ISRN gastroenterologyPub Date : 2013-05-15Print Date: 2013-01-01DOI: 10.1155/2013/214958
Takuji Kawamura, Koichiro Mandai, Koji Uno, Kenjiro Yasuda
{"title":"Does single-balloon enteroscopy contribute to successful endoscopic retrograde cholangiopancreatography in patients with surgically altered gastrointestinal anatomy?","authors":"Takuji Kawamura, Koichiro Mandai, Koji Uno, Kenjiro Yasuda","doi":"10.1155/2013/214958","DOIUrl":"https://doi.org/10.1155/2013/214958","url":null,"abstract":"<p><p>Background. Balloon-assisted enteroscopy has been recognized as a useful method for performing endoscopic retrograde cholangiopancreatography in patients with complex postsurgical anatomy. Objective. To clarify the usefulness of single-balloon enteroscopy for performing endoscopic retrograde cholangiopancreatography successfully in patients after Billroth II gastrectomy or Roux-en-Y reconstruction and compare it with that of conventional endoscopy. Patients and Methods. We analyzed 204 endoscopic retrograde cholangiopancreatography procedures performed at Kyoto Second Red Cross Hospital between 1997 and 2011 in 93 patients after Billroth II gastrectomy and Roux-en-Y reconstruction with gastrectomy and choledochojejunostomy. We compared recent results with those achieved before the advent of single-balloon enteroscopy (\"pre-single-balloon enteroscopy\" group versus \"post-single-balloon enteroscopy\" group). Results. The rate of reaching the blind end was 11/12 (91.7%) in post-single-balloon enteroscopy Roux-en-Y gastrectomy cases and 3/9 (33.3%) in pre-single-balloon enteroscopy Roux-en-Y gastrectomy cases (P = 0.015). The rate of accomplishing target procedures was 7/12 (58.3%) in post-single-balloon enteroscopy Roux-en-Y gastrectomy cases. No significant difference was found in the rates for Billroth II gastrectomy cases. Conclusion. The single-balloon enteroscopy system is effective in reaching the blind end in patients who have undergone Roux-en-Y reconstruction; however, further innovations are needed to accomplish endoscopic retrograde cholangiopancreatography-related procedures.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"214958"},"PeriodicalIF":0.0,"publicationDate":"2013-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/214958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31503901","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}
ISRN gastroenterologyPub Date : 2013-04-24Print Date: 2013-01-01DOI: 10.1155/2013/205417
R J L F Loffeld, P E P Dekkers
{"title":"Experience with oesophageal cancer: a ten-year single centre study reflecting daily practice.","authors":"R J L F Loffeld, P E P Dekkers","doi":"10.1155/2013/205417","DOIUrl":"https://doi.org/10.1155/2013/205417","url":null,"abstract":"<p><p>Introduction. Studied patients with oesophageal cancer do not represent normal daily presentation. Aim. A retrospective study was done in all consecutive patients in order to describe presentation, treatment, and survival. Patients. All patients in a ten-year period were included. Patients were grouped in three groups. Group 1: no metastases and potentially curable, dead, or alive at time of evaluation. Group 2: patients presenting with metastases and treated with palliative chemotherapy, and group 3: patients with or without metastases but untreatable because of low Karnofsky index or important comorbidity rendering treatment not feasible. Results. One hundred thirty one evaluable patients were included. There was no difference in histological type of the tumour. Patients in group 3 were significantly older. Survival was not different between groups 2 and 3. Survival in group 1 was significantly longer (P < 0.0001) compared with groups 2 and 3. Patients in group 1 received treatment with chemoradiation and surgery. Patients in groups 2 and 3 were more often treated with palliative chemotherapy and endoscopic stenting. Conclusion. The overall survival of oesophageal cancer in normal daily life is poor. Supportive care seems to be the best treatment option in patients with metastases or low Karnofsky index. Palliative chemotherapy does not add to overall survival.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"205417"},"PeriodicalIF":0.0,"publicationDate":"2013-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/205417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31460194","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":"Effect of Propofol on Acid Reflux Measured with the Bravo pH Monitoring System.","authors":"Anupama Chawla, Eugenia Girda, Grace Walker, Frances Turcotte Benedict, Mila Tempel, Jeffrey Morganstern","doi":"10.1155/2013/605931","DOIUrl":"https://doi.org/10.1155/2013/605931","url":null,"abstract":"<p><p>Background/Aim. The aim of this study was to determine the effect of propofol on acid reflux as measured with the Bravo pH monitoring system. Methods. 48-hour pH tracings of 88 children were retrospectively evaluated after placement of the Bravo capsule under propofol. Comparisons between day 1 and day 2, as well as 6-hour corresponding segments from day 1 and day 2, were made. Results. The number of reflux episodes was significantly increased during the first six-hour period on day one as compared to day 2 (P = 0.006). The fraction of time the pH was <4 was also increased during this period, though it did not reach statistical significance. When comparing full 24-hour periods, there was no difference noted in either the number of reflux episodes or the fraction of time pH < 4 between day one and day two. Conclusion. Our data suggest an increase in gastroesophageal reflux during the postanesthesia period. This could be a direct effect of propofol, or related to other factors. Regardless of the cause, monitoring of pH for the first 6 hours following propofol administration may not be reliable when assessing these patients. Monitoring pH over a prolonged 48-hour time period can overcome this obstacle.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"605931"},"PeriodicalIF":0.0,"publicationDate":"2013-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/605931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31446733","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}
ISRN gastroenterologyPub Date : 2013-04-21Print Date: 2013-01-01DOI: 10.1155/2013/862312
Aikaterini Thanou, Tauseef Ali, Omar Haq, Sindhu Kaitha, Jordan Morton, Stavros Stavrakis, Mary Beth Humphrey
{"title":"Utilization of Preventive Measures for Glucocorticoid-Induced Osteoporosis among Veterans with Inflammatory Bowel Disease.","authors":"Aikaterini Thanou, Tauseef Ali, Omar Haq, Sindhu Kaitha, Jordan Morton, Stavros Stavrakis, Mary Beth Humphrey","doi":"10.1155/2013/862312","DOIUrl":"https://doi.org/10.1155/2013/862312","url":null,"abstract":"<p><p>Purpose. We examined current osteoporosis prevention practices in patients with inflammatory bowel disease (IBD) on chronic steroid using the 2003 American Gastroenterological Association guidelines as standard of care. Methods. We identified all IBD patients followed at the Oklahoma City VA Medical Center from January 2003 to December 2010, who had been on daily oral steroids (prednisone ≥5 mg or budesonide ≥6 mg) for ≥3 consecutive months. Associations of calcium and vitamin D (vitD) prescribing and bone mineral density (BMD) testing with patient characteristics were examined by logistic regression. Results. Sixty-three of 384 consecutive patients met inclusion criteria. Among 86 steroid courses, calcium and vitD were concurrently prescribed in 46%, and BMD was tested in 30%. There was no association of demographic and clinical characteristics with calcium/vitD prescribing and BMD testing. By multivariate analysis, steroid initiation after 2006, compared to before 2006, was associated with a significant increase in calcium (OR = 3.17 and P = 0.02) and vitD (OR = 2.96 and P = 0.02) prescribing and BMD testing (OR = 4.63 and P = 0.004). Conclusions. We observed a low, yet increasing, adherence to osteoporosis prevention guidelines in IBD since 2003, which highlights the need for continued physician education to enhance guideline awareness and implementation.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"862312"},"PeriodicalIF":0.0,"publicationDate":"2013-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/862312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31537549","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}
ISRN gastroenterologyPub Date : 2013-04-18Print Date: 2013-01-01DOI: 10.1155/2013/352718
Martin Alexander Storr
{"title":"Microscopic colitis: epidemiology, pathophysiology, diagnosis and current management-an update 2013.","authors":"Martin Alexander Storr","doi":"10.1155/2013/352718","DOIUrl":"10.1155/2013/352718","url":null,"abstract":"<p><p>Microscopic colitis is a common cause of chronic diarrhea. Over the last years the incidence and the prevalence of microscopic colitis are rising and this rise is largely attributed to a rising awareness, and concomitantly an increasing number of diagnoses are made. Patients with microscopic colitis report watery, nonbloody diarrhea of chronic, intermittent, or chronic recurrent course. Following an unremarkable physical examination the diagnosis of microscopic colitis is made by colonoscopy, which shows essentially a normal colonic mucosa. Biopsies taken during the colonoscopy procedure will then finally establish the correct diagnosis. Histological workup can then confirm a diagnosis of microscopic colitis and can distinguish the two distinct histological forms, namely, collagenous colitis and lymphocytic colitis. Presently both forms are diagnosed and treated in the same way; thus the description of the two forms is not of clinical value, though this may change in future. Depending on the patients age and gender 10-30% of patients investigated for chronic diarrhea will be diagnosed with microscopic colitis if biopsies are taken. Microscopic colitis is most common in older patients, especially in female patients and is frequently associated with autoimmune disorders and the consumption of several drugs. This review summarizes the present knowledge of the epidemiology, the pathophysiology, and the diagnosis of microscopic colitis and discusses the former and the present treatment options.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"352718"},"PeriodicalIF":0.0,"publicationDate":"2013-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/352718","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31446734","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}
ISRN gastroenterologyPub Date : 2013-04-15Print Date: 2013-01-01DOI: 10.1155/2013/606258
Tamer Essawi, Wail Hammoudeh, Israr Sabri, Walid Sweidan, Mohammad A Farraj
{"title":"Determination of Helicobacter pylori Virulence Genes in Gastric Biopsies by PCR.","authors":"Tamer Essawi, Wail Hammoudeh, Israr Sabri, Walid Sweidan, Mohammad A Farraj","doi":"10.1155/2013/606258","DOIUrl":"https://doi.org/10.1155/2013/606258","url":null,"abstract":"<p><p>Aim. The aim of this study was to identify the presence of H. pylori in biopsy specimens from symptomatic patients by PCR. In addition, the rate of cagA, vacA, iceA1, and iceA2 virulence genes was determined. Materials and Methods. One hundred antral gastric biopsy specimens were collected during endoscopy from patients suffering from gastroduodenal symptoms. The samples were collected by the gastroenterologists in their own clinics in Ramallah, Palestine. DNA was extracted from the biopsies and subsequently used for PCR identification of H. pylori and the virulence genes using specific primers. Results. The rate of positive H. pylori in the collected biopsies was 44%. The rates of the virulence genes in this sample: cagA, vacA, iceA1, and iceA2 were 65.9%, 40.9%, 63.6%, and 84.1%, respectively. Conclusion. The iceA2 gene was the most frequent in this study. Much research is necessary to determine the presence of an association of this gene with gastric pathology. Variation in the rates of the iceA gene in different countries is a strong indication of its geographical distribution. This study would provide important information regarding the prevalence of virulence genes (vacA, cagA, iceA1, and iceA2) in H. pylori strains in the sample tested in this country.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"606258"},"PeriodicalIF":0.0,"publicationDate":"2013-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/606258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31537547","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":"Colon Mucosa Exhibits Loss of Ectopic MUC5AC Expression in Patients with Ulcerative Colitis Treated with Oral Tacrolimus.","authors":"Tsutomu Mizoshita, Satoshi Tanida, Hironobu Tsukamoto, Keiji Ozeki, Takahito Katano, Masahide Ebi, Yoshinori Mori, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh","doi":"10.1155/2013/304894","DOIUrl":"https://doi.org/10.1155/2013/304894","url":null,"abstract":"<p><p>Background. Tacrolimus (FK506) is effective for patients with ulcerative colitis (UC). However, there are few reports on tacrolimus therapy (TT) with respect to the relationship with endoscopic and clinicopathologic findings. Methods. Thirty patients with moderate/severe active UC refractory to or dependent on corticosteroid were treated with oral tacrolimus. The expression of ectopic MUC5AC in the colon was pathologically analyzed before and at 12 weeks after TT, evaluating the Mayo score and steroid-sparing effects. Results. Both mean disease and endoscopic activity index scores were reduced at levels of statistical significance in 26 UC patients receiving more than one month of TT (P < 0.0001). The dose of prednisolone was reduced by a statistically significant amount (P = 0.00022), and 14 of the 26 patients (53.8%) had steroid-free status 12 weeks after TT. The decrease in ectopic MUC5AC expression in the mucous cells of the colon was significantly associated with endoscopic improvement of inflammation in the UC patients with TT (P = 0.043). Loss of ectopic MUC5AC expression was detected in all patients who had complete response. Conclusions. Tacrolimus appears to be effective for the treatment of moderate/severe UC patients. Loss of ectopic MUC5AC expression may be important for pathologic remission in the colon of UC patients.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"304894"},"PeriodicalIF":0.0,"publicationDate":"2013-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/304894","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31446732","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}
ISRN gastroenterologyPub Date : 2013-04-04Print Date: 2013-01-01DOI: 10.1155/2013/630159
Wouter J de Jonge
{"title":"The Gut's Little Brain in Control of Intestinal Immunity.","authors":"Wouter J de Jonge","doi":"10.1155/2013/630159","DOIUrl":"https://doi.org/10.1155/2013/630159","url":null,"abstract":"<p><p>The gut immune system shares many mediators and receptors with the autonomic nervous system. Good examples thereof are the parasympathetic (vagal) and sympathetic neurotransmitters, for which many immune cell types in a gut context express receptors or enzymes required for their synthesis. For some of these the relevance for immune regulation has been recently defined. Earlier and more recent studies in neuroscience and immunology have indicated the anatomical and cellular basis for bidirectional interactions between the nervous and immune systems. Sympathetic immune modulation is well described earlier, and in the last decade the parasympathetic vagal nerve has been put forward as an integral part of an immune regulation network via its release of Ach, a system coined \"the cholinergic anti-inflammatory reflex.\" A prototypical example is the inflammatory reflex, comprised of an afferent arm that senses inflammation and an efferent arm: the cholinergic anti-inflammatory pathway, that inhibits innate immune responses. In this paper, the current understanding of how innate mucosal immunity can be influenced by the neuronal system is summarized, and cell types and receptors involved in this interaction will be highlighted. Focus will be given on the direct neuronal regulatory mechanisms, as well as current advances regarding the role of microbes in modulating communication in the gut-brain axis.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"630159"},"PeriodicalIF":0.0,"publicationDate":"2013-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/630159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31537548","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":"Differences in the Characteristics of Barrett's Esophagus and Barrett's Adenocarcinoma between the United States and Japan.","authors":"Makoto Oryu, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Shintaro Fujihara, Mitsuyoshi Kobayashi, Mitsugu Yasuda, Tsutomu Masaki","doi":"10.1155/2013/840690","DOIUrl":"10.1155/2013/840690","url":null,"abstract":"<p><p>In Europe and the United States, the incidence of esophageal adenocarcinoma has increased 6-fold in the last 25 years and currently accounts for more than 50% of all esophageal cancers. Barrett's esophagus is the source of Barrett's adenocarcinoma and is characterized by the replacement of squamous epithelium with columnar epithelium in the lower esophagus due to chronic gastroesophageal reflux disease (GERD). Even though the prevalence of GERD has recently been increasing in Japan as well as in Europe and the United States, the clinical situation of Barrett's esophagus and Barrett's adenocarcinoma differs from that in Western countries. In this paper, we focus on specific differences in the background factors and pathophysiology of these lesions.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"840690"},"PeriodicalIF":0.0,"publicationDate":"2013-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31375536","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}
ISRN gastroenterologyPub Date : 2013-01-01Epub Date: 2013-01-27DOI: 10.1155/2013/464053
Lanning Yin, Haipeng Liu, Youcheng Zhang, Wen Rong
{"title":"The surgical treatment for portal hypertension: a systematic review and meta-analysis.","authors":"Lanning Yin, Haipeng Liu, Youcheng Zhang, Wen Rong","doi":"10.1155/2013/464053","DOIUrl":"https://doi.org/10.1155/2013/464053","url":null,"abstract":"<p><p>Aim. To compare the effectiveness of surgical procedures (selective or nonselective shunt, devascularization, and combined shunt and devascularization) in preventing recurrent variceal bleeding and other complications in patients with portal hypertension. Methods. A systematic literature search of the Medline and Cochrane Library databases was carried out, and a meta-analysis was conducted according to the guidelines of the Quality of Reporting Meta-Analyses (QUOROM) statement. Results. There were a significantly higher reduction in rebleeding, yet a significantly more common encephalopathy (P = 0.05) in patients who underwent the shunt procedure compared with patients who had only a devascularization procedure. Further, there were no significant differences in rebleeding, late mortality, and encephalopathy between selective versus non-selective shunt. Next, the decrease of portal vein pressure, portal vein diameter, and free portal pressure in patients who underwent combined treatment with shunt and devascularization was more pronounced compared with patients who were treated with devascularization alone (P < 0.05). Conclusions. This meta-analysis shows clinical advantages of combined shunt and devascularization over devascularization in the prevention of recurrent variceal bleeding and other complications in patients with portal hypertension.</p>","PeriodicalId":89397,"journal":{"name":"ISRN gastroenterology","volume":"2013 ","pages":"464053"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/464053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31319516","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}