Journal of Gastroenterology and Hepatology最新文献_第9页

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16696

{"title":"Advanced Endoscopic Techniques","authors":"","doi":"10.1111/jgh.16696","DOIUrl":"https://doi.org/10.1111/jgh.16696","url":null,"abstract":"16Early experience with endoscopic submucosal dissection at Austin HealthSitong Chen1, Sujievvan Chandran1,2,3, Leonardo Zorron Cheng Tao Pu2,3, Nicholas Dalkie3, Rhys Vaughan1,2,3 and Marios Efthymiou1,2,31Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia; 2Liver Transplant Unit, Austin Health, Heidelberg, Australia; 3Department of Gastroenterology and Hepatology, Austin Health, Melbourne, AustraliaBackground and Aim: Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic procedure which employs en-bloc dissection technique to remove premalignant or early malignant gastrointestinal lesions. In Japan, ESD is considered as first line treatment for early gastrointestinal neoplasms, yet the wide adoption of ESD in the West has been slow. Barriers include the technical difficulty of ESD, lower prevalence of early gastric cancer in the West, and the lack of training opportunities. We know that gastric location is the easiest location to start training in ESD whereas colorectal ESD is more challenging. The aim of this study was to assess the early experience with ESD at Austin Health.Methods: A retrospective analysis was conducted on 31 consecutive gastrointestinal lesions in 27 patients who underwent ESD from June 2020 to April 2023 at Austin Health, Melbourne Australia. Clinical and procedural data, complications, and the efficacy and efficiency of the ESD procedure were evaluated.Results: Twenty-seven patients (12 females and 15 males) were enrolled in the study, with a mean age of 72.0 years. Overall, thirty-one lesions were resected, including 16 gastric lesions, 6 oesophageal lesions and 9 colorectal lesions. The mean size of the lesions was 35.8mm and the mean resected base area was 12.0cm2. In the total cohort, en-bloc resection rate was 96.8%. Final ESD histology upstaged the initial diagnosis in four lesions based on pre-ESD pinch biopsies and imaging. Eleven malignant lesions were found in the final pathology. Six complications were reported in our study, including two cases of intraoperative perforation and four cases of delayed bleeding (all the complications were managed medically/endoscopically). The mean hospital stay was 1.6 days for all patients, and 19 patients were discharged after an overnight admission.Conclusion: ESD is an effective and safe treatment for gastrointestinal neoplasms in an Australian tertiary centre and our early treatment outcomes were comparable to recently published large study data. Outcomes are likely to progressively improve with further experience.30Intrathoracic cholecystitis managed with endoscopic gallbladder drainageAndrea Huang1,4","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"3-24"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230935","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}

引用次数: 0

Luminal Basic Science 流明基础科学

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16703

{"title":"Luminal Basic Science","authors":"","doi":"10.1111/jgh.16703","DOIUrl":"https://doi.org/10.1111/jgh.16703","url":null,"abstract":"92Simethicone suppresses the growth of microbes cultured from the human duodenal mucosaThomas Fairlie1,2, Ayesha Shah1,2, Yenkai Lim2, Jing-Jie Teh2, Lauren Schooth2, Mark Morrison2 and Gerald Holtmann1,21Princess Alexandria Hospital, Metro South Health, Woolloongabba, Australia; 2University of Queensland, Brisbane, AustraliaBackground and Aim: Small intestinal dysbiosis (SID) is known to play an important role in the pathophysiology of various gastrointestinal and extraintestinal disorders, with recent studies linking select members of the duodenal microbiota with symptom severity in functional dyspepsia (FD). Simethicone is routinely used during endoscopy as an anti-foaming agent and at lower concentrations used to alleviate painful gut symptoms associated with excessive gas and/or bloating. Here, we assessed the effects from simethicone on the growth of a mixed culture of duodenal mucosa-associated microbiota (MAM).Methods: The consortia of duodenal MAM recovered from the biopsies of a non-FD asymptomatic control subject were anaerobically cultured using a duodenal habitat-simulating medium with no addition, or supplemented with a commercially available source of Simethicone to provide final concentrations of 0.2 mg/ml (lowest effective dose for antifoaming effects, 1 mg/mL, 2 mg/mL or 4 mg/mL. Three biological replicates with six technical replicates of the cultures (and uninoculated controls) were prepared using a 96-well microtitre plate format within an anaerobic chamber, then microbial growth (optical density change at 600 nm) at 37 °C was measured every 30 minutes for 18 hours using an automated microtiter plate also housed within the anaerobic chamber. The R package Growthcurver was applied to assess the growth kinetic profiles by calculating the area under the curve and statistical comparisons to control cultures calculated with a paired t-test.Results: Relative to control cultures, the growth kinetic profile (area under the curve) after 18 hours was unaffected by the addition of 0.2 mg/mL simethicone (P = 0.99), but progressively reduced by the addition of greater simethicone concentrations (Fig. 1). The reduction of growth kinetics with 2 mg/mL simethicone approached significance (P = 0.059) and were significantly reduced with 4 mg/mL simethicone (P = 0.023).139A whole blood interleukin-2 release assay offers a novel approach to detect and monitor pathogenic T cells to support epitope discovery and drug development in coeliac disease and beyondOlivia Moscatelli1, Amy Russell1, Lee Henneken2, Linda Fothergill1, Hugh Reid3, Jamie Rossjohn3, Melinda Hardy1, Vanessa Bryant1 and J","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"262-265"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230954","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}

引用次数: 0

Nursing 护理

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16705

{"title":"Nursing","authors":"","doi":"10.1111/jgh.16705","DOIUrl":"https://doi.org/10.1111/jgh.16705","url":null,"abstract":"181A clinical nurse specialist comprehensive hepatology clinic: Streamlining service deliveryMarcelle Perrin, Crystal Connelly, Vanessa Sheehan and Ying ShenFiona Stanley Hospital, Murdoch, AustraliaBackground: Advances in curative therapies for Hepatitis have seen the core role of the hepatology specialist nurses broaden significantly. In addition, hepatology service demand is increasing across both inpatient and outpatient settings. Transitioning to a new health service provided an opportunity to implement an alternative model to streamline access to hepatology services. A team of Hepatology Clinical Nurse Specialists deliver a clinic service to all hepatology patients aimed at managing extensive waitlists and ensuring appropriate services are provided in the timeliest manner. There is limited literature available on nurse-led hepatology clinics that are not condition specific. This clinic is the only one of its kind in Western Australia and, to our knowledge, nationally.Service structure and implementation: The clinic is autonomously led by a team of three Clinical Nurse Specialists and aims to divert from the Consultant waitlist where appropriate, provide baseline hepatology assessment including investigations and liver scan to facilitate early intervention and inform timely delivery of care, and improve the hepatology patient experience. A guideline and suite of standard operating procedures were developed and endorsed by the health service. Medical governance review is provided at weekly multidisciplinary team meetings. Patients are initially referred from Consultants or General Practitioners (GP) or identified through a virtual assessment triage of waitlisted patients. Hepatology screening and assessment is undertaken by a Hepatology Clinical Nurse Specialist and patients are either discharged from the service to the care of their GP, remain on the Consultant waitlist for review, or engage in ongoing monitoring and education within the clinic.Service delivery outcomes: Since implementation in 2022, the clinic has provided over 5,000 occasions of care. In the preceding year the clinic has had 195 referrals, with the primary sources of patient referrals being GPs (45%) and specialists (40%). The largest proportions of the cohort present due to deranged liver function tests (40%), followed by steatosis (29%). Seventy three percent of individuals referred engaged with the clinic service. Post assessment and clinic visit patients are most commonly identified to be suffering steatotic liver disease and are provided counselling and education. Half of presenting patients are discharged from the service to the care of their GP, resulting in a significant reduction to the waitlist for Consultant review. Ongoing surveillance is maintained for 40% of the presenting cohort. The service generates over $400,000 in activity-based funding per year to","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"306-308"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230956","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}

引用次数: 0

Hepatology Clinical 肝病学临床

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16700

{"title":"Hepatology Clinical","authors":"","doi":"10.1111/jgh.16700","DOIUrl":"https://doi.org/10.1111/jgh.16700","url":null,"abstract":"10Liver outcome score predicts long term clinical outcomes in primary biliary cholangitis: a multi-centre studyDujinthan Jayabalan1,2, Leon A Adams1,2, Yi Huang1, Luis Calzadilla Bertot1,2, Wendy Cheng3, Simon Hazeldine4, Briohny Smith1, Gerry MacQuillan1,2, Michael Wallace1,2, George Garas1,2 and Gary P Jeffrey1,21Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Australia; 2Medical School, University of Western Australia, Nedlands, Australia; 3Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia; 4Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, AustraliaBackground and Aim: Few predictive models of survival exist for primary biliary cholangitis (PBC) patients. This study investigated the natural history and assessed the accuracy of models for predicting liver-related outcomes in PBC patients.Methods: PBC patients were identified from the state-wide Hepascore and Clinical Outcome (HACO) cohort. Patients with PBC overlap syndromes were excluded. Overall death or transplant, liver-related mortality (liver-related death or transplant), and liver-related decompensation were determined using a population-based data linkage system. Accuracy of baseline Liver Outcome Score (LOS), composed of albumin, GGT, hyaluronic acid, age, sex, Hepascore and MELD were examined for predicting clinical outcomes.Results: 157 PBC patients (13% male, median age 60.5 years, median MELD 6, median Hepascore 0.22, 34% cirrhotic at enrolment) were followed for a median of 4.0 years (range, 0.01-9.5 years). Twelve patients died, 8 had liver-related deaths and 3 underwent liver transplant. Ten patients decompensated and two developed hepatocellular carcinoma. 5-year transplant-free survival was 92% (95% CI: 85-96%) overall, 71% (95% CI: 48-86%) in cirrhosis and 97% (95% CI: 91-99%) in non-cirrhotics (p<0.0001). 5-year liver-related mortality free rate was 95% (95% CI: 89-98%) in all, 76% (95% CI: 53-89%) in cirrhosis and 100% (95% CI: 100-100%) in non-cirrhotics (p<0.0001). Median time-to-decompensation was 3.3 years (range, 0.2-8.6). 5-year liver-related decompensation-free rate was 89% (95% CI: 78-95%) in all, 53% (95% CI: 22-76%) in cirrhosis, 98% (95% CI: 89-99.8%) in non-cirrhotics (p<0.0001). Multivariate analysis found LOS predicts overall death or transplant in all patients (HR 2.14; (95% CI: 1.26-3.62), p=0.005, C-statistic 0.89) and in cirrhotics (HR 2.24; (95% CI: 1.11-4.50), p=0.024, C-statistic 0.85). LOS predicted liver-related mortality in all (HR 2.40; (95% CI: 1.11-5.19), p=0.027, C-statistic 0.93) and in cirrhosis (HR 2.06; (95% CI: 0.98-4.31), p=0.056, C-statistic 0.93). LOS p","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"59-145"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230911","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}

引用次数: 0

Nutrition 营养学

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16706

{"title":"Nutrition","authors":"","doi":"10.1111/jgh.16706","DOIUrl":"https://doi.org/10.1111/jgh.16706","url":null,"abstract":"20Risk factors for central line-associated bloodstream infections in home parenteral nutrition patients: an observational cohort studyParis Hoey1, Douglas Roche1, Paul Chapman2, Vishal Kaushik1, Stacey Llewellyn3 and Niwansa Adris11Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia; 2Department of Infectious Disease, Royal Brisbane and Women's Hospital, Brisbane, Australia; 3QIMR Berghofer Medical Research Institute, Brisbane, AustraliaBackground and Aim: A central line-associated bloodstream infection (CLABSI) is a common and potentially life-threatening complication for patients with intestinal failure (IF) receiving home parenteral nutrition (HPN). In uncomplicated infections, The European Society for Clinical Nutrition and Metabolism guidelines advocate for central venous access (CVC) salvage for venous access preservation. Existing knowledge regarding the risk factors of HPN-related CLABSIs have been extrapolated from European and North American studies, and the effects of tropical climates and its potentially higher support requirements on the incidence of infection has not yet been studied. We sought to analyse the risk factors of developing HPN-related CLABSI, and assess CLABSI management, in a large Australian state with a highly dispersed population.Methods: A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a CVC at a Queensland tertiary referral centre, between 2016 and 2023. Patient charts were reviewed, and a univariate cox regression analysis model was used to identify predictors of CLABSI in the first CVC. Kaplan-Meier analysis was employed to build survival curves of time to CLABSI, and log-rank tests analysed survival between characteristics.Results: Nineteen patients had ≥1 CLABSI(s), accounting for a total of 39 episodes. Patients with ≥1 CLABSI(s) used regular opioids more than those who did not develop CLABSI (p=0.016). Fourteen patients (41%, n=14/34) developed a CLABSI in their first CVC. No patient or line characteristics, including tropical climate, were found to be predictive of CLABSI in their first CVC. The overall infection rate was 1.02 per 1000 catheter days. Most CLABSIs were caused by Enterobacterales (22%, n=12/55), followed by coagulase-negative Staphylococcus (18%, n=10/55). Administration of empiric antimicrobials within the standardised 3-hour sepsis timeframe was inadequate (50%, n=14/28), with only 25% (n=7/28) providing adequate cover of causative pathogens. The median time to effective antibiotic therapy was 22.7 hours (IQR 4.8-29.8). There were 3 CVC salvages (8%, n=3/39), all of which were successful.Conclusion: In this cohort of patients, regular opioid ","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"309-320"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230909","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}

引用次数: 0

Sustainability 可持续性

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16709

{"title":"Sustainability","authors":"","doi":"10.1111/jgh.16709","DOIUrl":"https://doi.org/10.1111/jgh.16709","url":null,"abstract":"65Using patient satisfaction scores to compare performance of nurse practitioner against doctors in direct access endoscopy clinicDavid Huynh, Aathavan Shanmuga Anandan, Ruth Ayers and Peter HendyMater Hospital Brisbane, Brisbane, AustraliaBackground and Aim: Physician shortages contribute to the growing presence of nurse practitioners (NP), driven by the expectation that NP can reduce outpatient wait times, leading to better patient outcomes. While Direct Assessment Endoscopy (DAE) aims to streamline access for simple cases, it still requires doctor involvement for consent and assessment. An NP-led care model presents an alternative, but concerns exist anecdotally about patient acceptance. We seek to assess patient expectations and acceptance of a newly introduced NP-led DAE clinic at Mater Health Brisbane (MHB).Methods: Patients attending DAE clinics at the MHB were surveyed across two months. Patients completed two survey sections: a pre- and post-consultation questionnaire using a 5-point Likert scale. The pre-consultation questions were set to determine if the patients had pre-conceived biases such as “expecting to see a doctor”. Post-consultation questions assessed ‘communication’, ‘experience’, ‘professionalism’, and ‘understanding’ of endoscopic procedures. Patients were blinded to whether they would see an NP or doctor for their endoscopic consultation. Scores were collated to compare NP against doctors.Results: 92 patients offered to participate in the survey with 71 (77%) patients completing questionnaires. 33 (46%) patients saw a doctor, and 38 saw an NP (54%). NP ratings were significantly higher than doctors regarding ‘professionalism and friendliness’ (see table 1). NP scores were numerically greater than doctors in ‘overall experience’, ‘understanding’, and ‘communication’. Of the total 71 patients, 61 had anticipated seeing a doctor. Of these 61 patients, 51% encountered an NP instead (n = 31). Of these 31 patients, 28 expressed no reservations about seeing either an NP or a doctor following the consultation. The average scores for doctors (Group A) regarding overall experience, professionalism, understanding, and communication were 4.0 (95% CI [3.5–4.5]), 4.2 (95% CI [3.8–4.7]), 4.5 (95% CI [4.3–4.7], and 4.5 (95% CI [4.3–4.7]), respectively. Conversely, patients with preconceived biases determined by all the patients wanting to see a doctor (Group B) reported average scores of 4.3 (95% CI [3.9–4.7]), 4.7 (95% CI [4.5–4.9]), 4.5 (95% CI [4.5–4.6]), and 4.5 (95% CI [4.4–4.8]) for the same attributes, respectively.Conclusion: Overall, NP results proved non-significantly higher in all metrics than doctors except ‘professionalism and friendliness’. We also showed that pre-existing biases did not significantly influence patients' overall experiences with NPs. This suggests that the integration of an NP into","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"373-374"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16709","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230937","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}

引用次数: 0

Luminal Clinical 流明临床

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16704

{"title":"Luminal Clinical","authors":"","doi":"10.1111/jgh.16704","DOIUrl":"https://doi.org/10.1111/jgh.16704","url":null,"abstract":"7Safety, efficacy and tolerability of an ultra-low volume bowel preparation (NER1006) – a real world experienceAnthony Sakiris, Arvinf Rajandran, Jane Lynch, Myles Rivlin and Sneha JohnGold Coast University Hospital, Gold Coast, AustraliaBackground and Aim: Endoscopic assessment with colonoscopy allows for the detection of polyps and adenomas which are precursors to colorectal adenocarcinoma. The quality of bowel preparation is of significant importance to the outcome of a colonoscopy as poor bowel preparation results in prolonged procedure times, the need for repeat procedures and missed lesions. A split-dose regimen of 3-4L Polyethylene Glycol (PEG) has historically been the recommended form of bowel preparation. NER1006 is a 1L split-dose PEG bowel preparation that is comparatively novel to Australia and has been adopted within our service since 2020. NER1006 provides enhanced osmotic activity from the high-dose ascorbate that is present in the second dose. Given its ultra-low volume, the aim of this study was to assess the safety, efficacy and tolerability of NER1006 in a real-world setting within our hospital network.Methods: This study was a retrospective analysis of prospectively collected data for colonoscopy procedures at two centres within our hospital health service. Patients who underwent a colonoscopy between July 2020 and February 2024 and received NER1006 as bowel preparation with a split-dose regime were analysed. The study population consisted of patients who returned a positive faecal occult blood test from the Australian National Bowel Cancer Screening Program (NBCSP) as well as symptomatic patients referred through our nurse-led Direct Access Colonoscopy clinic. The quality of the bowel preparation was quantified through the Boston Bowel Preparation Scale (BBPS). The Polyp Detection Rate (PDR), Adenoma Detection Rate (ADR), Sessile Serrated Lesion Detection Rate (SSLDR) and Advanced Adenoma Rate (AADR) were also calculated as quality indicators of colonoscopy. Adverse events related to NER1006 were classified as either minor or major. Major adverse events were defined as those requiring hospitalisation or those that prevented the patient from adequately completing their bowel preparation.Results: A total of 2920 colonoscopies were performed on 2874 patients. There were 1571 males, 1301 females and 2 indeterminate with a mean age of 57 years. 2827/2920 (97%) of the colonoscopies performed produced a BPPS score equal to or greater than 6 (good or excellent), with an average score of 7.90. Analysis revealed a 72% PDR, 55% ADR, 16% SSLDR and 25% AADR. There were 2 cases (0.07%) of major adverse events. One patient was unable to complete their bowel preparation due to vomiting and one patient presented with an acute kidney injury. There 98 cases (3.36%) of minor adverse events. Tachycardia (>100 bpm) was the most co","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"266-305"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230955","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}

引用次数: 0

Routine GI Endoscopy 常规消化内镜检查

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16708

{"title":"Routine GI Endoscopy","authors":"","doi":"10.1111/jgh.16708","DOIUrl":"https://doi.org/10.1111/jgh.16708","url":null,"abstract":"8A rare lesion of the oesophagus: oesophageal submucosal gland duct adenomaGary Zhang1,2, Spiro Raftopoulos1,2,3 and Priyanthi Kumarasinghe1,2,31Sir Charles Gairdner Osborne Park Health Care Group, Perth, Australia; 2The University of Western Australia, Perth, Australia; 3Curtin University, Bentley, AustraliaIntroduction: Oesophageal submucosal gland duct adenomas (ESGDA) are a rare oesophageal lesion usually diagnosed in males 50-80 years of age presenting with abdominal pain or incidentally. Less than 20 cases of ESGDA have been reported in the literature, with two cases reporting incidental accompanying oesophageal squamous cell carcinoma and gastric adenocarcinoma, respectively.Case report: A 68-year-old Caucasian man without other significant medical history presented with mild reflux symptoms. There were no associated alarm symptoms. He was a non-smoker and consumed up to 2 standard drinks of alcohol a day. Initial upper gastrointestinal endoscopy demonstrated a 10mm subepithelial lesion (SEL) at the gastroesophageal junction with normal overlying squamous mucosa and no evidence of reflux changes (figure 1). Pinch biopsies were acquired and reported as an inflammatory polyp with no evidence of dysplasia. The patient was referred for consideration of endoscopic removal following 8 weeks of high dose twice daily proton pump inhibitor therapy. On subsequent endoscopy, the SEL remained despite high dose PPI and therefore a decision was made for endoscopic removal via local excision using a band and ligation technique (figure 1A-C). The lesion was completely resected, retrieved, pinned and sent for pathological assessment. Histopathological assessment of the SEL demonstrated a predominantly submucosal lesion featuring localised hyperplastic and proliferated oesophageal glands and ducts without malignancy (figure 1D). With histochemical stains, the glandular epithelial cells showed diffuse cytoplasmic positivity with epithelial membrane antigen and CK7. Some basal cells showed a positive reaction with p63 and p40. There was no aberrant p53 over-expression or heightened ki-67 proliferation index. The lesion was consistent with an ESGDA. Endoscopic appearances at follow-up demonstrated a smooth, contracted scar (figure 1E).17Colonoscopy in octogenarians and older patients with 1L polyethylene glycol plus ascorbic acid bowel preparation in the real-world settingElena Perez-Arellano1, Salvador Machlab2, Miguel A Pantaleón3, Ricardo Gorjão4, Cátia Arieira5, Jose Cotter5, Vicente Lorenzo-Zúñiga6, Sarbelio Rodriguez Muñoz7, David Carral-Martínez8, Carmen Turbi9, Fatma Akriche10, José M Esteban11 and Katherine Davies","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"331-372"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16708","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230936","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}

引用次数: 0

Paediatrics 儿科

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16707

{"title":"Paediatrics","authors":"","doi":"10.1111/jgh.16707","DOIUrl":"https://doi.org/10.1111/jgh.16707","url":null,"abstract":"6Comparing real-world utilisation of dietary and medical therapies in paediatric and adult inflammatory bowel disease patients using CCCare: A cross-sectional studyJoseph Pipicella1,2,3, Wai Kin Su1,3,4, William Wilson5,6, Jane Andrews1,7,8 and Susan J Connor1,2,3,41Crohn's Colitis Cure, Sydney, Australia; 2South West Sydney Clinical Campus, University of New South Wales, Sydney, Australia; 3Ingham Institute for Applied Medical Research, Sydney, Australia; 4Department of Gastroenterology, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia; 5SA Health, Adelaide, Australia; 6Lyell McEwin Hospital, Adelaide, Australia; 7Central Adelaide Local Health Network, Adelaide, Australia; 8Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, AustraliaBackground and Aim: Approximately 10% of people with inflammatory bowel diseases (IBD) are diagnosed in childhood. Crohn’s Colitis Care (CCCare) is an IBD-specific electronic medical record (EMR) used across Australia and New Zealand, with a recent upgrade to incorporate paediatric functionality. Using CCCare, we explored the real-world use of dietary and medical therapies across the age spectrum in people with IBD under routine ambulatory care in ANZ.Methods: De-identified data from CCCare’s linked clinical quality registry were analysed in April 2024. All people with IBD under active care (clinical encounter within the prior 14 months) were included. Children were defined as being <18 years of age at time of extraction.Results: A total of 6,396 people with IBD were included. In the <18 years age group (n=172), 59.1% (n=101) were male with a median age of 15 years (IQR 12.8-16). The majority (93%, n=93) resided in Australia, and most had Crohn’s disease (66.5%, n=113), with 16.8% of them having ever had a perianal fistula. In the ≥18 years age group (n=6,224), 49.1% (n=3,055) were male with a median age of 42 years (IQR 32-57). The majority (76.5%, n=4,761) resided in Australia, and over half had Crohn’s disease (55.7%, n=113), with 15.9% having ever had a perianal fistula.Interestingly, 5-aminosalicylate use was more prevalent in adults than children (34% vs 27% respectively, P<0.05), whereas current immunomodulator use was less common in adults compared to children (29% vs 60% respectively, P<0.001). Current steroid use was ≤4% in both cohorts (P=0.26). Advanced therapy use by age group is shown below. Anti-TNF therapies (infliximab and adalimumab) were the predominant therapies in the paediatric cohort. Across the cohort, infliximab use decreased with age, whereas vedolizumab use increased with age. Dietary therapies were infrequently us","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"39 S1","pages":"321-330"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231050","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}

引用次数: 0

Application of linaclotide in bowel preparation for colonoscopy in patients with constipation: A prospective randomized controlled study 在便秘患者结肠镜检查前的肠道准备中应用利那洛肽：前瞻性随机对照研究

IF 4.1 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-10 DOI: 10.1111/jgh.16734

Haoxin Xu, Zhu He, Yulin Liu, Hong Xu, Pengfei Liu

{"title":"Application of linaclotide in bowel preparation for colonoscopy in patients with constipation: A prospective randomized controlled study","authors":"Haoxin Xu, Zhu He, Yulin Liu, Hong Xu, Pengfei Liu","doi":"10.1111/jgh.16734","DOIUrl":"https://doi.org/10.1111/jgh.16734","url":null,"abstract":"Background and AimColonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre‐colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG).MethodsIn this prospective, single‐center, randomized controlled trial, 322 participants were divided into two groups: a 3‐L PEG + 870‐μg linaclotide group (administered as a single dose for 3 days) and a 4‐L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction.ResultsThe study included 319 patients. The 3‐L PEG + linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4‐L PEG group (89.4% vs 73.6% and 37.5% vs 25.3%, respectively; P < 0.05). The mean BBPS score for the right colon in the 3‐L PEG + linaclotide group was significantly higher than that in the 4‐L PEG group. There were no significant between‐group differences regarding the detection rates of colonic polyps and adenomas (44.4% vs 37.7% and 23.1% vs 20.1%, respectively; P > 0.05). There were no significant between‐group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3‐L PEG + linaclotide group.ConclusionThe combination of 3‐L PEG and 870‐μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly.","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"56 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195643","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}

引用次数: 0