JGH Open最新文献

{"title":"Celiac disease with neurological manifestations mimicking stiff-person syndrome","authors":"Jie Niu,&nbsp;Huiying Zhao,&nbsp;Xuzhen Qin,&nbsp;Ji Li,&nbsp;Jingnan Li","doi":"10.1002/jgh3.13117","DOIUrl":"10.1002/jgh3.13117","url":null,"abstract":"<p>Celiac disease (CD), a gluten-related disease, is a multi-system rare disorder mainly involving the gastrointestinal tract. The clinical signs of CD are exceedingly heterogeneous, which increases the difficulty of clinical differential diagnosis. Neurological manifestations are one of the non-classical CD symptoms. As some patients present only neurological symptoms at early stages, the diagnosis of CD is always delayed. Correct diagnosis and management could decrease patient morbidity and deaths. A 32-year-old male was admitted to the hospital due to progressive muscle atrophy of both lower limbs and lumbar stiffness. Based on positive gluten-sensitive enteropathy autoantibody profiles and gastroscopy foundation, the diagnosis of CD was established. The patient was instructed to gluten-free diet. The antibody titer of gluten-sensitive enteropathy autoantibodies decreased, and the patient's symptoms alleviated. We emphasize the importance of CD screening in patients with neurological disorders of unknown aetiology.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11220829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499318","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":"Recent advances in measuring the effects of diet on gastrointestinal physiology: Probing the “leaky gut” and application of real-time ultrasound","authors":"Tamara Mogilevski,&nbsp;Giovanni Maconi,&nbsp;Peter R Gibson","doi":"10.1002/jgh3.13081","DOIUrl":"10.1002/jgh3.13081","url":null,"abstract":"<p>There is a large pool of ideas in both mainstream and non-mainstream medicine on how diet can be manipulated in order to treat or prevent illnesses. Despite this, our understanding of how specific changes in diet influence the structure and function of the gastrointestinal tract is limited. This review aims to describe two areas that might provide key information on the integrity and function of the gastrointestinal tract. First, demystifying the “leaky gut syndrome” requires rational application and interpretation of tests of intestinal barrier function. Multiple ways of measuring barrier function have been described, but the inherent difficulties in translation from animal studies to humans have created misinterpretations and misconceptions. The intrinsic nature of intestinal barrier function is dynamic. This is seldom considered in studies of intestinal barrier assessment. To adequately understand the effects of dietary interventions on intestinal barrier function, background barrier function in different regions of the gut and the dynamic responses to stressors (such as psychological stress) should be assessed as a minimum. Second, intestinal ultrasound, which is now established in the assessment and monitoring of inflammatory bowel disease, has hitherto been poorly evaluated in assessing real-time intestinal function and novel aspects of structure in patients with disorders of gut-brain interaction. In conclusion, a more complete functional and structural profile that these investigations enable should permit a greater understanding of the effects of dietary manipulation on the gastrointestinal tract and provide clinically relevant information that, amongst other advantages, might permit opportunities for personalized health care delivery.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493913","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":"Evolution in coeliac disease diagnosis and management","authors":"Jason A Tye-Din","doi":"10.1002/jgh3.13107","DOIUrl":"10.1002/jgh3.13107","url":null,"abstract":"<p>The traditional gut-centric view of coeliac disease is evolving as immune and genetic insights underscore the central importance of a systemic, T cell immune response to gluten in disease pathogenesis. As the field increasingly recognize the limitations of small intestinal histology as the diagnostic standard, data supporting the accuracy of an immune (serologic) diagnosis of coeliac disease - well demonstrated in children - are growing for adults. Novel biomarkers such as interleukin-2 that identify the gluten-specific T cell demonstrate high sensitivity and specificity for coeliac disease and offer the potential for a diagnostic approach that avoids the need for gluten challenge. Asymptomatic disease and manifestations outside the gut pose considerable challenges for diagnosis using a case-finding strategy and enthusiasm for population screening is growing. The gluten-free diet remains a highly restrictive treatment and there is a paucity of controlled data to inform a safe gluten intake threshold. Ongoing symptoms and enteropathy are common and require systematic evaluation. Slowly-responsive disease is prevalent in the older patient diagnosed with coeliac disease, and super-sensitivity to gluten is an emerging concept that may explain many cases of nonresponsive disease. While there is great interest in developing novel therapies for coeliac disease, no drug has yet been registered. Efficacy studies are generally assessing drugs in patients with treated coeliac disease who undergo gluten challenge or in patients with nonresponsive disease; however, substantial questions remain around specific endpoints relevant for patients, clinicians and regulatory agencies and optimal trial design. Novel immune tools are providing informative readouts for clinical trials and are now shaping their design.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493912","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":"Revolution in diet therapy for inflammatory bowel disease","authors":"Sarah L. Melton,&nbsp;Alice S. Day,&nbsp;Robert V. Bryant,&nbsp;Emma P. Halmos","doi":"10.1002/jgh3.13097","DOIUrl":"10.1002/jgh3.13097","url":null,"abstract":"<p>Until recently, diet as a therapeutic tool to treat inflammatory bowel disease (IBD) has not been proven effective. Nearly a century in the making we are in the grips of a revolution in diet therapies for IBD, driven by emerging data revealing diet as a key environmental factor associated with IBD susceptibility, and observational studies suggesting that dietary intake may play a role in the disease course of established IBD. This review summarizes the current evidence for diets trialed as induction and maintenance therapy for IBD. For Crohn's disease, exclusive enteral nutrition and the Crohn's disease exclusion diet with partial enteral nutrition are supported by emerging high-quality evidence as induction therapy, but are short-term approaches that are not feasible for prolonged use. Data on diet as maintenance therapy for Crohn's disease are conflicting, with some studies supporting fortification, and others suppression, of certain food components. For ulcerative colitis, data are not as robust for diet as induction and maintenance therapy; however, consistent themes are emerging, suggesting benefits for diets that are plant-based, high in fiber and low in animal protein. Further studies for both Crohn's disease and ulcerative colitis are eagerly awaited, which will allow specific recommendations to be made. Until this time, recommendations default to population based healthy eating guidelines.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493914","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":"GASTRODIET 2023, an international meeting on food, diet and gastrointestinal health, held 18–20 October 2023 at Monash University Prato Centre, Prato, Italy","authors":"Jane G Muir","doi":"10.1002/jgh3.13106","DOIUrl":"https://doi.org/10.1002/jgh3.13106","url":null,"abstract":"&lt;p&gt;After successful hosting two GASTRODIET conferences in 2015 and 2017, and following a six-year hiatus, the GASTRODIET 2023 meeting was finally organized again from the 18th to the 20th of October 2023 at the beautiful Monash University Prato Centre. The Monash University Prato Centre is in the heart of the small medieval town of Prato, nestled in Tuscany, and only 20 min by train from Florence. Located in the 18th – century palace, the &lt;i&gt;Palazzo Vaj&lt;/i&gt;, the Monash University Prato Centre provided the perfect venue for the 117 conference attendees. As the name suggests, this meeting is all about gastroenterology and diet. It brought together dietitians, gastroenterologist, and scientists from 28 countries across Asia, Europe, North and South America, Australia, and New Zealand.&lt;/p&gt;&lt;p&gt;The keynote address and JGH Foundation Lecture were given by Professor Eamonn Quigley (&lt;i&gt;Weill Cornell Medical College at Houston Methodist Hospital&lt;/i&gt;, &lt;i&gt;USA&lt;/i&gt;), which addressed the question ‘Can Diet Change the Natural History of Gastrointestinal Diseases?’ It provided the perfect insight and perspective and set the tone for the conference.&lt;/p&gt;&lt;p&gt;Since our last GASTRODIET meeting in 2017, there are a number of areas that are clearly advancing (evolution) and in some areas major innovation (revolution) is taking place.&lt;/p&gt;&lt;p&gt;The global adoption of the low FODMAP diet as a first-line treatment for IBS highlights its evolution. This evolution is also evident in the ‘fine-tuning’ of the diet to optimize its benefits, minimize potential risks, and enhance overall health parameters. Emphasizing the significance of the three phases of the diet program and introducing the concept of the less restrictive or ‘FODMAP gentle’ and the Mediterranean-style low FODMAP version of the diet have all been part of the evolution. Additionally, the diet's evolution has included the acknowledgement that IBS-like symptoms overlap with other conditions, leading to the testing of the diet in non-IBS populations such as the elderly and women with endometriosis as well as functional dyspepsia. Evolution in FODMAP diet therapy is also evident through understanding how manipulation of dietary fibers and the use of oral enzyme supplementation can be employed as adjunct therapies.&lt;/p&gt;&lt;p&gt;The diagnosis and management of coeliac disease are also evolving, with novel immune biomarkers being identified that may be used for diagnosis and avoid the need for the oral gluten challenge.&lt;/p&gt;&lt;p&gt;In relation to the role of diet in IBD (Crohn's disease and ulcerative colitis), we find ourselves in the ‘grip of a revolution.’ Evidence is emerging regarding the pivotal role diet may play as a significant environmental factor in IBD susceptibility, as well as in the course of established IBD. As we ‘watch this space,’ we eagerly await the outcome of several studies currently underway.&lt;/p&gt;&lt;p&gt;The ongoing evolution, and indeed revolution, of diet therapies in the management of gastrointestinal disorders neces","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.13106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141487971","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":"Adherence to therapeutic gastroscopy guidelines for acute esophageal food bolus impaction: Impact on adverse outcomes and length of stay","authors":"Fei Yang Pan,&nbsp;Tuan Anh Duong,&nbsp;Kimberley J. Davis,&nbsp;Matthew Smale,&nbsp;Sahil Kapoor,&nbsp;Claudia Rogge","doi":"10.1002/jgh3.13114","DOIUrl":"10.1002/jgh3.13114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>According to the European Society of Gastrointestinal Endoscopy (ESGE), gastroscopy should be conducted within 6 h for complete obstruction and 24 h for incomplete obstruction due to food bolus impaction. This study explores whether adults with acute esophageal food bolus (FB) impaction experience adverse outcomes when their time to esophagogastroduodenoscopy (EGD) deviates from the recommended guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was performed on the records of 248 patients who presented at the study site between 2015 and 2022 with symptoms of FB impaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred and forty-eight patients underwent EGD for FB impaction. Grade 1 (erosion, ulceration), Grade 2 (tear), and Grade 3 (perforation) complications were present in 31.6%, 6.9%, and 0.8% of cases, respectively. Of the 134 (54.0%) patients with complete obstruction, 51 (38.1%) received EGD within the recommended 6 h. Of the 114 (46%) patients with incomplete obstructions, 93 (81.6%) received EGD within the recommended 24 h. There was no statistically significant correlation between length of stay (LOS) post-EGD and any of ingestion to presentation time, presentation to EGD time, or ingestion to EGD time. Age and complication level were greater predictors of longer LOS than presentation to EGD time. Patients who presented in hours were significantly more likely to receive EGD within the 6- and 24-h guidelines than those who presented out of hours (50.7% <i>vs</i> 22.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Neither time to EGD from ingestion of food bolus nor time to EGD from hospital presentation correlated with complication rate, complication severity, or length of stay post-EGD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451856","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":"Are transmembrane 6 superfamily member 2 gene polymorphisms associated with steatohepatitis after pancreaticoduodenectomy?","authors":"Tomotaka Mori,&nbsp;Eisuke Ozawa,&nbsp;Ryu Sasaki,&nbsp;Akane Shimakura,&nbsp;Kosuke Takahashi,&nbsp;Yoko Kido,&nbsp;Yasuko Kanda,&nbsp;Satoshi Matsuo,&nbsp;Kazuaki Tajima,&nbsp;Asami Beppu,&nbsp;Yasuhiko Nakao,&nbsp;Masanori Fukushima,&nbsp;Masafumi Haraguchi,&nbsp;Satoshi Miuma,&nbsp;Hisamitsu Miyaaki,&nbsp;Tomohiko Adachi,&nbsp;Susumu Eguchi,&nbsp;Shinji Okano,&nbsp;Kazuhiko Nakao","doi":"10.1002/jgh3.13113","DOIUrl":"10.1002/jgh3.13113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>After pancreaticoduodenectomy, 20–40% of patients develop steatotic liver disease (SLD), and steatohepatitis can be a problem. Although patatin-like phospholipase domain-containing 3 protein (PNPLA3) and transmembrane 6 superfamily member 2 (TM6SF2) polymorphisms are involved in SLD and steatohepatitis development, whether this is the case after pancreaticoduodenectomy is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Forty-three patients with pancreatic cancer who underwent pancreaticoduodenectomy at our hospital between April 1, 2018, and March 31, 2021, were included. We extracted DNA from noncancerous areas of residual specimens after pancreaticoduodenectomy and determined PNPLA3 and TM6SF2 gene polymorphisms using real-time polymerase chain reaction. SLD was defined as a liver with an attenuation value of ≤40 HU or a liver-to-spleen ratio of ≤0.9 on computed tomography. We defined high hepatic fibrosis indexes (HFI) instead of steatohepatitis as a Fibrosis-4 index of ≥2.67 or nonalcoholic fatty liver disease fibrosis score of ≥0.675 in patients with SLD. The cumulative incidence of SLD (<i>P</i> = 0.299) and high HFI (<i>P</i> = 0.987) after pancreaticoduodenectomy were not significantly different between the PNPLA3 homozygous and minor allele groups. The incidences of high HFI at 1 year after pancreaticoduodenectomy were 16.8% and 27.0% in the TM6SF2 major homozygous and minor allele groups, respectively, with a significant difference in the cumulative incidence (<i>P</i> = 0.046).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The TM6SF2 minor allele may contribute to steatohepatitis development after pancreaticoduodenectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11197035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451857","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":"Gastric intestinal metaplasia: Prevalence in a large Australian center and nationwide survey of endoscopic practice","authors":"Imogen Hartley,&nbsp;Declan Connoley,&nbsp;Nikhita Sane,&nbsp;Ryan Hirsch,&nbsp;Dilini Abeywickrama,&nbsp;Nicholle Sim,&nbsp;Vinny Ea,&nbsp;Robert Azzopardi,&nbsp;Ian Simpson,&nbsp;Sally Bell,&nbsp;Simon Hew","doi":"10.1002/jgh3.13115","DOIUrl":"10.1002/jgh3.13115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) are early changes in the stepwise progression to gastric adenocarcinoma. There is heterogeneity in international guidelines regarding the endoscopic diagnosis and surveillance of AG and GIM. This study aims to determine the prevalence of GIM in an Australian center and assess the approach of Australian endoscopists for these two conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center retrospective study of adult patients between January 2015 and December 2020 diagnosed with GIM on gastric biopsy following upper gastric endoscopy. A web-based, 25-question, investigator-designed, multiple-choice survey was distributed among all registered endoscopists in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall prevalence of GIM within a single Australian center was 11.7% over 5 years. Of the 1026 patients identified, only 58.7% underwent mapping biopsies using the modified Sydney protocol. Among the cohort, 1.6% had low-grade dysplasia, 0.9% had high-grade dysplasia, and 1.8% had malignancy on initial gastroscopy. Two hundred and sixty-seven (7.2%) endoscopists completed the survey, 44.2% indicated they would perform mapping for all patients, and 36% only for high-risk patients. Only 1.5% (<i>n</i> = 4) of respondents were able to correctly identify all six endoscopic photos of GIM/AG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that in a large tertiary center, GIM is a prevalent endoscopic finding, but the associated rates of dysplasia and cancer were low. Additionally, among a small proportion of surveyed Australian endoscopists, there is notable variability in the endoscopic approach for AG and GIM and significant knowledge gaps. More training is required to increase the recognition of GIM and compliance with histological mapping.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11199814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141459900","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":"Endoscopic characteristics and performance of WASP classification in the diagnosis of colorectal sessile-serrated lesions in Vietnamese patients","authors":"Nhu Thi Hanh Vu,&nbsp;Huy Minh Le,&nbsp;Diem Thi-Ngoc Vo,&nbsp;Nhan Quang Le,&nbsp;Dung Dang Quy Ho,&nbsp;Duc Trong Quach","doi":"10.1002/jgh3.13109","DOIUrl":"10.1002/jgh3.13109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aims</h3>\u0000 \u0000 <p>Sessile-serrated lesions (SSLs) are challenging to detect due to their typically subtle appearance. The Workgroup serrAted polypS and Polyposis (WASP) classification was developed to diagnose SSLs endoscopically. This study aimed to evaluate the endoscopic characteristics of SSLs and the performance of the WASP classification in the Vietnamese population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study was carried out on patients with lower gastrointestinal symptoms who underwent colonoscopy at a Vietnamese tertiary hospital. Univariate and multivariate analyses were performed to identify endoscopic features associated with SSLs. The performance of the WASP classification for diagnosing SSLs was assessed, and SSLs were diagnosed according to the 2019 World Health Organization (WHO) criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 2489 patients, with a mean age of 52.1 ± 13.1 years and a female-to-male ratio of 1:1.1. A total of 121 specimens from 105 patients were diagnosed with SSLs. According to multivariate analysis, the endoscopic features significantly associated with SSLs were proximal location (odds ratio [OR]: 2.351; 95% confidence interval [CI]: 1.475–3.746), size &gt;5 mm (OR: 2.447; 95% CI: 1.551–3.862), flat morphology (OR: 2.781; 95% CI: 1.533–5.044), irregular shape (OR: 4.516; 95% CI: 2.173–9.388), varicose microvascular vessels (OR: 5.030; 95% CI: 2.657–9.522), and dark spots inside the crypts (OR: 5.955; 95% CI: 3.291–10.776). The accuracy of the WASP classification for diagnosing SSLs was 94.0% (95% CI: 92.8%–95.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Proximal location, size &gt;5 mm, flat morphology, irregular shape, varicose microvascular vessels, and dark spots inside the crypts were significantly associated with SSLs. The WASP classification had high accuracy in the diagnosis of SSLs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451858","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":"The clinical management of hepatic sarcoidosis: A systematic review","authors":"Ram Prasad Sinnanaidu,&nbsp;Vikneshwaran Chandra Kumar,&nbsp;Ranita Hisham Shunmugam,&nbsp;Sanjiv Mahadeva","doi":"10.1002/jgh3.13076","DOIUrl":"10.1002/jgh3.13076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hepatic sarcoidosis is an uncommon clinical condition in which clear recommendations are lacking in its treatment. We aimed to review systematically the literature on hepatic sarcoidosis treatment to guide clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using MEDLINE, PubMed, CINAHL, Cochrane Library, and Google Scholar databases, we searched original articles on clinical studies reporting the outcome of adult hepatic sarcoidosis patients following treatment with various pharmacological agents. The primary end point was focused on assessing symptomatic relief and biochemical improvement posttreatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 614 retrieved references, 34 published studies were eligible, providing data for a total of 268 patients with hepatic sarcoidosis. First-line therapy with corticosteroids alone was reported in 187 patients, whilst ursodeoxycholic acid (UDCA) was used in 40 patients. Symptomatic and biochemical responses were reported among 113(60.4%) and 80(42.8%) cases of corticosteroids respectively, whereas UDCA showed a complete response in 23(57.5%) patients. Second-line therapy was used in steroid-refractory cases, with most cases being reported for azathioprine (<i>n</i> = 32) and methotrexate (<i>n</i> = 28). Notably, 15(46.9%) and 11(39.2%) patients showed both clinical and biochemical responses respectively. Biological therapy including anti-tumor necrosis factor (anti-TNF) was used as third line therapy in twelve cases with a 72.7% symptomatic and biochemical response rate each.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The quality of evidence for the treatment of hepatic sarcoidosis was poor. Nevertheless, it appears that corticosteroid or UDCA may be utilized as first-line therapy. For cases that are refractory to corticosteroids, steroid-sparing immunosuppressive agents and anti-TNF have shown some promising results, but further high-quality studies are required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11187478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433041","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}