended in the current guidelines. Keywords: Crohn’s disease, ulcerative colitis, obesity, overweight","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"15 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135764339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications and Findings of Upper Gastrointestinal Endoscopy at a Tertiary Hospital in Ethiopia: A Cross-Sectional Study.","authors":"Abel Mureja Argaw,&nbsp;Samrawit Solomon Ethiopia,&nbsp;Geda Lelisa,&nbsp;Henok Fisseha,&nbsp;Biruk Mulugeta","doi":"10.2147/CEG.S436329","DOIUrl":"10.2147/CEG.S436329","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal disease is a significant global health problem. Symptoms related to digestive system diseases negatively affect quality of life and impose a significant economic impact. Upper gastrointestinal symptoms are common in the Ethiopian population, and the associated pathologies are diverse. Real-time endoscopic visualization of the upper gastrointestinal tract is crucial for diagnosis. However, local data on the indications for endoscopic evaluation and the common underlying pathologies are limited. This study aimed to assess the common indications and upper gastrointestinal endoscopic findings of patients presenting to Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted by reviewing the complete records of patients who underwent upper gastrointestinal endoscopic evaluation between January 2012 and December 2019. A structured checklist was used to screen records for completeness. Data were analyzed using Statistical Package for the Social Sciences software version 25. Chi-square test was used to compare variables, with statistical significance set at P < 0.05.</p><p><strong>Results: </strong>A total of 5753 patients underwent complete upper gastrointestinal tract endoscopic evaluation during the study period. The median age of the patients was 37 years. Males accounted for 63.4% of the patients. Dyspepsia (27.8%) was the most common indication for upper gastrointestinal endoscopic evaluation, followed by upper gastrointestinal bleeding (17.1%), and screening for varices (16.8%). Esophageal varices (35.8%), gastritis (18.1%), and duodenal ulcers (10.6%) were the most common pathologies found on esophagus, stomach, and duodenum, respectively. Common upper gastrointestinal pathologies are predominant among males and patients in their third decade of life.</p><p><strong>Conclusion: </strong>Dyspepsia was the most common indication for endoscopic evaluation of the upper gastrointestinal tract. Esophageal varices were the most common pathological finding, followed by gastroesophageal reflux disease, gastritis, portal hypertensive gastropathy, duodenal ulcer, and hiatal hernia. Esophagogastroduodenoscopy remains a vital tool for the diagnosis of pathologies of the upper gastrointestinal tract.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"16 ","pages":"187-196"},"PeriodicalIF":2.4,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71421206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wandering Spleen and Acute Gastric Volvulus in an Elderly Woman with Acute Abdomen: A Case Report.","authors":"Somprakas Basu,&nbsp;Arvind Pratap,&nbsp;Satyanam Kumar Bhartiya,&nbsp;Vijay Kumar Shukla","doi":"10.2147/CEG.S428679","DOIUrl":"10.2147/CEG.S428679","url":null,"abstract":"<p><p>Gastric volvulus is an uncommon clinical condition with the potentially life-threatening complication of acute gastric necrosis. A wandering spleen may also be associated with gastric volvulus and can produce a diagnostic dilemma as the cause of an acute abdomen. We present a case of an elderly woman who presented with acute abdominal symptoms. She did not have the classical Borchardt triad to diagnose gastric volvulus and had a coexisting wandering spleen. Although torsion and ischemia of the wandering spleen were initially thought to be the cause of acute abdomen, a subsequent contrast-enhanced CT (CECT) scan confirmed a coexistent mesenteric-axial gastric volvulus with gangrenous changes. We present this case to highlight a rare combination of pathologies, either of which can confuse the diagnosis or cause a delay in management. Early diagnosis with CECT is emphasized, and segmental resection is feasible when the rest of the viscus can be preserved.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"16 ","pages":"181-185"},"PeriodicalIF":2.4,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71410948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}