Journal of Gastroenterology and Hepatology最新文献

{"title":"Investigation of the effects of a new transdermal formulation of systemic diclofenac on the upper gastrointestinal mucosa in patients with low back pain: A comparative study with oral diclofenac","authors":"Hiroyuki Fukase,&nbsp;Seiji Futagami,&nbsp;Takatsugu Yamamoto,&nbsp;Tatsuhiro Masaoka,&nbsp;Takaaki Terahara,&nbsp;Koji Okawa,&nbsp;Yusuke Tanaka,&nbsp;Tsuyoshi Mita","doi":"10.1111/jgh.16810","DOIUrl":"10.1111/jgh.16810","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal mucosal damage attributed to a topical effect of NSAIDs on the gastrointestinal mucosa after oral administration and cyclooxygenase-1 inhibition. Diclofenac sodium systemic patch (DSSP), a transdermal patch from which diclofenac sodium is absorbed through the skin to exert its effects through the circulating blood, is considered to reduce the occurrence of gastrointestinal mucosal damage compared with oral diclofenac. This study aimed to compare the effect of DSSP on the upper gastrointestinal mucosa with that of an orally administered diclofenac sodium tablet (DST).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This randomized, evaluator-blinded study included Japanese patients with low back pain (LBP). The patients were administered with either DSSP (150 mg/day) or DST (75 mg/day) for 2 weeks. The primary endpoint was the incidence of gastroduodenal ulcers and/or erosions on upper gastrointestinal endoscopy after the study treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty patients each were randomly assigned to the DSSP and DST groups. The incidence of gastroduodenal ulcers and/or erosions was 26.7% and 86.2% in the DSSP and DST groups, respectively. The difference in the incidence was −59.5% (95% confidence interval: −77.0 to −34.6). No adverse events (AEs) were observed in the DSSP group, and 20.0% (6/30 patients) reported mild AEs in the DST group (excluding ulcers and erosions).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DSSP is associated with a lower risk of gastrointestinal mucosal damage than DST, which has the same active ingredient but uses a different route of administration, in patients with LBP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 12","pages":"2504-2510"},"PeriodicalIF":3.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16810","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contamination of Disposable Distal Cap Duodenoscopes and Detachable Elevator Duodenoscopes After Reprocessing: A Randomized Trial.","authors":"Wiriyaporn Ridtitid, Jirayus Buathong, Tanittha Chatsuwan, Phonthep Angsuwatcharakon, Thanawat Luangsukrerk, Parit Mekaroonkamol, Panida Piyachaturawat, Santi Kulpatcharapong, Pradermchai Kongkam, Rungsun Rerknimitr","doi":"10.1111/jgh.16827","DOIUrl":"https://doi.org/10.1111/jgh.16827","url":null,"abstract":"<p><strong>Background and aim: </strong>To reduce bacterial contamination after reprocessing, various new designs of duodenoscopes have been developed to better expose the elevator complex for cleaning. We compared the rates of bacterial contamination and organic residue in disposable distal cap duodenoscopes and detachable elevator duodenoscopes after manual cleaning and high-level disinfection (HLD), as well as their cost-effectiveness.</p><p><strong>Methods: </strong>A total of 162 duodenoscopes were randomly assigned to either Group A (disposable distal caps; n = 81) or Group B (detachable elevator; n = 81). A total of 324 samples from the elevator were collected for culture following manual cleaning (n = 81 in each group) and HLD (n = 81 in each group), followed by the adenosine triphosphate (ATP) testing for organic residue.</p><p><strong>Results: </strong>After manual cleaning, there was no difference in bacterial contamination rates (8.6% vs. 8.6%; p = 1.00) and mean ATP levels (164.6 ± 257.5 vs. 158.1 ± 286.1 RLUs; p = 0.88) between Groups A and B. After HLD, no bacterial contamination was observed in either group and the mean ATP levels were very low with no significant difference between the two groups (30.1 ± 45.3 vs. 37.5 ± 51.9 RLUs; p = 0.68). The expense in reprocessing (excluding the scope cost) for Group A was lower (2099 USD) than Group B (3854 USD) in providing comparable scope cleanliness.</p><p><strong>Conclusion: </strong>After manual cleaning, the bacterial contamination rate and organic residue levels in detachable elevator duodenoscopes and disposable distal caps duodenoscopes were comparable. No bacterial contamination was detected in either type of duodenoscope after reprocessing. Apart from the initial differences in scope cost, the disposable distal cap duodenoscope had lower cost on disposable items to have comparable disinfection result.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron and Inflammatory Cytokines Synergistically Induce Colonic Epithelial Cell Ferroptosis in Colitis.","authors":"Mo Wang, Chang Zheng, Fan Zhou, Xie Ying, Xiaoqi Zhang, Chunyan Peng, Lei Wang","doi":"10.1111/jgh.16826","DOIUrl":"https://doi.org/10.1111/jgh.16826","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is an inflammatory disease that occurs to the intestinal tract. Many patients with IBD often develop anemia and often receive oral iron supplementation. Many of them develop non-compliance with oral iron therapy, but the mechanisms are not well understood. We interrogated whether colonic epithelial iron overload impacts cell viability and disease severity. We observed increased expression of iron importers and iron accumulation in mature colonocytes in dextran sulfate sodium (DSS)-induced acute colitis and in humans with active colitis. Administration of hepcidin increased epithelial iron overload and aggravated colonic inflammation in DSS-treated mice and IL10^-/- mice. Hepcidin-induced iron accumulation increased colonic epithelial death, which was prevented by treatment with Trolox, a vitamin E analog and a scavenger of lipid peroxides. By using cultured Caco-2 cells, we showed that iron and inflammatory cytokines (TNF-α and IL-1β) induced a synergistic increase in the number of necrotic cells. We then showed that the combined treatment by hepcidin and cytokines increased labile iron content and lipid peroxidation in Caco-2 cells. Moreover, liproxstatin-1, a ferroptosis inhibitor, and deferoxamine, an iron chelator, both abolished the hepcidin/cytokines induced death of Caco-2 cells, suggesting ferroptosis. We further elucidated that inflammatory cytokines promote lipid peroxidation and ferroptosis by inducing NOX1-dependent exhaustion of reduced glutathione (GSH). Collectively, our findings demonstrate that the inflammatory context predisposes colonic epithelial cells to iron overload mediated ferroptosis, exacerbating colonic inflammation.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Impact of a Structured Capsule Endoscopy Training Program Using a New Validated Assessment Tool.","authors":"Tiago Lima Capela, João Carlos Gonçalves, Ana Isabel Ferreira, Vítor Macedo Silva, Cláudia Macedo, Cátia Arieira, Sofia Xavier, Tiago Cúrdia Gonçalves, Pedro Boal Carvalho, Francisca Dias de Castro, Joana Magalhães, Bruno Rosa, Maria João Moreira, José Cotter","doi":"10.1111/jgh.16823","DOIUrl":"https://doi.org/10.1111/jgh.16823","url":null,"abstract":"<p><strong>Background and aim: </strong>We aimed to develop and validate a simple capsule endoscopy (CE) training assessment tool, the Capsule Endoscopy Training Assessment (CETA), and prospectively use it to analyze the learning progression achieved by participants in our CE training program.</p><p><strong>Methods: </strong>Over a 3-year period, all participants in our CE training program completed pre-training and post-training CETA, ranging between 0% and 100%, and encompassing theoretical questions and interpretation of segmented CE videos. We compared the mean differences in overall, theoretical, and practical pre-training and post-training CETA, and assessed the influence of previous endoscopic experience (upper gastrointestinal endoscopy [UGE], colonoscopy, device-assisted enteroscopy [DAE] and CE) using generalized linear models.</p><p><strong>Results: </strong>Fifty-seven participants were included. After training, there was a significant increase in participants' overall (mean difference, 26.3; 95% confidence interval [CI], 20.70 to 31.83), theoretical (mean difference, 27.2; 95% CI, 19.81 to 34.57), and practical (mean difference, 25.9; 95% CI, 20.09 to 31.63) CETA components. Compared to those without experience, participants with previous endoscopic experience demonstrated a smaller increase in overall CETA after training (UGE, rate ratio, 0.76; 95% CI, 0.63 to 0.91; colonoscopy (rate ratio, 0.80; 95% CI, 0.67 to 0.95; DAE (rate ratio, 0.84; 95% CI, 0.73 to 0.97; CE, rate ratio, 0.81; 95% CI, 0.72 to 0.92, respectively).</p><p><strong>Conclusion: </strong>CETA is a valid and useful tool in assessing the learning progression achieved by participants following the CE training program. We demonstrated a significant improvement in participants' CETA after training, being the least experienced participants in endoscopic procedures who benefited the most from CE training.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White-Light Imaging and Image-Enhanced Endoscopy With Magnifying Endoscopy for the Optical Diagnosis of Superficial Nonampullary Duodenal Epithelial Tumors: A Systematic Review and Meta-Analysis.","authors":"Masao Yoshida, Yosuke Toya, Akifumi Notsu, Naomi Kakushima, Motohiko Kato, Naohisa Yahagi","doi":"10.1111/jgh.16822","DOIUrl":"https://doi.org/10.1111/jgh.16822","url":null,"abstract":"<p><strong>Background and aim: </strong>Optical diagnosis of superficial nonampullary duodenal epithelial tumors using white-light imaging (WLI) and/or narrow-band imaging with magnifying endoscopy (NBI-ME) is used to guide the treatment strategy and avoid biopsy-induced fibrosis. However, the effectiveness of this approach has not been elucidated. We conducted a systematic review and meta-analysis aiming to investigate the diagnostic yield between Vienna classification category 3 (VCL C3) and categories 4 or 5 (VCL C4/C5) using biopsy, WLI, NBI-ME, and WLI + NBI-ME.</p><p><strong>Methods: </strong>A literature search identified studies on the diagnosis of superficial nonampullary duodenal epithelial tumors using biopsy, WLI, or NBI-ME. A bivariate random-effects model was utilized to analyze the summary estimates of sensitivity and specificity, as well as the area under the summary receiver operating characteristic curves for diagnosing VCL C4/C5.</p><p><strong>Results: </strong>Ultimately, 13 studies were included in the meta-analysis. For the diagnosis of VCL C4/C5, summary estimates of sensitivity, specificity, and area under the curve were for biopsy 47% (95% confidence interval: 37-58), 86% (79-91), and 0.745; for WLI 80% (65-89), 80% (70-87), and 0.859; for NBI-ME were 72% (61-81), 76% (68-85), and 0.811; and for WLI + NBI-ME 88% (67-96), 87% (51-98), and 0.929, respectively.</p><p><strong>Conclusions: </strong>WLI, NBI-ME, and WLI + NBI-ME showed high values for sensitivity and area under the curve. Biopsies can be replaced by WLI, NBI-ME, and WLI + NBI-ME for the preoperative diagnosis of superficial nonampullary duodenal epithelial tumors. However, further accumulation of research findings is needed.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten-day versus 14-day vonoprazan-amoxicillin high-dose dual therapy for Helicobacter pylori eradication in China: A multicenter, open-label, randomized study","authors":"Aiping Lin,&nbsp;Zhihui Lin,&nbsp;Yijuan Liu,&nbsp;Shuo Chen,&nbsp;Yanfeng Shao,&nbsp;Feng Qiu,&nbsp;Zhongqin Xiao,&nbsp;Zhangkun Xu,&nbsp;Longqun Chen,&nbsp;Lianghuo Chen,&nbsp;Weixing Lin,&nbsp;Yongfu Wang,&nbsp;Zhonghua Huang,&nbsp;Zhenqun Lin,&nbsp;Xueping Huang","doi":"10.1111/jgh.16761","DOIUrl":"10.1111/jgh.16761","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Only a few studies have investigated the efficacy and safety of different durations of vonoprazan and amoxicillin (VA) high-dose dual therapy for the eradication of <i>Helicobacter pylori</i>. We aimed to compare the efficacy and safety of 10 days <i>versus</i> 14 days of VA high-dose dual therapy for <i>H. pylori</i> eradication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted in 14 centers in China. A total of 250 patients infected with <i>H. pylori</i> were randomly assigned to Group VA-10 or VA-14. Both groups received the VA dual therapy (vonoprazan 20 mg twice daily + amoxicillin 1000 mg three times daily). The primary endpoint was the <i>H. pylori</i> eradication rate. Secondary endpoints included adverse events and patient compliance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Group VA-10 achieved eradication rates of 89.60%, 91.06%, and 91.67% as determined by the intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analysis, respectively. The eradication rates were similar to those in Group VA-14: 91.20%, 93.44%, and 93.39%. The difference and 90% confidence interval boundary −1.60% (−7.73% to 4.53%) in the ITT analysis, −2.39% (−8.00% to 3.23%) in the MITT analysis, and −1.72% (−7.29% to 3.85%) in the PP analysis were greater than the predefined noninferiority margin of −10%, establishing a noninferiority of Group VA-10 <i>versus</i> Group VA-14 (noninferiority <i>P</i> = 0.001 in ITT analysis, <i>P</i> &lt; 0.001 in MITT analysis, and <i>P</i> &lt; 0.001 in PP analysis, respectively). No significant differences were observed in adverse events between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ten-day VA dual therapy achieves comparable efficacy and safety to the 14-day regimen in Chinese population, providing patients with greater convenience and economic benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 12","pages":"2645-2653"},"PeriodicalIF":3.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Lifestyles on Polyp Burden and Cancer Development in Hereditary Colorectal Cancer Syndromes.","authors":"Hye Kyung Hyun, Ji Soo Park, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim","doi":"10.1111/jgh.16833","DOIUrl":"https://doi.org/10.1111/jgh.16833","url":null,"abstract":"<p><strong>Background: </strong>Whether the progression of precursor lesions or the occurrence of cancer is influenced by lifestyle factors in carriers of genetic mutations has not been fully investigated, especially in Asian patients of hereditary colorectal cancer (CRC) syndrome.</p><p><strong>Methods: </strong>Patients at a high risk of hereditary CRC were included. For polyposis CRC syndromes, colorectal polyp burden was measured using at least 60 images per colonoscopy in each patient and classified into five stages using the International Society for Gastrointestinal Hereditary Tumours staging system according to the polyp number and size. Increase in tumor burden stage for polyposis CRC syndrome and the occurrence of CRC or any cancer for Lynch syndrome were analyzed according to lifestyle factors.</p><p><strong>Results: </strong>Ninety-six patients with suspected hereditary polyposis CRC syndrome and 106 patients with Lynch syndrome were recruited. For polyposis CRC syndromes, multivariate analysis showed that exposure to smoking and > 100 polyps independently predicted a high risk of increased polyp burden (p = 0.008 and p = 0.012, respectively). Significant genetic mutations or phenotype of polyposis syndromes were significantly associated with an increased polyp burden. For Lynch syndrome, smokers showed to be diagnosed with CRC in younger age than never-smokers (42.2 years vs. 49.0 years; p = 0.021), and heavy drinkers had high risk for occurrence of CRC (HR, 2.381, 95% CI, 1.338-4.236; p = 0.003) and any cancer (HR, 2.254; 95% CI, 1.334-3.806; p = 0.002).</p><p><strong>Conclusions: </strong>The lifestyle factors (smoking and alcohol consumption) were associated with increasing precursor lesions and occurrence of cancer in patients with hereditary CRC syndrome. Lifestyle modifications may reduce the risk of hereditary CRC in carriers.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PANoptosis-related genes: Molecular insights into immune dysregulation in ulcerative colitis.","authors":"Yuxiao Ji, Pengchong Li, Tingting Ning, Deyi Yang, Haiyun Shi, Xueyu Dong, Shengtao Zhu, Peng Li, Shutian Zhang","doi":"10.1111/jgh.16804","DOIUrl":"https://doi.org/10.1111/jgh.16804","url":null,"abstract":"<p><strong>Background and aim: </strong>Ulcerative colitis (UC) is a chronic inflammatory disease driven by immune dysregulation. PANoptosis, a novel form of programmed cell death, has been implicated in inflammatory diseases, but its specific role in UC remains unclear. This study aimed to identify PANoptosis-related genes (PRGs) that may contribute to immune dysregulation in UC.</p><p><strong>Methods: </strong>Using bioinformatics analysis of the GEO databases, we identified seven hub PRGs. Based on these genes, we developed a predictive model to differentiate UC patients from healthy controls, and evaluated its diagnostic performance using ROC curve analysis. We further conducted functional enrichment, GSVA, and immune infiltration analyses. Immunohistochemistry (IHC) was used to validate the expression of hub genes in UC patients.</p><p><strong>Results: </strong>The prediction model, based on the seven hub genes, exhibited diagnostic ability in discriminating UC patients from controls. Furthermore, these hub PRGs were found to be associated with immune cells, including dendritic cells, NK cells, macrophages, regulatory T cells (Tregs), and CD8+ T cells. They were also linked to key signaling pathways implicated in UC pathogenesis, such as IFNγ, TNFα, IL6-and JAK-STAT3, as well as hypoxia and apoptosis. Immunohistochemistry analysis validated the expression levels of hub PRGs in UC patients using paraffin sections of intestinal biopsy specimens.</p><p><strong>Conclusions: </strong>This study identified PANoptosis-related genes with potential diagnostic value for UC and suggest that PANoptosis may contribute to the pathogenesis of UC by regulating specific immune cells and interacting with key signaling pathways. This highlights the potential importance of PANoptosis-related genes as therapeutic targets in UC management.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Success Rate and Adverse Effects of Endoscopic Sphincterotomy Versus Endoscopic Papillary Large Balloon Dilation in Large Common Bile Duct Stones Removal. A Propensity Scores Inverse Weighting Analysis.","authors":"Chote Wongkanong, Thawee Ratanachu-Ek, Jayanton Patumanond","doi":"10.1111/jgh.16825","DOIUrl":"https://doi.org/10.1111/jgh.16825","url":null,"abstract":"<p><strong>Background/aims: </strong>Endoscopic sphincterotomy (EST) is a standard treatment for common bile duct (CBD) stones. Endoscopic sphincterotomy combined with endoscopic papillary large balloon dilation (EST-EPLBD) is an effective treatment for difficult CBD stones. This study aims to evaluate and compare the effectiveness and adverse effects of EST-EPLBD and EST in treating large CBD stones.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of 85 patients with large CBD stones who underwent either EST or EST-EPLBD, resulting in successful CBD stone extraction from January 2018 to June 2022. Propensity score inverse weighting was performed to reduce the possible bias in baseline characteristics between the two treatment groups. The success rate of complete stone removal in the first session, mechanical lithotripsy use, and adverse events were analyzed by multivariable risk regression analysis.</p><p><strong>Results: </strong>The rate of complete stone removal in one session of the EST-EPLBD group was higher than that of the EST group at 28.78% (95% confidence interval [CI] 4.43, 50.1; p = 0.003). Mechanical lithotripsy use was decreased in the EST-EPLBD group by 25.81% (95% CI 42.33,9.28; p = 0.002). However, the incidence of adverse events is comparable.</p><p><strong>Conclusion: </strong>EST-EPLBD may be utilized in the treatment of CBD stones that exceed a diameter of 10 mm. The EST-EPLBD increased the rate of complete stone removal in a single session and reduced the need for mechanical lithotripsy. Conversely, the incidence rate of adverse events is similar.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bowel Colonization With Carbapenem-Resistant Bacteria Is Associated With Short-Term Outcomes in Patients With Acute-On-Chronic Liver Failure.","authors":"Satender Pal Singh, Vikram Bhatia, Pratibha Kale, Guresh Kumar, Vikas Khillan, Rajan Vijayaraghavan","doi":"10.1111/jgh.16830","DOIUrl":"https://doi.org/10.1111/jgh.16830","url":null,"abstract":"<p><strong>Background: </strong>Bowel colonization with antimicrobial-resistant bacteria has been associated with worse clinical outcomes in patients with cirrhosis; however, it has not been studied in patients with acute-on-chronic liver failure (ACLF). We evaluated whether fecal isolation of carbapenem-resistant gram-negative bacteria (CR-GNB) among patients with ACLF affects short-term outcomes.</p><p><strong>Methods: </strong>Patients of APASL-ACLF (n = 339) were screened between June 2020 and December 2021, and 150 were included. Stool cultures were carried out at baseline and every 5 days thereafter until discharge or death. All surviving patients were followed until 60 days after discharge.</p><p><strong>Results: </strong>Mean age was 44.8 (8.8) years, with 86% males and alcohol as etiology in 66%. CR-GNB organisms were isolated from stool in 42% of hospitalized ACLF patients, with E. coli and Klebsiella pneumoniae as the most common species. Patients with CR-GNB fecal carriage were associated with higher CTP, MELD, and DF scores but not with recent antibiotics, proton pump inhibitors, or lactulose use. Extraintestinal infections developed in 59.3% overall, most commonly UTI, pneumonia, and SBP. Infectious complications developed in 57.3% and 19.7% with and without CR-GNB in the stool (RR: 5.5; p < 0.001). Peripheral cultures were positive in 60.7% with infections, with species concordant with the fecal isolates found in 90.7%. Isolation of CR-GNB from stool and high bilirubin were independently associated with both in-hospital mortality and 60-day mortality (p = 0.05).</p><p><strong>Conclusions: </strong>Hospitalized ACLF patients with CR-GNB in the stool have a significantly higher risk of extraintestinal infections, in-hospital mortality, and short-term mortality up to 60 days.</p><p><strong>Trial number: </strong>[NCT04383106].</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}