EMJ. Gastroenterology最新文献_第10页

Small Intestinal Tumours: An Overview on Classification, Diagnosis, and Treatment 小肠肿瘤:分类、诊断和治疗综述

EMJ. Gastroenterology Pub Date : 2014-12-03 DOI: 10.33590/emjgastroenterol/10311964

C. Notaristefano, P. Testoni

{"title":"Small Intestinal Tumours: An Overview on Classification, Diagnosis, and Treatment","authors":"C. Notaristefano, P. Testoni","doi":"10.33590/emjgastroenterol/10311964","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311964","url":null,"abstract":"The small intestinal neoplasia group includes different types of lesions and are a relatively rare event, accounting for only 3-6% of all gastrointestinal (GI) neoplasms and 1-3% of all GI malignancies. These lesions can be classified as epithelial and mesenchymal, either benign or malignant. Mesenchymal tumours include stromal tumours (GIST) and other neoplasms that might arise from soft tissue throughout the rest of the body (lipomas, leiomyomas and leiomyosarcomas, fibromas, desmoid tumours, and schwannomas). Other lesions occurring in the small bowel are carcinoids, lymphomas, and melanomas. To date, carcinoids and GIST are reported as the most frequent malignant lesions occurring in the small bowel. Factors that predispose to the development of malignant lesions are different, and they may be hereditary (Peutz-Jeghers syndrome, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer, neuroendocrine neoplasia Type 1, von Hippel-Lindau disease, and neurofibromatosis Type 1), acquired (sporadic colorectal cancer and small intestine adenomas, coeliac disease, Crohn’s disease), or environmental (diet, tobacco, and obesity). Small bowel tumours present with different and sometimes nonspecific symptoms, and a prompt diagnosis is not always so easily performed. Diagnostic tools, that may be both radiological and endoscopic, possess specificity and sensitivity, as well as different roles depending on the type of lesion. Treatment of these lesions may be different and, in recent years, new therapies have enabled an improvement in life expectancy.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86956959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

A Prokinetic Agent with a Dual Effect – Itopride – In the Treatment of Dysmotility 双效促动力剂——依托必利治疗运动障碍

EMJ. Gastroenterology Pub Date : 2014-12-03 DOI: 10.33590/emjgastroenterol/10314653

P. Dítě, M. Rydlo, M. Dockal, A. Martínek

引用次数: 0

Diagnostic Methods in Eosinophilic Oesophagitis: From Endoscopy to the Future 嗜酸性粒细胞性食管炎的诊断方法:从内镜到未来

EMJ. Gastroenterology Pub Date : 2014-12-03 DOI: 10.33590/emjgastroenterol/10311690

J. Rodríguez-Sánchez, B. López Viedma

引用次数: 0

The Management of Acute Upper Gastrointestinal Bleeding: A Comparison of Current Clinical Guidelines and Best Practice 急性上消化道出血的处理:当前临床指南和最佳实践的比较

EMJ. Gastroenterology Pub Date : 2014-12-03 DOI: 10.33590/emjgastroenterol/10314028

Alison Taylor, O. Redfern, M. Pericleous

{"title":"The Management of Acute Upper Gastrointestinal Bleeding: A Comparison of Current Clinical Guidelines and Best Practice","authors":"Alison Taylor, O. Redfern, M. Pericleous","doi":"10.33590/emjgastroenterol/10314028","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314028","url":null,"abstract":"Acute upper gastrointestinal bleeding (AUGIB) is the most common GI emergency, responsible for up to 70,000 hospital admissions in the UK and around 4,000 deaths. The latest UK national audit highlighted inconsistencies in both the management and service provision. Several national and international professional bodies have produced evidence-based recommendations on the management of AUGIB. We carried out a review of the guidance documentation published by four expert bodies including the National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network, the American College of Gastroenterology, and those published in the Annals of Internal Medicine. Consensus is still yet to be reached for initiating blood products in the emergency situation, with some evidence suggesting that liberal transfusion could exacerbate bleeding severity, although there is a lack of large randomised trials. It is widely agreed that prompt endoscopy within 24 hours improves outcomes, but evidence suggests that lowering this threshold confers no additional benefit. Use of proton pump inhibitors both pre and post-endoscopy for non-variceal bleeds is also advocated by professional bodies, with substantial evidence that it reduces the risk of re-bleeding. For patients with suspected oesophageal or gastric variceal bleeding, prophylactic antibiotics and vasopressin analogues are recommended, although guidelines vary on specific regimens. Recent UK and international guidelines provide a useful framework to guide management of patients who present to the emergency department with suspected AUGIB; however, their advice varies in some key areas due to a lack of large randomised trials as supporting evidence.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75628990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Highlights from the UEG Week Congress 2014: New Evidence and Novel Therapies for Irritable Bowel Syndrome 2014年UEG周大会亮点:肠易激综合征的新证据和新疗法

EMJ. Gastroenterology Pub Date : 2014-12-03 DOI: 10.33590/emjgastroenterol/10310342

C. Charles, E. Corazziari

{"title":"Highlights from the UEG Week Congress 2014: New Evidence and Novel Therapies for Irritable Bowel Syndrome","authors":"C. Charles, E. Corazziari","doi":"10.33590/emjgastroenterol/10310342","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310342","url":null,"abstract":"Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects up to 15% of the European and North American population, and is characterised by abdominal pain, bloating sensations, cramping, constipation, and diarrhoea. Main subtypes of IBS include constipation-predominant IBS (IBS-C), diarrhoea-predominant IBS (IBS-D), and mixed diarrhoea and constipation-associated IBS (IBS-M). The pathophysiology of IBS is still unclear, but important factors such as alterations in the brain-gut axis, bacterial overgrowth in the intestines, increased paracellular permeability, disruptions in the immune system, and accrued visceral sensitivity have been suggested. While many therapies are available to treat the symptoms associated with IBS, on a symptom-by-symptom basis, there are few effective treatments for IBS itself, including linaclotide, which was approved 2 years ago in Europe but only for IBS-C. Additional disease-modifying therapies to slow disease progression or achieve remission are needed as this represents a substantial unmet need. New emerging data on the pathophysiology of IBS are certainly promising; better knowledge of the underlying mechanisms will help refine the management of IBS, both in terms of diagnosis with the development of biomarkers, and in terms of therapeutic management with new pharmacological targets. Additional treatment options will be welcome given the variety of disease subtypes and presentations. The United European Gastroenterology (UEG) Week Congress, which was held in Vienna, Austria, 18th-22nd October 2014, was an excellent opportunity to share new findings on the pathophysiology and new clinical evidence and emerging therapies in the management of IBS. Selected abstracts received additional exposure through the “Posters in the Spotlight” session and the “Posters of Excellence” award; such abstracts will be developed in this review.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85331263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients 使用床边试验验证成人患者鼻胃管位置的风险

EMJ. Gastroenterology Pub Date : 2014-12-03 DOI: 10.33590/emjgastroenterol/10314375

M. Ni, O. Priest, L. Phillips, G. Hanna

{"title":"Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients","authors":"M. Ni, O. Priest, L. Phillips, G. Hanna","doi":"10.33590/emjgastroenterol/10314375","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314375","url":null,"abstract":"Nasogastric (NG) tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN) to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity) was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74891783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 15

Update on Barrett’s Oesophagus 巴雷特食道的最新进展

EMJ. Gastroenterology Pub Date : 2014-12-01 DOI: 10.33590/emjgastroenterol/10310225

C. Tarlarini, E. Grossi, S. Penco

{"title":"Update on Barrett’s Oesophagus","authors":"C. Tarlarini, E. Grossi, S. Penco","doi":"10.33590/emjgastroenterol/10310225","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310225","url":null,"abstract":"Barrett’s oesophagus (BO) is a precancerous lesion associated with the development of oesophageal adenocarcinoma (OAC). Although different types of metaplasia have been described in BO, only the presence of intestinal metaplasia with goblet cells seems to be indispensable for an accurate diagnosis. Surveillance in BO is still controversial and, to date, the endoscopic screening is recommended only for patients who have at least one risk factor for OAC in addition to chronic gastroesophageal reflux disease (GERD), including being 50 years of age, male gender, Caucasian ethnicity, hiatal hernia, increased body mass index, intra-abdominal distribution of fat, nocturnal reflux symptoms, and tobacco use. Moreover, genetic factors play an important and critical role in the development of BO. In particular, genes related to inflammation, DNA repair, and xenobiotic metabolism have been investigated. To date, relatively little is known about the mechanisms that confer susceptibility to BO carcinogenesis even though several risk factors, genetic and acquired, have been identified. Since BO is a complex disease we support the use of advanced intelligent systems to integrate all the variables involved in this complex pathology and in its progression to cancer. In this review we summarise some of the most interesting controversial topics about the diagnosis, pathogenesis, management, and treatment of BO.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"10 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72439537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-Surgical Therapy for Unresectable Hilar Cholangiocarcinoma 不可切除肝门胆管癌的非手术治疗

EMJ. Gastroenterology Pub Date : 2013-12-16 DOI: 10.33590/emjgastroenterol/10313433

M. Liberato, J. Canena

{"title":"Non-Surgical Therapy for Unresectable Hilar Cholangiocarcinoma","authors":"M. Liberato, J. Canena","doi":"10.33590/emjgastroenterol/10313433","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313433","url":null,"abstract":"Hilar cholangiocarcinoma (HCCA) is characterised by late clinical symptoms. As a consequence, most patients will not undergo surgery, and palliation is the main goal of therapy. For the few patients that undergo potentially curative surgery, the need for preoperative biliary drainage (PBD) continues to be debated and remains controversial, as there are many reports with conflicting results. For the palliation of unresectable HCCA, endoscopic or percutaneous transhepatic drainage (PTD) is typically preferred over surgical palliative resection. PTD can be useful in patients with altered anatomy, as a guide to endoscopic procedures (rendezvous technique), after failure of endotherapy or as a rescue\u0000therapy for the drainage of segments that have been opacified by endoscopy. Endoscopic palliative bile duct drainage can be performed with plastic stents (PSs) or self-expandable metal stents (SEMSs). Several studies have compared PSs and SEMSs for the palliation of HCCA, and all have been in favour of SEMS placement, which is associated with a lower number of reinterventions, superior cumulative stent patency and even improved survival. The optimal technique for endoscopic palliative metal stent placement and the benefits of bilateral versus unilateral stenting remain controversial and highly debated. Drainage of only 25-30% of the liver volume may be sufficient to ameliorate jaundice in most cases of HCCA. However, reports of bilateral drainage are associated with longer stent patency, lower reintervention rates and, perhaps, a better quality of life for patients. Furthermore, newly available stents may be associated with higher rates of technical success and increasing successful reintervention rates in bilateral stenting.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88094177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

A Review of Crohn’s Disease 克罗恩病的研究进展

EMJ. Gastroenterology Pub Date : 2013-12-16 DOI: 10.33590/emjgastroenterol/10311850

P. Hendy, A. Hart

{"title":"A Review of Crohn’s Disease","authors":"P. Hendy, A. Hart","doi":"10.33590/emjgastroenterol/10311850","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311850","url":null,"abstract":"Crohn’s disease is a chronic relapsing inflammatory bowel disease that may affect any part of the gastrointestinal tract. The ileum, colon, and perineum are most commonly affected. It is characterised by transmural inflammation, and granulomata may be present. Whilst the aetiology of Crohn’s disease is not completely understood, it is thought to be caused by the complex interplay between genetic, immunological, microbiological, and environmental factors. Current opinion is that, in genetically susceptible individuals, there is an immune dysregulation to an environmental factor, and the intestinal microbiota plays a central role. Genetic studies of patients with Crohn’s disease have found several gene mutations which affect the innate immune system. Two important mutations contributing towards the pathogenesis of Crohn’s disease are Nucleotide-binding oligomerisation domain-containing protein 2 (NOD2) and autophagyrelated 16-like 1 (ATG16L1). The most common symptoms of Crohn’s disease are diarrhoea, abdominal pain, weight loss, and fatigue. Symptoms reflect the site and behaviour of disease, and the presence or absence of strictures and fistulae. Extraintestinal manifestations may be present and typically affect the eyes, skin, joints, or biliary tree. Investigations are performed to map the disease location, assess disease severity, and survey for complications of the disease or treatment. Management is with smoking cessation, steroids, immunomodulators, anti-tumour necrosis factor (TNF) therapy, or surgery.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74536935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Managing Ulcerative Colitis: The Guidelines and Beyond 溃疡性结肠炎的管理:指南及其他

EMJ. Gastroenterology Pub Date : 2013-12-16 DOI: 10.33590/emjgastroenterol/10312665

M. R. Lie, C. J. van der Woude

引用次数: 0