Canadian Journal of Gastroenterology最新文献

{"title":"Antidepressant prophylaxis reduces depression risk but does not improve sustained virological response in hepatitis C interferon recipients without depression at baseline: a systematic review and meta-analysis.","authors":"Awad Al-Omari,&nbsp;Juthaporn Cowan,&nbsp;Lucy Turner,&nbsp;Curtis Cooper","doi":"10.1155/2013/832689","DOIUrl":"https://doi.org/10.1155/2013/832689","url":null,"abstract":"<p><strong>Background: </strong>Depression complicates interferon-based hepatitis C virus (HCV) antiviral therapy in 10% to 40% of cases, and diminishes patient well-being and ability to complete a full course of therapy. As a consequence, the likelihood of achieving a sustained virological response (SVR [ie, permanent viral eradication]) is reduced.</p><p><strong>Objective: </strong>To systematically review the evidence of whether pre-emptive antidepressant prophylaxis started before HCV antiviral initiation is beneficial.</p><p><strong>Methods: </strong>Inclusion was restricted to randomized controlled trials in which prophylactic antidepressant therapy was started at least two weeks before the initiation of HCV antiviral treatment. Studies pertaining to patients with active or recent depressive symptoms before commencing HCV antiviral therapy were excluded. English language articles from 1946 to July 2012 were included. The MEDLINE, Embase and Cochrane Central databases were searched. Where possible, meta-analyses were conducted evaluating the effect of antidepressant prophylaxis on SVR and major depression as well as on Montgomery-Asberg Depression Rating Scale and Beck Depression Index scores at four, 12 and 24 weeks. The Cochrane Collaboration tool was used to assess bias risk.</p><p><strong>Results: </strong>Six randomized clinical trials involving 522 patients met the inclusion criteria. Although the frequency of on-treatment clinical depression was decreased with antidepressant prophylaxis (risk ratio 0.60 [95% CI 0.38 to 0.93]; P=0.02; I2=24%), no benefit to SVR was identified (risk ratio 1.08 [95% CI 0.74 to 1.57]; P=0.69; I2=58%).</p><p><strong>Conclusion: </strong>This practice is not justified to improve SVR in populations free of active depressive symptoms leading up to HCV antiviral therapy.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 10","pages":"575-81"},"PeriodicalIF":2.7,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/832689","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31792725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the diagnosis and management of autoimmune hepatitis.","authors":"Albert J Czaja","doi":"10.1155/2013/981086","DOIUrl":"https://doi.org/10.1155/2013/981086","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune hepatitis has diverse clinical phenotypes and outcomes that challenge current diagnostic criteria and management algorithms.</p><p><strong>Objectives: </strong>To highlight the major difficulties in diagnosis and management, describe the efforts to ease them and encourage further progress in problem solving.</p><p><strong>Methods: </strong>The MEDLINE database was reviewed for published experiences from 1984 to 2013.</p><p><strong>Results: </strong>Acute or acute severe (fulminant) hepatitis, asymptomatic mild disease, and histological findings of centrilobular necrosis or bile duct injury can confound diagnosis and treatment. Continuation of conventional therapy until normal liver test results and liver tissue reduces the frequency of relapse, but does not prevent its occurrence. Problematic patients can be identified using mathematical models, clinical phenotype, serological markers and the speed of improvement after treatment; however, their recognition and treatment are inconsistent. Mycophenolate mofetil can rescue patients with azathioprine intolerance but is less effective for refractory disease. Budesonide in combination with azathioprine can be used frontline, but is effective primarily in noncirrhotic, uncomplicated disease. Molecular and cellular interventions are feasible but largely unevaluated.</p><p><strong>Discussion: </strong>Resolution of the current challenges requires revision of diagnostic criteria, characterization of biological markers that reflect pathogenic pathways, development of dynamic indexes based on changes in disease behaviour, and introduction of new pharmacological, molecular and cellular interventions that have undergone rigorous evaluation.</p><p><strong>Conclusion: </strong>These challenges reflect important remediable deficiencies in current management.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 9","pages":"531-9"},"PeriodicalIF":2.7,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/981086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31770144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closure of a percutaneous endoscopic gastrostomy-associated nonhealing gastrocutaneous fistula using endoscopic hemoclips.","authors":"Resheed Alkhiari,&nbsp;Deepti Jacob,&nbsp;Zain Kassam,&nbsp;Osama Abu Zaghlan,&nbsp;Frances Tse","doi":"10.1155/2013/145946","DOIUrl":"https://doi.org/10.1155/2013/145946","url":null,"abstract":"1Department of Medicine, McMaster University, Hamilton, Ontario; 2Department of Medicine, University of Calgary, Calgary, Alberta; 3Division of Gastroenterology, McMaster University, Hamilton, Ontario; 4Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA Correspondence: Dr Frances Tse, Division of Gastroenterology, McMaster University, Room 2F53, 1200 Main Street West, Hamilton, Ontario L8N 3Z5. Telephone 905-521-2100 ext 76733, fax 905-523-6048, e-mail tsef@mcmaster.ca Received for publication April 21, 2013. Accepted May 12, 2013 Case presentation A 53-year-old man admitted for stem cell transplantation in the context of acute myeloid leukemia was referred for gastric content leakage from a persistent gastrocutaneous fistula. A percutaneous endoscopic gastrostomy (PEG) tube had been placed for four months due to suboptimal nutrition. The PEG tube was subsequently removed due to improvement in caloric intake and nutritional status. Unfortunately, drainage of gastric contents (approximately 250 mL/day) from the gastrocutaneous fistula after removal of the PEG tube persisted. This led to peristomal skin maceration and breakdown resulting in local cutaneous bleeding from the PEG tube site. Despite conservative management with bowel rest, proton pump inhibitor therapy, wound care and parenteral nutrition, drainage and bleeding from the gastrocutaneous fistula site persisted. The remainder of his medical history was noncontributory. Physical examination using subjective global assessment revealed a hemodynamically stable man with adequate nutritional status, without any examination or laboratory contraindications to endoscopy. Informed consent was obtained to proceed with an attempt to close the gastrocutaneous fistula via endoscopic hemoclips before considering surgical closure. During endoscopy, the opening of the fistula was identified in the antrum (Figure 1). Single-modality therapy was used and three hemoclips were placed in an attempt to close the fistula site (Figure 2). A stoma bag was placed over the pre-existing fistula site; no air leakage was observed at the time of endoscopy. The fistula tract closed within 24 h after the procedure with no further leakage noted. The patient was closely followed over the ensuing week. Daily clinical assessments were conducted and no evidence of gastric content was noted at the previous fistula site. The patient was kept nil per os for three days and proton pump inhibitor therapy was continued. His diet was then advanced. The lack of gastric output from the fistula tract postendoclip placement, even after the initiation of oral feeds, confirmed the successful outcome of the procedure (Figure 3).","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 9","pages":"501-2"},"PeriodicalIF":2.7,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/145946","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31770136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General anesthetic versus light sedation: effect on pediatric endoscopy wait times.","authors":"Christine Edwards,&nbsp;Vikram Kapoor,&nbsp;Christopher Samuel,&nbsp;Robert Issenman,&nbsp;Herbert Brill","doi":"10.1155/2013/201025","DOIUrl":"https://doi.org/10.1155/2013/201025","url":null,"abstract":"<p><strong>Background: </strong>Wait times are an important measure of health care system effectiveness. There are no studies describing wait times in pediatric gastroenterology for either outpatient visits or endoscopy. Pediatric endoscopy is performed under light sedation or general anesthesia. The latter is hypothesized to be associated with a longer wait time due to practical limits on access to anesthesia in the Canadian health care system.</p><p><strong>Objective: </strong>To identify wait time differences according to sedation type and measure adverse clinical outcomes that may arise from increased wait time to endoscopy in pediatric patients.</p><p><strong>Methods: </strong>The present study was a retrospective review of medical charts of all patients <18 years of age who had been assessed in the pediatric gastroenterology clinic and were scheduled for an elective outpatient endoscopic procedure at McMaster Children's Hospital (Hamilton, Ontario) between January 2006 and December 2007. The primary outcome measure was time between clinic visit and date of endoscopy. Secondary outcome measures included other defined waiting periods and complications while waiting, such as emergency room visits and hospital admissions.</p><p><strong>Results: </strong>The median wait time to procedure was 64 days for general anesthesia patients and 22 days for patients who underwent light sedation (P<0.0001). There was no significant difference between the two groups with regard to the number of emergency room visits or hospital admissions, both pre- and postendoscopy.</p><p><strong>Conclusions: </strong>Due to the lack of pediatric anesthetic resources, patients who were administered general anesthesia experienced a longer wait time for endoscopy compared with patients who underwent light sedation. This did not result in adverse clinical outcomes in this population.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 9","pages":"519-22"},"PeriodicalIF":2.7,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/201025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31770140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic position change at colonoscopy improves adenoma detection.","authors":"Subrata Ghosh,&nbsp;Marietta Iacucci","doi":"10.1155/2013/575412","DOIUrl":"https://doi.org/10.1155/2013/575412","url":null,"abstract":"Colonoscopy has led the way with regard to quality assurance in gastroenterology and endoscopy services. Widespread adoption of colonoscopic screening and surveillance to detect colonic adenoma has driven much of the quality improvement. Improved bowel preparation regimens, better training of both trainees and trainers, optimizing withdrawal time of colonoscope to permit careful inspection, use of magnetic endoscopic imaging, better colonoscopies that now permit retroflexion in the right colon, regular and routine monitoring of colonoscopic performance and feedback, and single balloon-assisted colonoscopies in patients who failed conventional colonoscopy have all contributed to more efficient, effective and safer colonoscopies. Patient satisfaction with colonoscopy is high (1), and quality improvement driven by national guidelines and training has been encouraging (2). \u0000 \u0000Dynamic position changes during colonoscope withdrawal was pioneered by the St Mark’s Hospital group from London, United Kingdom, and was incorporated into their training program. This group conducted a randomized crossover trial and reported that position changes during colonoscopic withdrawal significantly improved polyp and adenoma detection rates (3). In the current issue of the Journal, Koksal et al, from Turkey (4) (pages 509–512), confirmed this in a randomized study in which the investigators randomly assigned patients 1:1 to examination in either the left lateral position during colonoscope withdrawal or other positions (Table 1). An increase in adenoma detection rate of 9.8% in the transverse colon, splenic flexure, descending and sigmoid colon was noted in the group examined by dynamic position changes. \u0000 \u0000 \u0000 \u0000TABLE 1 \u0000 \u0000Dynamic patient positioning during colonoscope withdrawal (Koksal et al, pages 509–512) \u0000 \u0000 \u0000 \u0000Dynamic position change is intuitive because air naturally rises to the highest position. Such position changes result in better distension with less insufflation of air, shifting of fluids and residues, and opening tight angles at flexures. Hence, this may also help ease insertion. However, the patients need to be lightly sedated and moving from the left lateral to supine position is relatively easy, but moving to the right lateral position is more cumbersome. It is possible that simply a ‘tilt’ to the right side rather than full right lateral decubitus may suffice, but this needs to be proven. Most Canadian colonoscopists do not routinely practice dynamic position changes at colonoscopy. On current evidence, a supportive case can be made for such practice to be adopted. This will also emphasize good practice during colonoscope withdrawal, not just in the time taken, but optimum positioning, carefully looking behind folds, optimizing luminal distension and suctioning all residues and fluid. While optimum insertion technique to reach the cecum makes a good colonoscopist, it is withdrawal technique that makes a great colonoscopist. Certainly, such meticulousn","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 9","pages":"508"},"PeriodicalIF":2.7,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/575412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31770137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A simple method to improve adenoma detection rate during colonoscopy: altering patient position.","authors":"Aydın Şeref Köksal,&nbsp;Ismail Hakkı Kalkan,&nbsp;Serkan Torun,&nbsp;Ismail Taşkıran,&nbsp;Erkin Öztaş,&nbsp;Ertuğrul Kayaçetin,&nbsp;Nurgül Şaşmaz","doi":"10.1155/2013/276043","DOIUrl":"https://doi.org/10.1155/2013/276043","url":null,"abstract":"<p><strong>Background: </strong>Colonoscopy is currently considered to be the gold standard method for detecting and removing adenomatous polyps. However, tandem colonoscopy studies reveal a pooled polyp miss rate of 22%.</p><p><strong>Objective: </strong>A prospective randomized trial was conducted to assess whether alteration of patient position during colonoscopy withdrawal increases the adenoma detection rate (ADR).</p><p><strong>Method: </strong>The study group included 120 patients who presented for elective colonoscopic examination. After reaching the cecum, patients were randomly assigned in a 1:1 ratio to examination in either the left lateral position or other positions (left lateral position for the cecum, ascending colon and hepatic flexure; supine for transverse colon; and supine and right lateral position for splenic flexure, descending and sigmoid colon) first. Examination of the colon was performed segment by segment. The size, morphology and location of all polyps were recorded. Polyps were removed immediately after examination of a colon segment when all positions were completed. ADR and polyp detection rates (PDR) were calculated.</p><p><strong>Results: </strong>A total of 102 patients completed the study. Examination in the left lateral position revealed 66 polyps in 31 patients (PDR 30.3%) and 42 adenomas in 24 patients (ADR 23.5%). PDR increased to 43.1% (81 polyps in 44 patients) and the ADR to 33.3% (53 adenomas in 34 patients) after the colon was examined in the additional positions (P<0.001 and P=0.002, respectively). The increase in the number of adenomas detected was statistically significant in the transverse and sigmoid colon. The addition of position changes led to a 9.8% increase in the ADR in the transverse colon, splenic flexure, and descending and sigmoid colon. The frequency of surveillance interval was shortened in nine (8.8%) patients after examination of the colon in dynamic positions.</p><p><strong>Conclusion: </strong>Alteration of patient position during colonoscopy withdrawal is a simple and effective method to improve ADR.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 9","pages":"509-12"},"PeriodicalIF":2.7,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/276043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31770138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary drainage method and temporal trends in patients admitted with cholangitis: a national audit.","authors":"Julia McNabb-Baltar,&nbsp;Quoc-Dien Trinh,&nbsp;Alan N Barkun","doi":"10.1155/2013/175143","DOIUrl":"https://doi.org/10.1155/2013/175143","url":null,"abstract":"<p><strong>Background: </strong>In patients presenting with ascending cholangitis, better outcomes are reported in those undergoing endoscopic retrograde cholangiopancreatography (ERCP) compared with surgical drainage.</p><p><strong>Objective: </strong>To identify factors associated with the type of intervention, and to examine temporal trends in the treatment of ascending cholangitis.</p><p><strong>Methods: </strong>Data were extracted from the Nationwide Inpatient Sample. Patients ≥18 years of age with a diagnosis of cholangitis between 1998 and 2009 were selected. Temporal trends were assessed using Poisson regression models. Multivariable models were fitted to predict the likelihood of a patient undergoing ERCP, percutaneous or surgical drainage, or no drainage.</p><p><strong>Results: </strong>A weighted estimate of 248,942 patients admitted for cholangitis was identified. Overall, 131,052 patients were treated with ERCP (52.6%), 10,486 with percutaneous drainage (4.2%) and 12,460 with surgical drainage (5.0%); 43.0% did not receive drainage during the admission. Temporal trends between 1998 and 2009 showed a decline in surgical and percutaneous drainage, and a rise in ERCP. In multivariable analyses adjusted for clustering, ERCP and percutaneous drainage were more often performed in institutions with a high volume of admissions for cholangitis, those with a greater bed number and hospitals located in urban areas.</p><p><strong>Conclusion: </strong>Over the past decade, the use of surgical and percutaneous drainage has decreased while that of ERCP has risen. Patients treated at institutions with a low volume of admissions for cholangitis, small bed number and in rural areas were less likely to undergo ERCP or percutaneous drainage.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 9","pages":"513-8"},"PeriodicalIF":2.7,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/175143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31770139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunoglobulin G4-related pancreatic and biliary diseases.","authors":"Hisham Al-Dhahab,&nbsp;Julia McNabb-Baltar,&nbsp;Said Al-Busafi,&nbsp;Alan N Barkun","doi":"10.1155/2013/180461","DOIUrl":"https://doi.org/10.1155/2013/180461","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune pancreatitis and autoimmune cholangitis are new clinical entities that are now recognized as the pancreatico-biliary manifestations of immunoglobulin (Ig) G4-related disease.</p><p><strong>Objective: </strong>To summarize important clinical aspects of IgG4-related pancreatic and biliary diseases, and to review the role of IgG4 in the diagnosis of autoimmune pancreatitis (AIP) and autoimmune cholangitis (AIC).</p><p><strong>Methods: </strong>A narrative review was performed using the PubMed database and the following keywords: \"IgG4\", \"IgG4 related disease\", \"autoimmune pancreatitis\", \"sclerosing cholangitis\" and \"autoimmune cholangitis\". A total of 955 articles were retrieved; of these, 381 contained relevant data regarding the IgG4 molecule, pathogenesis of IgG-related diseases, and diagnosis, management and long-term follow-up for patients with AIP and AIC. Of these 381 articles, 66 of the most pertinent were selected.</p><p><strong>Results: </strong>The selected studies demonstrated the increasing clinical importance of both AIP and AIC, which can mimic pancreatic cancer and cholangiocarcinoma, respectively. IgG4 titration in tissue or blood cannot be used alone to diagnose all IgG4-related diseases; however, it is often a useful adjunct to clinical, radiological and histological features. AIP and AIC respond to steroids; however, relapse is common and long-term maintenance treatment often required.</p><p><strong>Conclusions: </strong>A review of the diagnosis and management of both AIC and AIP is timely and pertinent to clinical practice because the amount of information regarding these conditions has increased substantially in the past few years, resulting in significant impact on the clinical management of affected patients.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 9","pages":"523-30"},"PeriodicalIF":2.7,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/180461","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31770141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of stool DNA testing for multiple markers of colorectal cancer and advanced adenoma: a meta-analysis.","authors":"Hua Yang,&nbsp;Bing-Qing Xia,&nbsp;Bo Jiang,&nbsp;Guozhen Wang,&nbsp;Yi-Peng Yang,&nbsp;Hao Chen,&nbsp;Bing-Sheng Li,&nbsp;An-Gao Xu,&nbsp;Yun-Bo Huang,&nbsp;Xin-Ying Wang","doi":"10.1155/2013/258030","DOIUrl":"https://doi.org/10.1155/2013/258030","url":null,"abstract":"<p><strong>Background and objectives: </strong>The diagnostic value of stool DNA (sDNA) testing for colorectal neoplasms remains controversial. To compensate for the lack of large-scale unbiased population studies, a meta-analysis was performed to evaluate the diagnostic value of sDNA testing for multiple markers of colorectal cancer (CRC) and advanced adenoma.</p><p><strong>Methods: </strong>The PubMed, Science Direct, Biosis Review, Cochrane Library and Embase databases were systematically searched in January 2012 without time restriction. Meta-analysis was performed using a random-effects model using sensitivity, specificity, diagnostic OR (DOR), summary ROC curves, area under the curve (AUC), and 95% CIs as effect measures. Heterogeneity was measured using the χ(2) test and Q statistic; subgroup analysis was also conducted.</p><p><strong>Results: </strong>A total of 20 studies comprising 5876 individuals were eligible. There was no heterogeneity for CRC, but adenoma and advanced adenoma harboured considerable heterogeneity influenced by risk classification and various detection markers. Stratification analysis according to risk classification showed that multiple markers had a high DOR for the high-risk subgroups of both CRC (sensitivity 0.759 [95% CI 0.711 to 0.804]; specificity 0.883 [95% CI 0.846 to 0.913]; AUC 0.906) and advanced adenoma (sensitivity 0.683 [95% CI 0.584 to 0.771]; specificity 0.918 [95% CI 0.866 to 0.954]; AUC 0.946) but not for the average-risk subgroups of either. In the methylation subgroup, sDNA testing had significantly higher DOR for CRC (sensitivity 0.753 [95% CI 0.685 to 0.812]; specificity 0.913 [95% CI 0.860 to 0.950]; AUC 0.918) and advanced adenoma (sensitivity 0.623 [95% CI 0.527 to 0.712]; specificity 0.926 [95% CI 0.882 to 0.958]; AUC 0.910) compared with the mutation subgroup. There was no significant heterogeneity among studies for subgroup analysis.</p><p><strong>Conclusion: </strong>sDNA testing for multiple markers had strong diagnostic significance for CRC and advanced adenoma in high-risk subjects. Methylation makers had more diagnostic value than mutation markers.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"467-75"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/258030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31650424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging of the perineum in pediatric patients with inflammatory bowel disease.","authors":"Douglas H Jamieson,&nbsp;Peter Shipman,&nbsp;Kevan Jacobson","doi":"10.1155/2013/624141","DOIUrl":"https://doi.org/10.1155/2013/624141","url":null,"abstract":"<p><p>Magnetic resonance imaging (MRI) has profoundly changed and improved the investigation of abdominal and pelvic inflammatory bowel disease (IBD) in pediatrics. Using an imaging modality without ionizing radiation is of particular advantage because the pediatric IBD population is young and often requires repeat evaluation. MRI of the pelvis has become the imaging gold standard for detecting and monitoring perianal disease while bowel-directed imaging techniques (eg, enterography, enteroclysis and colonography) can accurately evaluate bowel inflammation in IBD. With recent technological innovations leading to faster and higher resolution, the role of MRI in IBD will likely continue to expand. The present article focuses on MRI of the perineum in pediatric IBD.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"476-80"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/624141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31650425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}