BACKGROUND Eosinophilic gastroenteritis(EGE)is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract.Glucocorticoids remain the most common treatment method.However,disease ...BACKGROUND Eosinophilic gastroenteritis(EGE)is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract.Glucocorticoids remain the most common treatment method.However,disease relapse and glucocorticoid dependence remain notable problems.To date,few studies have illuminated the prognosis of EGE and risk factors for disease relapse.AIM To describe the clinical characteristics of EGE and possible predictive factors for disease relapse based on long-term follow-up.METHODS This was a retrospective cohort study of 55 patients diagnosed with EGE admitted to one medical center between 2013 and 2022.Clinical records were collected and analyzed.Kaplan-Meier curves and log-rank tests were conducted to reveal the risk factors for long-term relapse-free survival(RFS).RESULTS EGE showed a median onset age of 38 years and a slight female predominance(56.4%).The main clinical symptoms were abdominal pain(89.1%),diarrhea(61.8%),nausea(52.7%),distension(49.1%)and vomiting(47.3%).Forty-three(78.2%)patients received glucocorticoid treatment,and compared with patients without glucocorticoid treatments,they were more likely to have elevated serum immunoglobin E(IgE)(86.8%vs 50.0%,P=0.022)and descending duodenal involvement(62.8%vs 27.3%,P=0.046)at diagnosis.With a median follow-up of 67 mo,all patients survived,and 56.4%had at least one relapse.Six variables at baseline might have been associated with the overall RFS rate,including age at diagnosis<40 years[hazard ratio(HR)2.0408,95%confidence interval(CI):1.0082–4.1312,P=0.044],body mass index(BMI)>24 kg/m^(2)(HR 0.3922,95%CI:0.1916-0.8027,P=0.014),disease duration from symptom onset to diagnosis>3.5 mo(HR 2.4725,95%CI:1.220-5.0110,P=0.011),vomiting(HR 3.1259,95%CI:1.5246-6.4093,P=0.001),total serum IgE>300 KU/L at diagnosis(HR 0.2773,95%CI:0.1204-0.6384,P=0.022)and glucocorticoid treatment(HR 6.1434,95%CI:2.8446-13.2676,P=0.003).CONCLUSION In patients with EGE,younger onset age,longer disease course,vomiting and glucocorticoid treatment were risk factors for disease relapse,whereas higher BMI and total IgE level at baseline were protective.展开更多
BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis an...BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.展开更多
BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To ex...BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To explore the clinical characteristics,treatment patterns,and short-term outcomes in CEG patients in China.METHODS We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology.Patients and treating physicians completed a questionnaire regarding history,endoscopic findings,and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment.RESULTS Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included.Epigastric pain(68.0%),abdominal distension(62.6%),and postprandial fullness(47.5%)were the most common presenting symptoms.Gastritis was classified as chronic non-atrophic in 69.9%of patients.Among those with erosive lesions,72.1%of patients had lesions in the antrum,51.0%had multiple lesions,and 67.3%had superficial flat lesions.In patients with epigastric pain,the combination of a mucosal protective agent(MPA)and proton pump inhibitor was more effective.For those with postprandial fullness,acid regurgitation,early satiety,or nausea,a MPA appeared more promising.CONCLUSION CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms.Gastroscopy may play a major role in its detection and diagnosis.Treatment should be individualized based on symptom profile.展开更多
AIM To investigate the effects of VSL#3 on tumor formation, and fecal and intestinal mucosal microbiota in azoxymethane/dextran sulfate sodium(AOM/DSS) induced mice model. METHODS C57 BL/6 mice were administered AOM/D...AIM To investigate the effects of VSL#3 on tumor formation, and fecal and intestinal mucosal microbiota in azoxymethane/dextran sulfate sodium(AOM/DSS) induced mice model. METHODS C57 BL/6 mice were administered AOM/DSS to develop the ulcerative colitis(UC) carcinogenesis model. Mice were treated with 5-ASA(75 mg/kg/d), VSL#3(1.5 × 109 CFU/d), or 5-ASA combined with VSL#3 by gavage from the day of AOM injection for three months(five days/week). The tumor load was compared in each group, and tumor necrosis factor(TNF-α) and interleukin(IL)-6 levels were evaluated in colon tissue. The stool and intestinal mucosa samples were collected to analyze the differences in the intestinal microbiota by 16 s rDNA sequencing method.RESULTS VSL#3 significantly reduced the tumor load in AOM/DSS-induced mice model and decreased the level of TNF-α and IL-6 in colon tissue. The model group had a lower level of Lactobacillus and higher level of Oscillibacter and Lachnoclostridium in fecal microbiota than the control group. After the intervention with 5-ASA and VSL#3, Bacillus and Lactococcus were increased, while Lachnoclostridium and Oscillibacter were reduced. 5-ASA combined with VSL#3 increased the Lactobacillus and decreased the Oscillibacter. The intestinal mucosal microbiota analysis showed a lower level of Bifidobacterium and Ruminococcaceae_UCG-014 and higher level of Al oprevotel a in the model group as compared to the control group. After supplementation with VSL#3, Bifidobacterium was increased. 5-ASA combined with VSL#3 increased the level of both Lachnoclostridium and Bifidobacterium. CONCLUSION VSL#3 can prevent UC-associated carcinogenesis in mice, reduce the colonic mucosal inflammation levels, and rebalance the fecal and mucosal intestinal microbiota.展开更多
BACKGROUND Dysbacteriosis may be a crucial environmental factor for ulcerative colitis(UC).Further study is required on microbiota alterations in the gastrointestinal tract of patients with UC for better clinical mana...BACKGROUND Dysbacteriosis may be a crucial environmental factor for ulcerative colitis(UC).Further study is required on microbiota alterations in the gastrointestinal tract of patients with UC for better clinical management and treatment.AIM To analyze the relationship between different clinical features and the intestinal microbiota,including bacteria and fungi,in Chinese patients with UC.METHODS Eligible inpatients were enrolled from January 1,2018 to June 30,2019,and stool and mucosa samples were collected.UC was diagnosed by endoscopy,pathology,Mayo Score,and Montreal classification.Gene amplicon sequencing of 16S rRNA gene and fungal internal transcribed spacer gene was used to detect the intestinal microbiota composition.Alpha diversity,principal component analysis,similarity analysis,and Metastats analysis were employed to evaluate differences among groups.RESULTS A total of 89 patients with UC and 33 non-inflammatory bowel disease(IBD)controls were enrolled.For bacterial analysis,72 stool and 48 mucosa samples were obtained from patients with UC and 21 stool and 12 mucosa samples were obtained from the controls.For fungal analysis,stool samples were obtained from 43 patients with UC and 15 controls.A significant difference existed between the fecal and mucosal bacteria of patients with UC.Theα-diversity of intestinal bacteria and the relative abundance of some families,such as Lachnospiraceae and Ruminococcaceae,decreased with the increasing severity of bowel inflammation,while Escherichia-Shigella showed the opposite trend.More intermicrobial correlations in UC in remission than in active patients were observed.The bacteriafungi correlations became single and uneven in patients with UC.CONCLUSION The intestinal bacteria flora of patients with UC differs significantly in terms of various sample types and disease activities.The intermicrobial correlations change in patients with UC compared with non-IBD controls.展开更多
Objective While the upregulation of cytochrome P450 family 24 subfamily A member 1(CYP24A1)gene expression has been reported in colon cancer,its role in tumorigenesis remains largely unknown.In this study,we aimed to ...Objective While the upregulation of cytochrome P450 family 24 subfamily A member 1(CYP24A1)gene expression has been reported in colon cancer,its role in tumorigenesis remains largely unknown.In this study,we aimed to investigate the involvement of CYP24A1 in Wnt pathway regulation via the nuclear factor kappa B(NF-κB)pathway.Methods The human colon cancer cell lines HCT-116 and Caco-2 were subjected to stimulation with interleukin-6(IL-6)as well as tumor necrosis factor alpha(TNF-α),with subsequent treatment using the NF-κB pathway-specific inhibitor ammonium pyrrolidinedithiocarbamate(PDTC).Furthermore,CYP24A1 expression was subjected to knockdown via the use of small interfering RNA(siRNA).Subsequently,NF-κB pathway activation was determined by an electrophoretic mobility shift assay,and the transcriptional activity ofβ-catenin was determined by a dual-luciferase reporter assay.A mouse ulcerative colitis(UC)-associated carcinogenesis model was established,wherein TNF-αand the NF-κB pathway were blocked by anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides,respectively.Then the tumor size and protein level of CYP24A1 were determined.Results IL-6 and TNF-αupregulated CYP24A1 expression and activated the NF-κB pathway in colon cancer cells.PDTC significantly inhibited this increase in CYP24A1 expression.Additionally,knockdown of CYP24A1 expression by siRNA could partially antagonize Wnt pathway activation.Upregulated CYP24A1 expression was observed in the colonic epithelial cells of UC-associated carcinoma mouse models.Anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides decreased the tumor size and suppressed CYP24A1 expression.Conclusion Taken together,this study suggests that inflammatory factors may increase CYP24A1 expression via NF-κB pathway activation,which in turn stimulates Wnt signaling.展开更多
BACKGROUND Giant simple hepatic cysts causing intrahepatic duct dilatation and obstructive jaundice are uncommon.A variety of measures with different clinical efficacies and invasiveness have been developed.Nonsurgica...BACKGROUND Giant simple hepatic cysts causing intrahepatic duct dilatation and obstructive jaundice are uncommon.A variety of measures with different clinical efficacies and invasiveness have been developed.Nonsurgical management,such as percutaneous aspiration and sclerotherapy,is often applied.CASE SUMMARY The case is a 39-year-old female with a 5-mo history of cutaneous and scleral icterus,loss of appetite,and dark urine.Lab tests showed jaundice and liver function abnormalities.Imaging revealed a giant simple hepatic cyst obstructing the intrahepatic bile ducts.A combination of percutaneous catheter aspiration and lauromacrogol sclerotherapy was successfully performed and the effects were satisfactory with the size of cyst decreasing from 13.7 cm×13.1 cm to 3.0 cm×3.0 cm.Further literature review presented the challenges of managing giant simple hepatic cysts that cause obstructive jaundice and compared the safety and efficacy of a combination of percutaneous aspiration and lauromacrogol sclerotherapy with other management strategies.CONCLUSION Giant simple hepatic cysts can cause obstructive jaundice,and a combination of percutaneous catheter aspiration and sclerotherapy with lauromacrogol are suggested to treat such cases.展开更多
AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these gen...AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these genetic polymorphisms and the three diseases. METHODS We evaluated genetic polymorphisms in 144 newly diagnosed colonic polyp patients,96 colon cancer patients and 44 ulcerative colitis patients. The four SNPs genotyped were rs4809957,rs6068816,rs6091822 and rs8124792. The control group consisted of 504 East Asians enrolled in the 1000 Genomes Project. Correlations between CYP24A1 SNPs and the diseases were analyzed by Fisher's exact probability test.RESULTS CYP24A1 polymorphisms rs4809957 A/G and rs6068816 C/T showed a statistically significant association with risk of the three diseases,when both the genotypes and allele frequencies were considered. With regard to rs6091822 G/T,all three diseases were related to risk allele carriers(GT + TT) vs wild-type(GG),but the associations between the allele frequencies and the diseases were not significant. The risk of colonic polyps and colon cancer was related to the allele frequencies of rs8124792 G/A,and this association remained for genotype frequencies of this SNP. CONCLUSION Four SNPs are related to the risk of colonic polyps and colon cancer. G allele in rs6091822 G/T may play an anti-cancer role only if it is homozygous. The A allele,which is a minor component of rs8124792,may be indicated in the diagnosis of colonic polyps or colon cancer rather than ulcerative colitis.展开更多
Human cytomegalovirus(CMV) is a herpesvirus,which establishes lifelong latency after primary infection and leads to severe disease in immunocompromised patients. However,CMV infection in immunocompetent patients is us...Human cytomegalovirus(CMV) is a herpesvirus,which establishes lifelong latency after primary infection and leads to severe disease in immunocompromised patients. However,CMV infection in immunocompetent patients is usually asymptomatic and severe organ damage is rarely reported. We report a case of severe CMV hepatitis in an immunocompetent patient presenting with cholestasis,portal hypertensionrelated ascites and pancytopenia. The patient was asymptomatic with normal liver function and negative CMV DNA after two weeks of antiviral therapy. This case is an example of a common infection with an uncommon presentation,and suggests that testing for CMV should be carried out,even in patients with normal immune status,presenting with severe liver damage or cholestasis.展开更多
Background:Imbalance of intestinal microbiota was closely related to colitis.Under these circumstances,regulation of enteric flora may be beneficial to the repair of inflammation.We aimed to investigate the effects of...Background:Imbalance of intestinal microbiota was closely related to colitis.Under these circumstances,regulation of enteric flora may be beneficial to the repair of inflammation.We aimed to investigate the effects of probiotics (Bifidobacterium and Lactobacillus),prebiotics and their combination on inflammation,and microflora in mice of acute colitis.Methods:C57BL/6J mice were divided into six groups randomly (blank control group,model control group,probiotics group,synbiotics group,lactitol group and probiotics + lactitol group).Each group was given 2.5% dextran sulfate sodium drinking water for 5 days other than the blank control group.Except for the model control group,the other four groups were intervened with probiotics,synbiotics (probiotics and inulin),lactitol,and probiotics + lactitol.Mice were sacrificed after 1 week of gavage,and pathologic scores were calculated.The feces of different periods and intestinal mucosa samples were collected to analyze the differences of intestinal microbiota by 16S rRNA sequencing.Differences of two groups or multiple groups were statistically examined through unpaired Student t test and analysis of variance (ANOVA),respectively.ANOVA,Tukey,Anosim,and metastats analysis were used to compare differences of microbiota among different groups.Results:After gavage for 1 week,the pathologic scores of groups with the intervention were significantly lower than those in the model control group,and the difference was statistically significant (P < 0.05).The model control group was higher in the genus of Bacteroides (relative abundance:0.3679 vs.0.0099,P =0.0016) and lower in Lactobacillus (relative abundance:0.0020 vs.0.0122,P =0.0188),Roseburia (relative abundance:0.0004 vs.0.0109,P =0.0157),compared with the blank control group.However,the same phenomenon was not found in groups gavaged with probiotics and lactitol.Compared with model control group,mice with intervention were increased with Bifidobacterium (relative abundance:0.0172 vs.0.0039,P =0.0139),Lachnospiraceae_NK4A136_group (relative abundance:0.1139 vs.0.0320,P =0.0344),Lachnospiraceae_UCG-006 (relative abundance:0.0432 vs.0.0054,P =0.0454),and decreased with Alistipes (relative abundance:0.0036 vs.0.0105,P =0.0207) in varying degrees.The mucosal flora was more abundant than the fecal flora,and genus of Mucispirillum (relative abundance:0.0207 vs.0.0001,P =0.0034) was more common in the mucosa.Lactitol group showed higher level of Akkermansia than model control group (relative abundance:0.0138 vs.0.0055,P =0.0415),probiotics group (relative abundance:0.0138 vs.0.0022,P =0.0041),and synbiotics group (relative abundance:0.0138 vs.0.0011,P =0.0034),while probiotics + lactitol group had more abundant Akkermansia than synbiotics group (relative abundance:0.0215 vs.0.0013,P =0.0315).Conclusions:Probiotics and prebiotics reduce the degree of inflammation in acute colitis mice obviously.Mice with acute colitis show reduced beneficial genera and increased harmful genera.Supplementation of probiotics and prebiotics display the advantage of increasing the proportion of helpful bacteria and regulating the balance of intestinal microbiota.Lactitol might promote the proliferation of Akkermansia.展开更多
Background： Clarifying the risk factors for postoperative complications and taking measures to minimize these complications will improve the outcomes in patients with ulcerative colitis （UC）.This study aimed to sys...Background： Clarifying the risk factors for postoperative complications and taking measures to minimize these complications will improve the outcomes in patients with ulcerative colitis （UC）.This study aimed to systemically explore the risk factors for short-term postoperative complications in Chinese UC patients undergoing ileocolorectal surgery.Methods： Forty-nine UC patients undergoing proctocolectomy or ileostomy were retrospectively enrolled.Univariate and multivariate logistic regression analyses were conducted to reveal the risk factors among the clinical, laboratory, and surgical variables as well as preoperative medications.Results： Twenty-two （44.9%） patients who suffered from at least one short-term postoperative event had more severe hypoalbuminemia （P =0.007） and an increased prevalence of preoperative corticosteroid usage （prednisone more than 20 mg daily or equivalent） for more than 6 weeks （59.1% vs.25.9%, P =0.023） compared with patients without short-term postoperative complications.Based on the multivariate logistic regression analysis, the odds ratio （95% confidence interval） values of these two risk factors were 1.756 （0.889-3.470, P =0.105） and 3.233 （0.916-11.406, P =0.068）, respectively.In 32 severe UC patients, prolonged preoperative hospital stay worsened the short-term postoperative outcomes.Conclusions： Preoperative corticosteroids usage and hypoalbuminemia worsened the short-term outcomes following ileocolorectal surgery in Chinese UC patients.展开更多
Celiac disease (CD),once considered a gastrointestinal condition,is now known as a systemic autoimmune disease initiated by exposure to dietary gluten mainly in human leukocyte antigen DQ2 (HLA-DQ2) or HLA-DQ8 carrier...Celiac disease (CD),once considered a gastrointestinal condition,is now known as a systemic autoimmune disease initiated by exposure to dietary gluten mainly in human leukocyte antigen DQ2 (HLA-DQ2) or HLA-DQ8 carriers.The classic presentations of CD include intestinal manifestations such as chronic diarrhea,bloating,abdominal pain,constipation,weight loss,or poor growth in children.Iron-deficiency,osteoporosis,and neuropathy attributable to vitamin B12 deficiency is also frequently seen in celiac patients.Immune responses spreading to tissues apart from the intestine cause dermatologic conditions such as dermatitis herpetiformis,and even increased risk of miscarriage in women.展开更多
Background:Colorectal cancer(CRC)has become one of the major life-threatening complications in patients with inflammatory bowel disease(IBD),which includes ulcerative colitis(UC)and Crohn's disease(CD).This study ...Background:Colorectal cancer(CRC)has become one of the major life-threatening complications in patients with inflammatory bowel disease(IBD),which includes ulcerative colitis(UC)and Crohn's disease(CD).This study aimed to explore the clinicalpathologic similarities and differences in the IBD-associ吐ed CRC(IBD-CRC)between patients in China and Canada.Methods:Data of 78 patients with IBD-CRC retrospectively retrieved from two representative medical institutions in Beijing(China)and Calgary(Canada)over the same past 13 years,including 25(22 UC-associated and three CD-associated)from Beijing group and 53(32 UC-associated and 21 CD-associated)from Calgary group,were compared with regards to their clinical and pathologic characteristics.Results:Several known features of IBD-CRC were seen in both groups,including long duration and large extent of colitis,active inflammation background,multifocal lesions,and advanced tumor-node-metastasis stage.Beijing group showed a significantly higher percentage of UC(88.0%vs.60.4%,P=0.018),younger age at diagnosis of CRC(48.6±12.8 years vs.61.6±14.7 years,P<0.001),lower ratio of mucinous adenocarcinoma(7.1%us.42.4%,P=0.001)compared with Calgary group.None of the Beijing group had concurrent primary sclerosing cholangitis,while 5.7%of Calgary group did.Surveillance colonoscopy favored the detection rate of precancerous lesions(41.4%vs.17.0%,P=0.002).Conclusions:As compared with patients from the Calgary group,the IBD-CRC patients in Beijing group were younger,less CDassociated and had less mucinous features,otherwise they were similar in many common features.展开更多
Background:Data from single-center experience or small sample-sized studies have shown that chromoendoscopy(CE)might be superior to white-light endoscopy(WLE)for dysplasia surveillance in ulcerative colitis(UC)patient...Background:Data from single-center experience or small sample-sized studies have shown that chromoendoscopy(CE)might be superior to white-light endoscopy(WLE)for dysplasia surveillance in ulcerative colitis(UC)patients.We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies(WLT),WLE with random biopsies(WLR),and dye-based CE with targeted biopsies(CET)in UC patients.Methods:Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms(WLT,WLR,and CET).Only high-definition endoscopy was used in all three groups.The patients were followed up by annual endoscopy with biopsies through December 2017.Results:With a median follow-up time of 55 months,a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set:WLT(n=43),WLR(n=40),and CET(n=39).A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients.WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT(8.1%and 9.7%vs 1.9%;P=0.014 and 0.004,respectively).WLR obtained more biopsied samples than WLT and CET(16.465.1 vs 4.361.4 and 4.361.4;both P<0.001).During the second half of the follow-up(37-69 months),CET could identify more colonoscopies that diagnosed dysplasia than WLT(13.3%vs 1.6%,P=0.015)and showed a trend for increasing the detection rate compared with WLR(13.3%vs 4.9%,P=0.107).Conclusions:For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC,CET appeared to be more effective thanWLT and less tedious than WLR.CET was found to be particularly useful when a long-term(>3 years)follow-up was conducted for dysplasia surveillance.The trial was registered on www.chictr.org.cn(ChiCTR1900023689).展开更多
The homeostasis of the gut-brain axis has been shown to exert several effects on physiological and psychological health.The gut hormones released by enteroendocrine cells scattered throughout the gastrointestinal trac...The homeostasis of the gut-brain axis has been shown to exert several effects on physiological and psychological health.The gut hormones released by enteroendocrine cells scattered throughout the gastrointestinal tract are important signaling molecules within the gut-brain axis.The interaction between gut microbiota and gut hormones has been greatly appreciated in gut-brain cross-talk.The microbiota plays an essential role in modulating many gut-brain axis-related diseases,ranging from gastrointestinal disorders to psychiatric diseases.Similarly,gut hormones also play pleiotropic and important roles in maintaining health,and are key signals involved in gut-brain axis.More importantly,gut microbiota can affect the release and functions of gut hormones.This review highlights the role of gut microbiota in the gut-brain axis and focuses on how microbiota-related gut hormones modulate various physiological functions.Future studies could target the microbiota-hormones-gut brain axis to develop novel therapeutics for different psychiatric and gastrointestinal disorders,such as obesity,anxiety,and depression.展开更多
The human gastrointestinal tract accommodates an entire micro-environment for divergent physiologic processes,the dysbiosis of this micro-ecology has a strong inter-action with the pathogenesis of inflammatory bowel d...The human gastrointestinal tract accommodates an entire micro-environment for divergent physiologic processes,the dysbiosis of this micro-ecology has a strong inter-action with the pathogenesis of inflammatory bowel disease(IBD).In the past few years,with the advances in the understanding of microbiome,its metabolites and further application of next generation sequencing,analysis of dynamic alteration of gut micro-environment was realized,which provides numerous information beyond simple microbiota structure or metabolites differences under chronic colitis status.The subsequent intervention strategies targeting the modulation of intestinal micro-environment have been explored as a potential therapy.In this review,we will summarize the recent knowledge about multi-dimensional dysbiosis,the inter-action between fungus and bacteria under inflamed mucosa,and the clinical application of probiotics and fecal microbiota transplantation as a promising therapeutic approach in IBD.展开更多
Injection sclerotherapy is most effective for internal hemorrhoids,especially for patients with bleeding.Howev-er,traditional sclerotherapy via anoscope may cause iatrogenic risk and complications due to misplaced inj...Injection sclerotherapy is most effective for internal hemorrhoids,especially for patients with bleeding.Howev-er,traditional sclerotherapy via anoscope may cause iatrogenic risk and complications due to misplaced injections.[1]The flexible endoscopic sclerotherapy for internal hemorrhoids using a short needle without cap assistant was first reported in 1991 in the United States.[2]The flexible endoscopic injection using a short needle with cap assistant was reported in 2014 in Japan.[3]Cap-assisted endoscopic sclerotherapy(CAES)primarily using a long needle was reported in 2015[4]as an emerging flexible endoscopic therapy,and has been widely used for internal hemorrhoids and some prolapse in China.A panel of experts aimed to develop expert recommendations for CAES and derived guidelines on the key issues in hemorrhoidal disease,including rationale,new positioning methods for anus,indications,contraindications,techniques,post-procedure management,and core outcome set for evaluation[Figure 1].展开更多
Colorectal cancer(CRC)is the third most commonly diagnosed malignant tumor in the world.The past few years have seen a remarkable increase in both incidence and mortality of CRC in developing countries like China,posi...Colorectal cancer(CRC)is the third most commonly diagnosed malignant tumor in the world.The past few years have seen a remarkable increase in both incidence and mortality of CRC in developing countries like China,posing a serious threat to human health.It is currently believed that about 70%of colorectal cancers are derived from conventional adenomas and 30%are derived from serrated adenomas.[1]As reported,CRC incidence rates per 10,000 person-years were 20.0 for advanced adenoma and 9.1 for non-advanced adenoma.[2]Colonoscopy,as an important tool for CRC screening and follow-up,can prevent the development of CRC by detecting and removing precancerous lesions,thereby effectively reducing the incidence and mortality.Current guidelines for post-polypectomy surveillance mostly recommend a 3-to 10-year interval according to baseline risk stratification.[3]However,there is no such guideline in China yet and doctors tend to perform the next colonoscopy within 1 year,which is much shorter than current international recommendations.展开更多
Background： Overexpression and constitutive activation of signal transducer and activator of transcription （STAT） 3 have been suggested in the tumorigenesis of many human cancers, including multiple carcinomas, mel...Background： Overexpression and constitutive activation of signal transducer and activator of transcription （STAT） 3 have been suggested in the tumorigenesis of many human cancers, including multiple carcinomas, melanoma, and lymphoma. The diagnosis ofhepatocellular carcinoma （HCC） in lobectomy specimens is usually straightforward, but distinguishing cirrhosis from well-differentiated HCC can be challenging in core biopsies. Our aims were to investigate the expression level of STAT3 and phosphorylated STAT3 （pSTAT3） in HCC and cirrhosis, and the application of STAT3 in the differential diagnosis of HCC and cirrhosis. Methods： Sixty cases were divided into three groups： patients with HCC only （Group 1）, HCC and cirrhosis （Group 2）, and cirrhosis only （Group 3）. Formalin-fixed and paraffin-embedded tissue sections were stained immunohistochemically for STAT3, pSTAT3, and CD163. The values obtained from the tissue sections of each group were compared in statistical analysis. Results： STAT3 showed a high level in HCC and was a significant marker for differentiating HCC from cirrhosis （P 〈 0.0001 ）. The odds ratio between HCC and cirrhosis increased 34.4 times when the intensity of STAT3 increased by 1 level. Spearman＇s correlation and Chi-square tests also demonstrated that expression level of STAT3 did not correlate with age, gender, or the presence of a cirrhotic background. Conclusions： STAT3 staining differs significantly in HCC and cirrhosis. The findings reinforce the role of STAT3 in the tumorigenesis of HCC and provide a useful marker to differentiate HCC from cirrhosis in challenging liver biopsies.展开更多
基金National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-022CAMS Innovation Fund for Medical Sciences,No.CIFMS 2021-1-I2M-003and Undergraduate Innovation Program,No.2023zglc06076.
文摘BACKGROUND Eosinophilic gastroenteritis(EGE)is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract.Glucocorticoids remain the most common treatment method.However,disease relapse and glucocorticoid dependence remain notable problems.To date,few studies have illuminated the prognosis of EGE and risk factors for disease relapse.AIM To describe the clinical characteristics of EGE and possible predictive factors for disease relapse based on long-term follow-up.METHODS This was a retrospective cohort study of 55 patients diagnosed with EGE admitted to one medical center between 2013 and 2022.Clinical records were collected and analyzed.Kaplan-Meier curves and log-rank tests were conducted to reveal the risk factors for long-term relapse-free survival(RFS).RESULTS EGE showed a median onset age of 38 years and a slight female predominance(56.4%).The main clinical symptoms were abdominal pain(89.1%),diarrhea(61.8%),nausea(52.7%),distension(49.1%)and vomiting(47.3%).Forty-three(78.2%)patients received glucocorticoid treatment,and compared with patients without glucocorticoid treatments,they were more likely to have elevated serum immunoglobin E(IgE)(86.8%vs 50.0%,P=0.022)and descending duodenal involvement(62.8%vs 27.3%,P=0.046)at diagnosis.With a median follow-up of 67 mo,all patients survived,and 56.4%had at least one relapse.Six variables at baseline might have been associated with the overall RFS rate,including age at diagnosis<40 years[hazard ratio(HR)2.0408,95%confidence interval(CI):1.0082–4.1312,P=0.044],body mass index(BMI)>24 kg/m^(2)(HR 0.3922,95%CI:0.1916-0.8027,P=0.014),disease duration from symptom onset to diagnosis>3.5 mo(HR 2.4725,95%CI:1.220-5.0110,P=0.011),vomiting(HR 3.1259,95%CI:1.5246-6.4093,P=0.001),total serum IgE>300 KU/L at diagnosis(HR 0.2773,95%CI:0.1204-0.6384,P=0.022)and glucocorticoid treatment(HR 6.1434,95%CI:2.8446-13.2676,P=0.003).CONCLUSION In patients with EGE,younger onset age,longer disease course,vomiting and glucocorticoid treatment were risk factors for disease relapse,whereas higher BMI and total IgE level at baseline were protective.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-022 and No.2022-PUMCH-D-002CAMS Innovation Fund for Medical Sciences,No.2021-1-I2M-003+1 种基金Undergraduate Innovation Program,No.2023-zglc-06034National Key Clinical Specialty Construction Project,No.ZK108000。
文摘BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.
基金the National Key Clinical Specialty Construction Project,No.ZK108000CAMS Innovation Fund for Medical Sciences,No.2021-I2M-C&T-A-001 and No.2022-I2M-C&T-B-012.
文摘BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To explore the clinical characteristics,treatment patterns,and short-term outcomes in CEG patients in China.METHODS We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology.Patients and treating physicians completed a questionnaire regarding history,endoscopic findings,and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment.RESULTS Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included.Epigastric pain(68.0%),abdominal distension(62.6%),and postprandial fullness(47.5%)were the most common presenting symptoms.Gastritis was classified as chronic non-atrophic in 69.9%of patients.Among those with erosive lesions,72.1%of patients had lesions in the antrum,51.0%had multiple lesions,and 67.3%had superficial flat lesions.In patients with epigastric pain,the combination of a mucosal protective agent(MPA)and proton pump inhibitor was more effective.For those with postprandial fullness,acid regurgitation,early satiety,or nausea,a MPA appeared more promising.CONCLUSION CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms.Gastroscopy may play a major role in its detection and diagnosis.Treatment should be individualized based on symptom profile.
基金Supported by the National Natural Science Foundation of China,No.81370500 and No.81770559
文摘AIM To investigate the effects of VSL#3 on tumor formation, and fecal and intestinal mucosal microbiota in azoxymethane/dextran sulfate sodium(AOM/DSS) induced mice model. METHODS C57 BL/6 mice were administered AOM/DSS to develop the ulcerative colitis(UC) carcinogenesis model. Mice were treated with 5-ASA(75 mg/kg/d), VSL#3(1.5 × 109 CFU/d), or 5-ASA combined with VSL#3 by gavage from the day of AOM injection for three months(five days/week). The tumor load was compared in each group, and tumor necrosis factor(TNF-α) and interleukin(IL)-6 levels were evaluated in colon tissue. The stool and intestinal mucosa samples were collected to analyze the differences in the intestinal microbiota by 16 s rDNA sequencing method.RESULTS VSL#3 significantly reduced the tumor load in AOM/DSS-induced mice model and decreased the level of TNF-α and IL-6 in colon tissue. The model group had a lower level of Lactobacillus and higher level of Oscillibacter and Lachnoclostridium in fecal microbiota than the control group. After the intervention with 5-ASA and VSL#3, Bacillus and Lactococcus were increased, while Lachnoclostridium and Oscillibacter were reduced. 5-ASA combined with VSL#3 increased the Lactobacillus and decreased the Oscillibacter. The intestinal mucosal microbiota analysis showed a lower level of Bifidobacterium and Ruminococcaceae_UCG-014 and higher level of Al oprevotel a in the model group as compared to the control group. After supplementation with VSL#3, Bifidobacterium was increased. 5-ASA combined with VSL#3 increased the level of both Lachnoclostridium and Bifidobacterium. CONCLUSION VSL#3 can prevent UC-associated carcinogenesis in mice, reduce the colonic mucosal inflammation levels, and rebalance the fecal and mucosal intestinal microbiota.
基金Supported by the 13th Five-Year Plan for National Key R&D Program of China,No.2018YFC1705402National Natural Science Foundation of China,No.81770559 and No.81370500.
文摘BACKGROUND Dysbacteriosis may be a crucial environmental factor for ulcerative colitis(UC).Further study is required on microbiota alterations in the gastrointestinal tract of patients with UC for better clinical management and treatment.AIM To analyze the relationship between different clinical features and the intestinal microbiota,including bacteria and fungi,in Chinese patients with UC.METHODS Eligible inpatients were enrolled from January 1,2018 to June 30,2019,and stool and mucosa samples were collected.UC was diagnosed by endoscopy,pathology,Mayo Score,and Montreal classification.Gene amplicon sequencing of 16S rRNA gene and fungal internal transcribed spacer gene was used to detect the intestinal microbiota composition.Alpha diversity,principal component analysis,similarity analysis,and Metastats analysis were employed to evaluate differences among groups.RESULTS A total of 89 patients with UC and 33 non-inflammatory bowel disease(IBD)controls were enrolled.For bacterial analysis,72 stool and 48 mucosa samples were obtained from patients with UC and 21 stool and 12 mucosa samples were obtained from the controls.For fungal analysis,stool samples were obtained from 43 patients with UC and 15 controls.A significant difference existed between the fecal and mucosal bacteria of patients with UC.Theα-diversity of intestinal bacteria and the relative abundance of some families,such as Lachnospiraceae and Ruminococcaceae,decreased with the increasing severity of bowel inflammation,while Escherichia-Shigella showed the opposite trend.More intermicrobial correlations in UC in remission than in active patients were observed.The bacteriafungi correlations became single and uneven in patients with UC.CONCLUSION The intestinal bacteria flora of patients with UC differs significantly in terms of various sample types and disease activities.The intermicrobial correlations change in patients with UC compared with non-IBD controls.
基金supported by grants from the National Natural Science Foundation of China(No.81370500 and No.81770559)CAMS Innovation Fund for Medical Sciences(No.CIFMS2021-I2M-C&T-A-001 and No.2016-I2M-3-005)the CAMS Initiative for Innovative Medicine(No.CAMS-a12M 2016-I2M-1-007).
文摘Objective While the upregulation of cytochrome P450 family 24 subfamily A member 1(CYP24A1)gene expression has been reported in colon cancer,its role in tumorigenesis remains largely unknown.In this study,we aimed to investigate the involvement of CYP24A1 in Wnt pathway regulation via the nuclear factor kappa B(NF-κB)pathway.Methods The human colon cancer cell lines HCT-116 and Caco-2 were subjected to stimulation with interleukin-6(IL-6)as well as tumor necrosis factor alpha(TNF-α),with subsequent treatment using the NF-κB pathway-specific inhibitor ammonium pyrrolidinedithiocarbamate(PDTC).Furthermore,CYP24A1 expression was subjected to knockdown via the use of small interfering RNA(siRNA).Subsequently,NF-κB pathway activation was determined by an electrophoretic mobility shift assay,and the transcriptional activity ofβ-catenin was determined by a dual-luciferase reporter assay.A mouse ulcerative colitis(UC)-associated carcinogenesis model was established,wherein TNF-αand the NF-κB pathway were blocked by anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides,respectively.Then the tumor size and protein level of CYP24A1 were determined.Results IL-6 and TNF-αupregulated CYP24A1 expression and activated the NF-κB pathway in colon cancer cells.PDTC significantly inhibited this increase in CYP24A1 expression.Additionally,knockdown of CYP24A1 expression by siRNA could partially antagonize Wnt pathway activation.Upregulated CYP24A1 expression was observed in the colonic epithelial cells of UC-associated carcinoma mouse models.Anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides decreased the tumor size and suppressed CYP24A1 expression.Conclusion Taken together,this study suggests that inflammatory factors may increase CYP24A1 expression via NF-κB pathway activation,which in turn stimulates Wnt signaling.
基金the Peking Union Medical College Education Reform Program,No. 2019zlgc0116the 13th Five-Year Plan for National Key R&D Program of China,No. 2018YFC1705402+1 种基金National Natural Science Foundation of China,No. 81770559 and No. 81370500Medical and Health Technology Innovation Project of the Chinese Academy of Medical Sciences,No. 2020-I2M-2-013
文摘BACKGROUND Giant simple hepatic cysts causing intrahepatic duct dilatation and obstructive jaundice are uncommon.A variety of measures with different clinical efficacies and invasiveness have been developed.Nonsurgical management,such as percutaneous aspiration and sclerotherapy,is often applied.CASE SUMMARY The case is a 39-year-old female with a 5-mo history of cutaneous and scleral icterus,loss of appetite,and dark urine.Lab tests showed jaundice and liver function abnormalities.Imaging revealed a giant simple hepatic cyst obstructing the intrahepatic bile ducts.A combination of percutaneous catheter aspiration and lauromacrogol sclerotherapy was successfully performed and the effects were satisfactory with the size of cyst decreasing from 13.7 cm×13.1 cm to 3.0 cm×3.0 cm.Further literature review presented the challenges of managing giant simple hepatic cysts that cause obstructive jaundice and compared the safety and efficacy of a combination of percutaneous aspiration and lauromacrogol sclerotherapy with other management strategies.CONCLUSION Giant simple hepatic cysts can cause obstructive jaundice,and a combination of percutaneous catheter aspiration and sclerotherapy with lauromacrogol are suggested to treat such cases.
基金Supported by the Special Fund for Health Research and Development,Beijing Municipal Government,China,No.2011-4001-01
文摘AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these genetic polymorphisms and the three diseases. METHODS We evaluated genetic polymorphisms in 144 newly diagnosed colonic polyp patients,96 colon cancer patients and 44 ulcerative colitis patients. The four SNPs genotyped were rs4809957,rs6068816,rs6091822 and rs8124792. The control group consisted of 504 East Asians enrolled in the 1000 Genomes Project. Correlations between CYP24A1 SNPs and the diseases were analyzed by Fisher's exact probability test.RESULTS CYP24A1 polymorphisms rs4809957 A/G and rs6068816 C/T showed a statistically significant association with risk of the three diseases,when both the genotypes and allele frequencies were considered. With regard to rs6091822 G/T,all three diseases were related to risk allele carriers(GT + TT) vs wild-type(GG),but the associations between the allele frequencies and the diseases were not significant. The risk of colonic polyps and colon cancer was related to the allele frequencies of rs8124792 G/A,and this association remained for genotype frequencies of this SNP. CONCLUSION Four SNPs are related to the risk of colonic polyps and colon cancer. G allele in rs6091822 G/T may play an anti-cancer role only if it is homozygous. The A allele,which is a minor component of rs8124792,may be indicated in the diagnosis of colonic polyps or colon cancer rather than ulcerative colitis.
文摘Human cytomegalovirus(CMV) is a herpesvirus,which establishes lifelong latency after primary infection and leads to severe disease in immunocompromised patients. However,CMV infection in immunocompetent patients is usually asymptomatic and severe organ damage is rarely reported. We report a case of severe CMV hepatitis in an immunocompetent patient presenting with cholestasis,portal hypertensionrelated ascites and pancytopenia. The patient was asymptomatic with normal liver function and negative CMV DNA after two weeks of antiviral therapy. This case is an example of a common infection with an uncommon presentation,and suggests that testing for CMV should be carried out,even in patients with normal immune status,presenting with severe liver damage or cholestasis.
基金grants from the National Natural Science Foundation of China (No. 81370500 and No. 81770559).
文摘Background:Imbalance of intestinal microbiota was closely related to colitis.Under these circumstances,regulation of enteric flora may be beneficial to the repair of inflammation.We aimed to investigate the effects of probiotics (Bifidobacterium and Lactobacillus),prebiotics and their combination on inflammation,and microflora in mice of acute colitis.Methods:C57BL/6J mice were divided into six groups randomly (blank control group,model control group,probiotics group,synbiotics group,lactitol group and probiotics + lactitol group).Each group was given 2.5% dextran sulfate sodium drinking water for 5 days other than the blank control group.Except for the model control group,the other four groups were intervened with probiotics,synbiotics (probiotics and inulin),lactitol,and probiotics + lactitol.Mice were sacrificed after 1 week of gavage,and pathologic scores were calculated.The feces of different periods and intestinal mucosa samples were collected to analyze the differences of intestinal microbiota by 16S rRNA sequencing.Differences of two groups or multiple groups were statistically examined through unpaired Student t test and analysis of variance (ANOVA),respectively.ANOVA,Tukey,Anosim,and metastats analysis were used to compare differences of microbiota among different groups.Results:After gavage for 1 week,the pathologic scores of groups with the intervention were significantly lower than those in the model control group,and the difference was statistically significant (P < 0.05).The model control group was higher in the genus of Bacteroides (relative abundance:0.3679 vs.0.0099,P =0.0016) and lower in Lactobacillus (relative abundance:0.0020 vs.0.0122,P =0.0188),Roseburia (relative abundance:0.0004 vs.0.0109,P =0.0157),compared with the blank control group.However,the same phenomenon was not found in groups gavaged with probiotics and lactitol.Compared with model control group,mice with intervention were increased with Bifidobacterium (relative abundance:0.0172 vs.0.0039,P =0.0139),Lachnospiraceae_NK4A136_group (relative abundance:0.1139 vs.0.0320,P =0.0344),Lachnospiraceae_UCG-006 (relative abundance:0.0432 vs.0.0054,P =0.0454),and decreased with Alistipes (relative abundance:0.0036 vs.0.0105,P =0.0207) in varying degrees.The mucosal flora was more abundant than the fecal flora,and genus of Mucispirillum (relative abundance:0.0207 vs.0.0001,P =0.0034) was more common in the mucosa.Lactitol group showed higher level of Akkermansia than model control group (relative abundance:0.0138 vs.0.0055,P =0.0415),probiotics group (relative abundance:0.0138 vs.0.0022,P =0.0041),and synbiotics group (relative abundance:0.0138 vs.0.0011,P =0.0034),while probiotics + lactitol group had more abundant Akkermansia than synbiotics group (relative abundance:0.0215 vs.0.0013,P =0.0315).Conclusions:Probiotics and prebiotics reduce the degree of inflammation in acute colitis mice obviously.Mice with acute colitis show reduced beneficial genera and increased harmful genera.Supplementation of probiotics and prebiotics display the advantage of increasing the proportion of helpful bacteria and regulating the balance of intestinal microbiota.Lactitol might promote the proliferation of Akkermansia.
文摘Background： Clarifying the risk factors for postoperative complications and taking measures to minimize these complications will improve the outcomes in patients with ulcerative colitis （UC）.This study aimed to systemically explore the risk factors for short-term postoperative complications in Chinese UC patients undergoing ileocolorectal surgery.Methods： Forty-nine UC patients undergoing proctocolectomy or ileostomy were retrospectively enrolled.Univariate and multivariate logistic regression analyses were conducted to reveal the risk factors among the clinical, laboratory, and surgical variables as well as preoperative medications.Results： Twenty-two （44.9%） patients who suffered from at least one short-term postoperative event had more severe hypoalbuminemia （P =0.007） and an increased prevalence of preoperative corticosteroid usage （prednisone more than 20 mg daily or equivalent） for more than 6 weeks （59.1% vs.25.9%, P =0.023） compared with patients without short-term postoperative complications.Based on the multivariate logistic regression analysis, the odds ratio （95% confidence interval） values of these two risk factors were 1.756 （0.889-3.470, P =0.105） and 3.233 （0.916-11.406, P =0.068）, respectively.In 32 severe UC patients, prolonged preoperative hospital stay worsened the short-term postoperative outcomes.Conclusions： Preoperative corticosteroids usage and hypoalbuminemia worsened the short-term outcomes following ileocolorectal surgery in Chinese UC patients.
文摘Celiac disease (CD),once considered a gastrointestinal condition,is now known as a systemic autoimmune disease initiated by exposure to dietary gluten mainly in human leukocyte antigen DQ2 (HLA-DQ2) or HLA-DQ8 carriers.The classic presentations of CD include intestinal manifestations such as chronic diarrhea,bloating,abdominal pain,constipation,weight loss,or poor growth in children.Iron-deficiency,osteoporosis,and neuropathy attributable to vitamin B12 deficiency is also frequently seen in celiac patients.Immune responses spreading to tissues apart from the intestine cause dermatologic conditions such as dermatitis herpetiformis,and even increased risk of miscarriage in women.
文摘Background:Colorectal cancer(CRC)has become one of the major life-threatening complications in patients with inflammatory bowel disease(IBD),which includes ulcerative colitis(UC)and Crohn's disease(CD).This study aimed to explore the clinicalpathologic similarities and differences in the IBD-associ吐ed CRC(IBD-CRC)between patients in China and Canada.Methods:Data of 78 patients with IBD-CRC retrospectively retrieved from two representative medical institutions in Beijing(China)and Calgary(Canada)over the same past 13 years,including 25(22 UC-associated and three CD-associated)from Beijing group and 53(32 UC-associated and 21 CD-associated)from Calgary group,were compared with regards to their clinical and pathologic characteristics.Results:Several known features of IBD-CRC were seen in both groups,including long duration and large extent of colitis,active inflammation background,multifocal lesions,and advanced tumor-node-metastasis stage.Beijing group showed a significantly higher percentage of UC(88.0%vs.60.4%,P=0.018),younger age at diagnosis of CRC(48.6±12.8 years vs.61.6±14.7 years,P<0.001),lower ratio of mucinous adenocarcinoma(7.1%us.42.4%,P=0.001)compared with Calgary group.None of the Beijing group had concurrent primary sclerosing cholangitis,while 5.7%of Calgary group did.Surveillance colonoscopy favored the detection rate of precancerous lesions(41.4%vs.17.0%,P=0.002).Conclusions:As compared with patients from the Calgary group,the IBD-CRC patients in Beijing group were younger,less CDassociated and had less mucinous features,otherwise they were similar in many common features.
基金supported by the Chinese National Scientific Research Special-Purpose Project in Public Health Profession Funds[No.201002020]National Natural Science Foundation of China[81421003 and 81627807]+1 种基金National Key Research and Development Plan[2017YFC0908300]Independent Funds of the Key Laboratory[CBSKL2015Z01].
文摘Background:Data from single-center experience or small sample-sized studies have shown that chromoendoscopy(CE)might be superior to white-light endoscopy(WLE)for dysplasia surveillance in ulcerative colitis(UC)patients.We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies(WLT),WLE with random biopsies(WLR),and dye-based CE with targeted biopsies(CET)in UC patients.Methods:Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms(WLT,WLR,and CET).Only high-definition endoscopy was used in all three groups.The patients were followed up by annual endoscopy with biopsies through December 2017.Results:With a median follow-up time of 55 months,a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set:WLT(n=43),WLR(n=40),and CET(n=39).A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients.WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT(8.1%and 9.7%vs 1.9%;P=0.014 and 0.004,respectively).WLR obtained more biopsied samples than WLT and CET(16.465.1 vs 4.361.4 and 4.361.4;both P<0.001).During the second half of the follow-up(37-69 months),CET could identify more colonoscopies that diagnosed dysplasia than WLT(13.3%vs 1.6%,P=0.015)and showed a trend for increasing the detection rate compared with WLR(13.3%vs 4.9%,P=0.107).Conclusions:For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC,CET appeared to be more effective thanWLT and less tedious than WLR.CET was found to be particularly useful when a long-term(>3 years)follow-up was conducted for dysplasia surveillance.The trial was registered on www.chictr.org.cn(ChiCTR1900023689).
基金supported by grants from the National Natural Science Foundation of China(Nos.81730016,81900483).
文摘The homeostasis of the gut-brain axis has been shown to exert several effects on physiological and psychological health.The gut hormones released by enteroendocrine cells scattered throughout the gastrointestinal tract are important signaling molecules within the gut-brain axis.The interaction between gut microbiota and gut hormones has been greatly appreciated in gut-brain cross-talk.The microbiota plays an essential role in modulating many gut-brain axis-related diseases,ranging from gastrointestinal disorders to psychiatric diseases.Similarly,gut hormones also play pleiotropic and important roles in maintaining health,and are key signals involved in gut-brain axis.More importantly,gut microbiota can affect the release and functions of gut hormones.This review highlights the role of gut microbiota in the gut-brain axis and focuses on how microbiota-related gut hormones modulate various physiological functions.Future studies could target the microbiota-hormones-gut brain axis to develop novel therapeutics for different psychiatric and gastrointestinal disorders,such as obesity,anxiety,and depression.
基金supported by a grant from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2016-12M-3-001).
文摘The human gastrointestinal tract accommodates an entire micro-environment for divergent physiologic processes,the dysbiosis of this micro-ecology has a strong inter-action with the pathogenesis of inflammatory bowel disease(IBD).In the past few years,with the advances in the understanding of microbiome,its metabolites and further application of next generation sequencing,analysis of dynamic alteration of gut micro-environment was realized,which provides numerous information beyond simple microbiota structure or metabolites differences under chronic colitis status.The subsequent intervention strategies targeting the modulation of intestinal micro-environment have been explored as a potential therapy.In this review,we will summarize the recent knowledge about multi-dimensional dysbiosis,the inter-action between fungus and bacteria under inflamed mucosa,and the clinical application of probiotics and fecal microbiota transplantation as a promising therapeutic approach in IBD.
基金the Nanjing Medical University Fan Daiming Research Funds for Holistic Integrative Medicine.the Tianyu Pharmaceutical Co.,Ltd and China Gut Conference for the meeting.
文摘Injection sclerotherapy is most effective for internal hemorrhoids,especially for patients with bleeding.Howev-er,traditional sclerotherapy via anoscope may cause iatrogenic risk and complications due to misplaced injections.[1]The flexible endoscopic sclerotherapy for internal hemorrhoids using a short needle without cap assistant was first reported in 1991 in the United States.[2]The flexible endoscopic injection using a short needle with cap assistant was reported in 2014 in Japan.[3]Cap-assisted endoscopic sclerotherapy(CAES)primarily using a long needle was reported in 2015[4]as an emerging flexible endoscopic therapy,and has been widely used for internal hemorrhoids and some prolapse in China.A panel of experts aimed to develop expert recommendations for CAES and derived guidelines on the key issues in hemorrhoidal disease,including rationale,new positioning methods for anus,indications,contraindications,techniques,post-procedure management,and core outcome set for evaluation[Figure 1].
基金This work was supported by grants from the National Natural Science Foundation of China(No.81770559 and 81370500)。
文摘Colorectal cancer(CRC)is the third most commonly diagnosed malignant tumor in the world.The past few years have seen a remarkable increase in both incidence and mortality of CRC in developing countries like China,posing a serious threat to human health.It is currently believed that about 70%of colorectal cancers are derived from conventional adenomas and 30%are derived from serrated adenomas.[1]As reported,CRC incidence rates per 10,000 person-years were 20.0 for advanced adenoma and 9.1 for non-advanced adenoma.[2]Colonoscopy,as an important tool for CRC screening and follow-up,can prevent the development of CRC by detecting and removing precancerous lesions,thereby effectively reducing the incidence and mortality.Current guidelines for post-polypectomy surveillance mostly recommend a 3-to 10-year interval according to baseline risk stratification.[3]However,there is no such guideline in China yet and doctors tend to perform the next colonoscopy within 1 year,which is much shorter than current international recommendations.
文摘Background： Overexpression and constitutive activation of signal transducer and activator of transcription （STAT） 3 have been suggested in the tumorigenesis of many human cancers, including multiple carcinomas, melanoma, and lymphoma. The diagnosis ofhepatocellular carcinoma （HCC） in lobectomy specimens is usually straightforward, but distinguishing cirrhosis from well-differentiated HCC can be challenging in core biopsies. Our aims were to investigate the expression level of STAT3 and phosphorylated STAT3 （pSTAT3） in HCC and cirrhosis, and the application of STAT3 in the differential diagnosis of HCC and cirrhosis. Methods： Sixty cases were divided into three groups： patients with HCC only （Group 1）, HCC and cirrhosis （Group 2）, and cirrhosis only （Group 3）. Formalin-fixed and paraffin-embedded tissue sections were stained immunohistochemically for STAT3, pSTAT3, and CD163. The values obtained from the tissue sections of each group were compared in statistical analysis. Results： STAT3 showed a high level in HCC and was a significant marker for differentiating HCC from cirrhosis （P 〈 0.0001 ）. The odds ratio between HCC and cirrhosis increased 34.4 times when the intensity of STAT3 increased by 1 level. Spearman＇s correlation and Chi-square tests also demonstrated that expression level of STAT3 did not correlate with age, gender, or the presence of a cirrhotic background. Conclusions： STAT3 staining differs significantly in HCC and cirrhosis. The findings reinforce the role of STAT3 in the tumorigenesis of HCC and provide a useful marker to differentiate HCC from cirrhosis in challenging liver biopsies.
