The concept of fecal microbiota transplantation(FMT)has been used in traditional Chinese medicine at least since the 4thcentury.Evidence from recent human studies strongly supports the link between intestinal bacteria...The concept of fecal microbiota transplantation(FMT)has been used in traditional Chinese medicine at least since the 4thcentury.Evidence from recent human studies strongly supports the link between intestinal bacteria and inflammatory bowel disease.We proposed that standardized FMT might be a promising rescue therapy for refractory inflammatory bowel disease.However,there were no reports of FMT used in patients with severe Crohn’s disease(CD).Here,we report the successful treatment of standardized FMT as a rescue therapy for a case of refractory CD complicated with fistula,residual Barium sulfate and formation of intraperitoneal large inflammatory mass.As far as we know,this is the first case of severe CD treated using FMT through mid-gut.展开更多
Eosinophilic gastroenteritis is a rare disease of unknown etiology.It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations.W...Eosinophilic gastroenteritis is a rare disease of unknown etiology.It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations.We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man.The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital.Then he was misdiagnosed as having Crohn’s disease in another university teaching hospital.Finally,the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn’s disease by fecal microbiota transplantation.Physical examination revealed a slight distended abdomen with diffuse tenderness.Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%,as well as eosinopenia,monocytopenia and lymphocytopenia.Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon.We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations.The patient was treated by fecal microbiota transplantation combined with oral prednisone,and was free from gastrointestinal symptoms at the time when we reported his disease.This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.展开更多
AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy(CAES) for internal hemorrhoids.METHODS: A pilot study on CAES for grade Ⅰ to Ⅲ intern...AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy(CAES) for internal hemorrhoids.METHODS: A pilot study on CAES for grade Ⅰ to Ⅲ internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent.RESULTS: A total of 30 patients with grade Ⅰ to Ⅲ internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One(3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma.CONCLUSION: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids.展开更多
AIM: To evaluate the technique of transpancreatic septotomy(TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography(ERCP).METHODS: Between May 2012 and April 2013, 1074 pat...AIM: To evaluate the technique of transpancreatic septotomy(TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography(ERCP).METHODS: Between May 2012 and April 2013, 1074 patients were referred to our department for ERCP. We excluded 15 patients with previous Billroth Ⅱ gastrectomy, Roux-en-Y anastomosis, duodenal stenosis, or duodenal papilla tumor. Among 1059 patients who underwent ERCP, there were 163 patients with difficult bile duct cannulation. Pancreatic guidewire or pancreatic duct plastic stent assistance allowed for successful ERCP completion in 94 patients. We retrospectively analyzed clinical data from 69 failed patients(36 transpancreatic septotomies and 33 needle-knife sphincterotomies). RESULTS: Of the 69 patients who underwent precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates in the TS and needle knife sphincterotomy(NKS) groups were 97.2%(35/36) and 96.9%(32/33), respectively, which were not significantly different(P > 0.05). Complications occurred in 11 cases, including acute pancreatitis(n = 6), bleeding(n = 2), and cholangitis(n = 3). The total frequency of complications in the TS group was lower than that in the NKS group(8.3% vs 24.2%, P < 0.05).CONCLUSION: Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in ERCP. TS and NKS markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer as compared with NKS.展开更多
Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and for...Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and foreign bodies in the esophagus. She attempted suicide by swallowing 26 coins and two other foreign bodies. A gastroscope was used to remove all foreign bodies in the lower esophagus. In total, 26 coins, one ferrous ring and one cylindrical plastic object were retrieved. To our knowledge, this is the first clinical report on retrieval of so many foreign bodies in a single case.展开更多
Recent studies showed that pseudogenes can regulate the expression of their coding gene partners by competing for miRNAs. The E2F family plays a crucial role in the control of cell cycle checkpoint. E2F3P1 is a pseudo...Recent studies showed that pseudogenes can regulate the expression of their coding gene partners by competing for miRNAs. The E2F family plays a crucial role in the control of cell cycle checkpoint. E2F3P1 is a pseudogene of E2F3. Few studies focused on genetic variations on pseudogenes. In this study, we performed a case-control study to assess the association between single nucleotide polymorphisms (SNPs) in E2F3P1 and hepatocellular carcinoma (HCC) risk in 1050 hepatitis B virus (HBV)-positive HCC cases and 1050 chronic HBV carriers. Logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between genotypes and HCC risk. We found that the variant CT/TT genotypes of rs1838149 were associated with a significantly decreased risk of HCC (adjusted OR=0.66, 95% CIs=0.51-0.86, P=0.002) compared to those with wildtype CC homozygote. Furthermore, the AA genotype of rs9909601 had an increased HCC risk with an adjusted OR of 1.41 (95% CIs=1.07-1.86), and the A allele of rs9909601 was significantly associated with HCC risk compared to those with the G allele (adjusted OR=1.17, 95% CIs=1.03-1.33, P=0.017). These results indicate that genetic variations in the pseudogene E2F3P1 may confer HCC risk.展开更多
Fecal microbiota transplantation(FMT),also known as fecal bacterial therapy,is a treatment option that can quickly reconstruct the normal composition of intestinal microbes,and it has a good therapeutic effect on Clos...Fecal microbiota transplantation(FMT),also known as fecal bacterial therapy,is a treatment option that can quickly reconstruct the normal composition of intestinal microbes,and it has a good therapeutic effect on Clostridium difficile infection,as well as on other microecological disorders.However,the causal mechanism of FMT efficacy remains to be clarified,its safety is a major problem,and the standardization and acceptability of FMT need to be improved.This review summarizes its current research status and potential research areas that need to be strengthened,and proposes to clarify the safety of FMT and the causal relationship between FMT and therapeutic effectiveness based on germ-free animals.Meanwhile,the research system is combined with multiomics technology to screen the effective bacteria in FMT,and develop standard,safe,effective and controllable flora of FMT.展开更多
Amyotrophic lateral sclerosis(ALS) is known as a progressive paralysis disorder characterized by degeneration of upper and lower motor neurons, and has an average survival time of three to five years. Growing evidence...Amyotrophic lateral sclerosis(ALS) is known as a progressive paralysis disorder characterized by degeneration of upper and lower motor neurons, and has an average survival time of three to five years. Growing evidence has suggested a bidirectional link between gut microbiota and neurodegeneration. Here we aimed to report one female case with ALS, who benefited from washed microbiota transplantation(WMT), an improved fecal microbiota transplantation(FMT), through a transendoscopic enteral tube during a 12-month follow-up. Notedly, the accidental scalp trauma the patient suffered later was treated with prescribed antibiotics that caused ALS deterioration. The subsequent rescue WMTs successfully stopped the progression of the disease with a quick improvement. The plateaus and reversals occurred during the whole course of WMT. The stool and blood samples from the first WMT to the last were collected for dynamic microbial and metabolomic analysis. We observed the microbial and metabolomic changing trend consistent with the disease status. This case report for the first time shows the direct clinical evidence on using WMT for treating ALS, indicating that WMT may be the novel treatment strategy for controlling this so-called incurable disease.展开更多
Hepatoblastoma is the most frequent liver malignancy in children.HepG2 has been discovered as a hepatoblastoma-derived cell line and tends to form clumps in culture.Intriguingly,we observed that the addition of calciu...Hepatoblastoma is the most frequent liver malignancy in children.HepG2 has been discovered as a hepatoblastoma-derived cell line and tends to form clumps in culture.Intriguingly,we observed that the addition of calcium ions reduced cell clumping and disassociated HepG2 cells.The calcium signal is in connection with a series of processes critical in the tumorigenesis.Here,we demonstrated that extracellular calcium ions induced morphological changes and enhanced the epithelial-mesenchymal transition in HepG2 cells.Mechanistically,calcium ions promoted HepG2 proliferation and migration by up-regulating the phosphorylation levels of focal adhesion kinase(FAK),protein kinase B,and p38 mitogen-activated protein kinase.The inhibitor of FAK or Ca2+/calmodulin-dependent kinaseⅡ(CaMKⅡ)reversed the Ca2+-induced effects on HepG2 cells,including cell proliferation and migration,epithelial-mesenchymal transition protein expression levels,and phosphorylation levels of FAK and protein kinase B.Moreover,calcium ions decreased HepG2 cells'sensitivity to cisplatin.Furthermore,we found that the expression levels of FAK and CaMKⅡwere increased in hepatoblastoma.The group with high expression levels of FAK and CaMKⅡexhibited significantly lower ImmunoScore as well as CD8+T and NK cells.The expression of CaMKⅡwas positively correlated with that of PDCD1 and LAG3.Correspondingly,the expression of FAK was negatively correlated with that of TNFSF9,TNFRSF4,and TNFRSF18.Collectively,extracellular calcium accelerates HepG2 cell proliferation and migration via FAK and CaMKⅡand enhances cisplatin resistance.FAK and CaMKⅡshape immune cell infiltration and responses in tumor microenvironments,thereby serving as potential targets for hepatoblastoma.展开更多
Fecal microbiota transplantation(FMT)is a promising strategy that involves reconstruction of gut microbiota.Recently,it has been considered as a treatment of Crohn’s disease(CD)and certain neurological diseases.Here,...Fecal microbiota transplantation(FMT)is a promising strategy that involves reconstruction of gut microbiota.Recently,it has been considered as a treatment of Crohn’s disease(CD)and certain neurological diseases.Here,to the best of our knowledge,we report the first case that used FMT to achieve remission of intestinal and neurological symptoms in a girl with CD and a 17-year history of epilepsy.During the 20 mo of follow-up,FMT has proved its efficacy in preventing relapse of seizures after withdrawing the antiepileptic drugs.Furthermore,this finding highlights the role of microbiota-gut-brain axis and inspires a novel treatment for epilepsy through remodeling gut microbiota.展开更多
Endoscopic cannulation of the biliary tract is a challenging technique in cases of periampullary diverticula.Many new devices and new manipulations for successful biliary cannulation have been reported.Endoscopy used ...Endoscopic cannulation of the biliary tract is a challenging technique in cases of periampullary diverticula.Many new devices and new manipulations for successful biliary cannulation have been reported.Endoscopy used to locate and cannulate a papilla hidden within a duodenal diverticulum is an effective method.However,the question of which endoscope should be chosen for this procedure,duodenoscope or gastroscope,waits to be answered.展开更多
AIM: To investigate the relationship between cholecystectomy and fatty liver disease(FLD) in a Chinese population.METHODS: A total of 32428 subjects who had voluntarily undergone annual health checkups in the Second A...AIM: To investigate the relationship between cholecystectomy and fatty liver disease(FLD) in a Chinese population.METHODS: A total of 32428 subjects who had voluntarily undergone annual health checkups in the Second Affiliated Hospital of Nanjing Medical University from January 2011 to May 2013 were included in this study. Basic data collection, physical examination, laboratory examination, and abdominal ultrasound examination were performed.RESULTS: Subjects undergoing cholecystectomy were associated with greater age, female sex, higher body mass index, and higher levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, and triglycerides. However, no significant differences were found in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, gammaglutamyl transpeptidase, albumin, and serum uric acid. The overall prevalence of FLD diagnosed by ultrasonography was high at 38.4%. The prevalence of FLD was significantly higher for subjects who had undergone cholecystectomy(46.9%) than those who had not undergone cholecystectomy(38.1%; χ2 test, P < 0.001). Cholecystectomy was positively associated with FLD(OR = 1.433, 95%CI: 1.259-1.631). However, after adjusting for possible factors associated withFLD, multivariate regression analysis showed that the association between cholecystectomy and FLD was not statistically significant(OR = 1.096; 95%CI: 0.939-1.279). CONCLUSION: According to our study results, cholecystectomy may not be a significant risk factor for FLD.展开更多
A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previ...A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.展开更多
BACKGROUND Artificial intelligence in colonoscopy is an emerging field,and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas.Several deep learning-bas...BACKGROUND Artificial intelligence in colonoscopy is an emerging field,and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas.Several deep learning-based computer-assisted detection(CADe)techniques were established from small single-center datasets,and unrepresentative learning materials might confine their application and generalization in wide practice.Although CADes have been reported to identify polyps in colonoscopic images and videos in real time,their diagnostic performance deserves to be further validated in clinical practice.AIM To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies.METHODS With high-quality screening and labeling from 55 qualified colonoscopists,a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe.In addition,the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps.Finally,we conducted a selfcontrolled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital.RESULTS The CADe was able to identify polyps in the test dataset with 95.0%sensitivity and 99.1%specificity.For colonoscopy videos,all 86 polyps were detected with 92.2%sensitivity and 93.6%specificity in frame-by-frame analysis.In the prospective validation,the sensitivity of CAD in identifying polyps was 98.4%(185/188).Folds,reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies.Colonoscopists can detect more polyps(0.90 vs 0.82,P<0.001)and adenomas(0.32 vs 0.30,P=0.045)with the aid of CADe,particularly polyps<5 mm and flat polyps(0.65 vs 0.57,P<0.001;0.74 vs 0.67,P=0.001,respectively).However,high efficacy is not realized in colonoscopies with inadequate bowel preparation and withdrawal time(P=0.32;P=0.16,respectively).CONCLUSION CADe is feasible in the clinical setting and might help endoscopists detect more polyps and adenomas,and further confirmation is warranted.展开更多
BACKGROUND Transendoscopic enteral tubing(TET)has been used in China as a novel delivery route for fecal microbiota transplantation(FMT)into the whole colon with a high degree of patient satisfaction among adults.AIM ...BACKGROUND Transendoscopic enteral tubing(TET)has been used in China as a novel delivery route for fecal microbiota transplantation(FMT)into the whole colon with a high degree of patient satisfaction among adults.AIM To explore the recognition and attitudes of FMT through TET in patients with inflammatory bowel disease(IBD).METHODS An anonymous questionnaire,evaluating their awareness and attitudes toward FMT and TET was distributed among IBD patients in two provinces of Eastern and Southwestern China.Question formats included single-choice questions,multiple-choice questions and sorting questions.Patients who had not undergone FMT were mainly investigated for their cognition and acceptance of FMT and TET.Patients who had experience of FMT,the way they underwent FMT and acceptance of TET were the main interest.Then all the patients were asked whether they would recommend FMT and TET.This study also analyzed the preference of FMT delivery in IBD patients and the patient-related factors associated with it.RESULTS A total of 620 eligible questionnaires were included in the analysis.The survey showed that 44.6%(228/511)of patients did not know that FMT is a therapeutic option in IBD,and 80.6%(412/511)of them did not know the concept of TET.More than half(63.2%,323/511)of the participants stated that they would agree to undergo FMT through TET.Of the patients who underwent FMT via TET[62.4%(68/109)],the majority[95.6%(65/68)]of them were satisfied with TET.Patients who had undergone FMT and TET were more likely to recommend FMT than patients who had not(94.5%vs 86.3%,P=0.018 and 98.5%vs 87.8%,P=0.017).Patients’choice for the delivery way of FMT would be affected by the type of disease and whether the patient had the experience of FMT.When compared to patients without experience of FMT,Crohn’s disease and ulcerative colitis patients who had experience of FMT preferred mid-gut TET(P<0.001)and colonic TET(P<0.001),respectively.CONCLUSION Patients’experience of FMT through TET lead them to maintain a positive attitude towards FMT.The present findings highlighted the significance of patient education on FMT and TET.展开更多
A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In hi...A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In his past history,he received proximal gastrectomy and modified double tracks anastomosis.Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis,especially accompanied with anastomotic stenosis,has been rarely reported.In the present case,the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket.The patient had good palliation of his symptoms after removal of the stone.展开更多
BACKGROUND Colonic transendoscopic enteral tubing(TET)requires double cecal intubation,raising a common concern of how to save cecal intubation time and make the tube stable.We hypothesized that cap-assisted colonosco...BACKGROUND Colonic transendoscopic enteral tubing(TET)requires double cecal intubation,raising a common concern of how to save cecal intubation time and make the tube stable.We hypothesized that cap-assisted colonoscopy(CC)might reduce the second cecal intubation time and bring potential benefits during the TET procedure.AIM To investigate if CC can decrease the second cecal intubation time compared with regular colonoscopy(RC).METHODS This prospective multicenter,randomized controlled trial was performed at four centers.Subjects≥7 years needing colonic TET were recruited from August 2018 to January 2020.All subjects were randomly assigned to two groups.The primary outcome was the second cecal intubation time.Secondary outcomes included success rate,insertion pain score,single clip fixation time,purpose and retention time of TET tube,length of TET tube inserted into the colon,and all procedurerelated(serious)adverse events.RESULTS A total of 331 subjects were randomized to the RC(n=165)or CC(n=166)group.The median time of the second cecal intubation was significantly shorter for CC than RC(2.2 min vs 2.8 min,P<0.001).In patients with constipation,the median time of second cecal intubation in the CC group(n=50)was shorter than that in the RC group(n=43)(2.6 min vs 3.8 min,P=0.004).However,no difference was observed in the CC(n=42)and RC(n=46)groups of ulcerative colitis patients(2.0 min vs 2.5 min,P=0.152).The insertion pain score during the procedure in CC(n=14)was lower than that in RC(n=19)in unsedated colonoscopy(3.8±1.7 vs 5.4±1.9;P=0.015).Multivariate analysis revealed that only CC(odds ratio[OR]:2.250,95%confidence interval[CI]:1.161-4.360;P=0.016)was an independent factor affecting the second cecal intubation time in difficult colonoscopy.CC did not affect the colonic TET tube’s retention time and length of the tube inserted into the colon.Moreover,multivariate analysis found that only endoscopic clip number(OR:2.201,95%CI:1.541-3.143;P<0.001)was an independent factor affecting the retention time.Multiple regression analysis showed that height(OR:1.144,95%CI:1.027-1.275;P=0.014)was the only independent factor influencing the length of TET tube inserted into the colon in adults.CONCLUSION CC for colonic TET procedure is a safe and less painful technique,which can reduce cecal intubation time.展开更多
The human gut microbiome has primarily been studied through the use of fecal samples,a practice that has generated vital knowledge on the composition and functional capacities of gastrointestinal microbial communities...The human gut microbiome has primarily been studied through the use of fecal samples,a practice that has generated vital knowledge on the composition and functional capacities of gastrointestinal microbial communities.However,this reliance on fecal materials limits the investigation of microbial dynamics in other locations along the gastrointestinal tract(in situ),and the infrequent availability of fecal samples prevents analysis at finer temporal scales(e.g.,hours).In our study,we utilized colonic transendoscopic enteral tubing,a technology originally developed for fecal microbiota transplantation,to sample the ileocecal microbiome twice daily;metagenomic and metatranscriptomic analyses were then conducted on these samples.A total of 43 ileocecal and 28 urine and fecal samples were collected from five healthy volunteers.The ileocecal and fecal microbiomes,as profiled in the five volunteers,were found to be similar in metagenomic profiling,yet their active genes(metatranscriptome)were found to be highly distinct.Both microbiomes were perturbed after laxative exposure;over time,they exhibited reduced dissimilarity to their pre-treatment state,thereby demonstrating resilience as an innate property of the gut microbiome,although they did not fully recover within our observation time window.Sampling of the ileocecal microbiome during the day and at night revealed the existence of diurnal rhythms in a series of bacterial species and functional pathways,particularly those related to short-chain fatty acid production,such as Propionibacterium acnes and coenzyme A biosynthesis Ⅱ.Autocorrelation analysis and fluctuations decomposition further indicated the significant periodicity of the diurnal oscillations.Metabolomic profiling in the fecal and urine samples mirrored the perturbance and recovery in the gut microbiome,indicating the crucial contribution of the gut microbiome to many key metabolites involved in host health.This study provides novel insights into the human gut microbiome and its inner resilience and diurnal rhythms,as well as the potential consequences of these to the host.展开更多
AIM:To conduct a meta-analysis to estimate the determinants of the association between erosive esophagitis (EE)and body mass index(BMI). METHODS:We identified the studies using PubMed. Studies were selected for analys...AIM:To conduct a meta-analysis to estimate the determinants of the association between erosive esophagitis (EE)and body mass index(BMI). METHODS:We identified the studies using PubMed. Studies were selected for analysis based on certain inclusion and exclusion criteria.Data were extracted from each study on the basis of predefined items.Metaanalyses were performed to verify the risk factors,such as obesity and gender. RESULTS:Twenty-one studies were included in this systematic review.These studies demonstrated an association between increasing BMI and the presence of EE[95%confidence interval(CI):1.35-1.88,overweight,odds ratio(OR)=1.60,P value homogeneity =0.003,95%CI:1.65-2.55,obese,OR=2.05,P< 0.01].The heterogeneity disappeared by stratifying for gender.No publication bias was observed in this metaanalysis by the Egger method. CONCLUSION:This analysis demonstrates a positive association between BMI and the presence of EE,especially in males.The risk seems to progressively increase with increasing weight.展开更多
基金Supported by(in part)The Public Donated Grant "Intestine Initiative"
文摘The concept of fecal microbiota transplantation(FMT)has been used in traditional Chinese medicine at least since the 4thcentury.Evidence from recent human studies strongly supports the link between intestinal bacteria and inflammatory bowel disease.We proposed that standardized FMT might be a promising rescue therapy for refractory inflammatory bowel disease.However,there were no reports of FMT used in patients with severe Crohn’s disease(CD).Here,we report the successful treatment of standardized FMT as a rescue therapy for a case of refractory CD complicated with fistula,residual Barium sulfate and formation of intraperitoneal large inflammatory mass.As far as we know,this is the first case of severe CD treated using FMT through mid-gut.
基金Supported by Partially supported by the grant"Intestine Initiative"
文摘Eosinophilic gastroenteritis is a rare disease of unknown etiology.It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations.We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man.The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital.Then he was misdiagnosed as having Crohn’s disease in another university teaching hospital.Finally,the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn’s disease by fecal microbiota transplantation.Physical examination revealed a slight distended abdomen with diffuse tenderness.Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%,as well as eosinopenia,monocytopenia and lymphocytopenia.Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon.We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations.The patient was treated by fecal microbiota transplantation combined with oral prednisone,and was free from gastrointestinal symptoms at the time when we reported his disease.This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.
基金Supported by The Intestine Initiative FoundationClinical Science and Technology Foundation of Jiangsu Province,No.BL2014097+1 种基金the National Science and Technology Major Project,No.2012BAI06B03the National Gastroenterology Research Project,No.2015BAI13B07
文摘AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy(CAES) for internal hemorrhoids.METHODS: A pilot study on CAES for grade Ⅰ to Ⅲ internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent.RESULTS: A total of 30 patients with grade Ⅰ to Ⅲ internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One(3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma.CONCLUSION: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids.
文摘AIM: To evaluate the technique of transpancreatic septotomy(TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography(ERCP).METHODS: Between May 2012 and April 2013, 1074 patients were referred to our department for ERCP. We excluded 15 patients with previous Billroth Ⅱ gastrectomy, Roux-en-Y anastomosis, duodenal stenosis, or duodenal papilla tumor. Among 1059 patients who underwent ERCP, there were 163 patients with difficult bile duct cannulation. Pancreatic guidewire or pancreatic duct plastic stent assistance allowed for successful ERCP completion in 94 patients. We retrospectively analyzed clinical data from 69 failed patients(36 transpancreatic septotomies and 33 needle-knife sphincterotomies). RESULTS: Of the 69 patients who underwent precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates in the TS and needle knife sphincterotomy(NKS) groups were 97.2%(35/36) and 96.9%(32/33), respectively, which were not significantly different(P > 0.05). Complications occurred in 11 cases, including acute pancreatitis(n = 6), bleeding(n = 2), and cholangitis(n = 3). The total frequency of complications in the TS group was lower than that in the NKS group(8.3% vs 24.2%, P < 0.05).CONCLUSION: Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in ERCP. TS and NKS markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer as compared with NKS.
文摘Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and foreign bodies in the esophagus. She attempted suicide by swallowing 26 coins and two other foreign bodies. A gastroscope was used to remove all foreign bodies in the lower esophagus. In total, 26 coins, one ferrous ring and one cylindrical plastic object were retrieved. To our knowledge, this is the first clinical report on retrieval of so many foreign bodies in a single case.
基金funded by the National Key Basic Research Program (2013CB911400)the Foundation for the Program for New Century Excellent Talents in University (NCET-10-0178)+5 种基金the Author of National Excellent Doctoral Dissertation (201081)the National Natural Science Foundation of China (30800946 and 81072344)the State Key Infectious Disease Project of China (2012ZX10002010, 2012ZX10002016)the National Major S&T Projects 2011ZX10004902)the National Science Fund for Creative Research Groups (30921006)the Priority Academic Program for the Development of Jiangsu Higher Education Institutions (Public Health and Preventive Medicine)
文摘Recent studies showed that pseudogenes can regulate the expression of their coding gene partners by competing for miRNAs. The E2F family plays a crucial role in the control of cell cycle checkpoint. E2F3P1 is a pseudogene of E2F3. Few studies focused on genetic variations on pseudogenes. In this study, we performed a case-control study to assess the association between single nucleotide polymorphisms (SNPs) in E2F3P1 and hepatocellular carcinoma (HCC) risk in 1050 hepatitis B virus (HBV)-positive HCC cases and 1050 chronic HBV carriers. Logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between genotypes and HCC risk. We found that the variant CT/TT genotypes of rs1838149 were associated with a significantly decreased risk of HCC (adjusted OR=0.66, 95% CIs=0.51-0.86, P=0.002) compared to those with wildtype CC homozygote. Furthermore, the AA genotype of rs9909601 had an increased HCC risk with an adjusted OR of 1.41 (95% CIs=1.07-1.86), and the A allele of rs9909601 was significantly associated with HCC risk compared to those with the G allele (adjusted OR=1.17, 95% CIs=1.03-1.33, P=0.017). These results indicate that genetic variations in the pseudogene E2F3P1 may confer HCC risk.
文摘Fecal microbiota transplantation(FMT),also known as fecal bacterial therapy,is a treatment option that can quickly reconstruct the normal composition of intestinal microbes,and it has a good therapeutic effect on Clostridium difficile infection,as well as on other microecological disorders.However,the causal mechanism of FMT efficacy remains to be clarified,its safety is a major problem,and the standardization and acceptability of FMT need to be improved.This review summarizes its current research status and potential research areas that need to be strengthened,and proposes to clarify the safety of FMT and the causal relationship between FMT and therapeutic effectiveness based on germ-free animals.Meanwhile,the research system is combined with multiomics technology to screen the effective bacteria in FMT,and develop standard,safe,effective and controllable flora of FMT.
基金funded by the National Natural Science Foundation of China (Grant No. 81873548)the Nanjing Medical University Fan Daiming Research Funds for Holistic Integrative Medicine。
文摘Amyotrophic lateral sclerosis(ALS) is known as a progressive paralysis disorder characterized by degeneration of upper and lower motor neurons, and has an average survival time of three to five years. Growing evidence has suggested a bidirectional link between gut microbiota and neurodegeneration. Here we aimed to report one female case with ALS, who benefited from washed microbiota transplantation(WMT), an improved fecal microbiota transplantation(FMT), through a transendoscopic enteral tube during a 12-month follow-up. Notedly, the accidental scalp trauma the patient suffered later was treated with prescribed antibiotics that caused ALS deterioration. The subsequent rescue WMTs successfully stopped the progression of the disease with a quick improvement. The plateaus and reversals occurred during the whole course of WMT. The stool and blood samples from the first WMT to the last were collected for dynamic microbial and metabolomic analysis. We observed the microbial and metabolomic changing trend consistent with the disease status. This case report for the first time shows the direct clinical evidence on using WMT for treating ALS, indicating that WMT may be the novel treatment strategy for controlling this so-called incurable disease.
基金funded by the Jiangsu Medical Scientific Research Project of Jiangsu Health Commission(to Q.Y.)the 789 Outstanding Talent Program of SAHNMU(Grant No.789ZYRC 202070102 to Q.Y.)+1 种基金the Guangzhou Key Medical Discipline Construction Project(to Q.Y.)the National Natural Science Foundation of China(Grant Nos.81870409 and 81671543 to Q.Y.).
文摘Hepatoblastoma is the most frequent liver malignancy in children.HepG2 has been discovered as a hepatoblastoma-derived cell line and tends to form clumps in culture.Intriguingly,we observed that the addition of calcium ions reduced cell clumping and disassociated HepG2 cells.The calcium signal is in connection with a series of processes critical in the tumorigenesis.Here,we demonstrated that extracellular calcium ions induced morphological changes and enhanced the epithelial-mesenchymal transition in HepG2 cells.Mechanistically,calcium ions promoted HepG2 proliferation and migration by up-regulating the phosphorylation levels of focal adhesion kinase(FAK),protein kinase B,and p38 mitogen-activated protein kinase.The inhibitor of FAK or Ca2+/calmodulin-dependent kinaseⅡ(CaMKⅡ)reversed the Ca2+-induced effects on HepG2 cells,including cell proliferation and migration,epithelial-mesenchymal transition protein expression levels,and phosphorylation levels of FAK and protein kinase B.Moreover,calcium ions decreased HepG2 cells'sensitivity to cisplatin.Furthermore,we found that the expression levels of FAK and CaMKⅡwere increased in hepatoblastoma.The group with high expression levels of FAK and CaMKⅡexhibited significantly lower ImmunoScore as well as CD8+T and NK cells.The expression of CaMKⅡwas positively correlated with that of PDCD1 and LAG3.Correspondingly,the expression of FAK was negatively correlated with that of TNFSF9,TNFRSF4,and TNFRSF18.Collectively,extracellular calcium accelerates HepG2 cell proliferation and migration via FAK and CaMKⅡand enhances cisplatin resistance.FAK and CaMKⅡshape immune cell infiltration and responses in tumor microenvironments,thereby serving as potential targets for hepatoblastoma.
基金Supported by The Public Donated Grant"Intestine Initiative"National Nature Science Foundation of China,No.81670495
文摘Fecal microbiota transplantation(FMT)is a promising strategy that involves reconstruction of gut microbiota.Recently,it has been considered as a treatment of Crohn’s disease(CD)and certain neurological diseases.Here,to the best of our knowledge,we report the first case that used FMT to achieve remission of intestinal and neurological symptoms in a girl with CD and a 17-year history of epilepsy.During the 20 mo of follow-up,FMT has proved its efficacy in preventing relapse of seizures after withdrawing the antiepileptic drugs.Furthermore,this finding highlights the role of microbiota-gut-brain axis and inspires a novel treatment for epilepsy through remodeling gut microbiota.
文摘Endoscopic cannulation of the biliary tract is a challenging technique in cases of periampullary diverticula.Many new devices and new manipulations for successful biliary cannulation have been reported.Endoscopy used to locate and cannulate a papilla hidden within a duodenal diverticulum is an effective method.However,the question of which endoscope should be chosen for this procedure,duodenoscope or gastroscope,waits to be answered.
文摘AIM: To investigate the relationship between cholecystectomy and fatty liver disease(FLD) in a Chinese population.METHODS: A total of 32428 subjects who had voluntarily undergone annual health checkups in the Second Affiliated Hospital of Nanjing Medical University from January 2011 to May 2013 were included in this study. Basic data collection, physical examination, laboratory examination, and abdominal ultrasound examination were performed.RESULTS: Subjects undergoing cholecystectomy were associated with greater age, female sex, higher body mass index, and higher levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, and triglycerides. However, no significant differences were found in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, gammaglutamyl transpeptidase, albumin, and serum uric acid. The overall prevalence of FLD diagnosed by ultrasonography was high at 38.4%. The prevalence of FLD was significantly higher for subjects who had undergone cholecystectomy(46.9%) than those who had not undergone cholecystectomy(38.1%; χ2 test, P < 0.001). Cholecystectomy was positively associated with FLD(OR = 1.433, 95%CI: 1.259-1.631). However, after adjusting for possible factors associated withFLD, multivariate regression analysis showed that the association between cholecystectomy and FLD was not statistically significant(OR = 1.096; 95%CI: 0.939-1.279). CONCLUSION: According to our study results, cholecystectomy may not be a significant risk factor for FLD.
文摘A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.
基金the National Key R&D Program of China,No.2018YFC1313103the National Natural Science Foundation of China,No.81670473 and No.81873546+1 种基金the“Shu Guang”Project of Shanghai Municipal Education Commission and Shanghai Education Development Foundation,No.19SG30the Key Area Research and Development Program of Guangdong Province,China,No.2018B010111001.
文摘BACKGROUND Artificial intelligence in colonoscopy is an emerging field,and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas.Several deep learning-based computer-assisted detection(CADe)techniques were established from small single-center datasets,and unrepresentative learning materials might confine their application and generalization in wide practice.Although CADes have been reported to identify polyps in colonoscopic images and videos in real time,their diagnostic performance deserves to be further validated in clinical practice.AIM To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies.METHODS With high-quality screening and labeling from 55 qualified colonoscopists,a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe.In addition,the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps.Finally,we conducted a selfcontrolled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital.RESULTS The CADe was able to identify polyps in the test dataset with 95.0%sensitivity and 99.1%specificity.For colonoscopy videos,all 86 polyps were detected with 92.2%sensitivity and 93.6%specificity in frame-by-frame analysis.In the prospective validation,the sensitivity of CAD in identifying polyps was 98.4%(185/188).Folds,reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies.Colonoscopists can detect more polyps(0.90 vs 0.82,P<0.001)and adenomas(0.32 vs 0.30,P=0.045)with the aid of CADe,particularly polyps<5 mm and flat polyps(0.65 vs 0.57,P<0.001;0.74 vs 0.67,P=0.001,respectively).However,high efficacy is not realized in colonoscopies with inadequate bowel preparation and withdrawal time(P=0.32;P=0.16,respectively).CONCLUSION CADe is feasible in the clinical setting and might help endoscopists detect more polyps and adenomas,and further confirmation is warranted.
基金Jiangsu Province Creation Team and Leading Talents Project (to Zhang FM)。
文摘BACKGROUND Transendoscopic enteral tubing(TET)has been used in China as a novel delivery route for fecal microbiota transplantation(FMT)into the whole colon with a high degree of patient satisfaction among adults.AIM To explore the recognition and attitudes of FMT through TET in patients with inflammatory bowel disease(IBD).METHODS An anonymous questionnaire,evaluating their awareness and attitudes toward FMT and TET was distributed among IBD patients in two provinces of Eastern and Southwestern China.Question formats included single-choice questions,multiple-choice questions and sorting questions.Patients who had not undergone FMT were mainly investigated for their cognition and acceptance of FMT and TET.Patients who had experience of FMT,the way they underwent FMT and acceptance of TET were the main interest.Then all the patients were asked whether they would recommend FMT and TET.This study also analyzed the preference of FMT delivery in IBD patients and the patient-related factors associated with it.RESULTS A total of 620 eligible questionnaires were included in the analysis.The survey showed that 44.6%(228/511)of patients did not know that FMT is a therapeutic option in IBD,and 80.6%(412/511)of them did not know the concept of TET.More than half(63.2%,323/511)of the participants stated that they would agree to undergo FMT through TET.Of the patients who underwent FMT via TET[62.4%(68/109)],the majority[95.6%(65/68)]of them were satisfied with TET.Patients who had undergone FMT and TET were more likely to recommend FMT than patients who had not(94.5%vs 86.3%,P=0.018 and 98.5%vs 87.8%,P=0.017).Patients’choice for the delivery way of FMT would be affected by the type of disease and whether the patient had the experience of FMT.When compared to patients without experience of FMT,Crohn’s disease and ulcerative colitis patients who had experience of FMT preferred mid-gut TET(P<0.001)and colonic TET(P<0.001),respectively.CONCLUSION Patients’experience of FMT through TET lead them to maintain a positive attitude towards FMT.The present findings highlighted the significance of patient education on FMT and TET.
基金Supported by the Key Research and Development Program of the Science and Technology Department,Jiangsu Province,China,No.BE2015722the Science and Technology Development Fund Project of Nanjing Medical University,Jiangsu Province,China,No.2011NJMU246
文摘A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In his past history,he received proximal gastrectomy and modified double tracks anastomosis.Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis,especially accompanied with anastomotic stenosis,has been rarely reported.In the present case,the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket.The patient had good palliation of his symptoms after removal of the stone.
基金the public donated Intestine Initiative FoundationJiangsu Province Creation Team and Leading Talents Project+1 种基金National Natural Science Foundation of China,No.81670495,No.81600417Topnotch Talent Research Projects,No.LGY2017080.
文摘BACKGROUND Colonic transendoscopic enteral tubing(TET)requires double cecal intubation,raising a common concern of how to save cecal intubation time and make the tube stable.We hypothesized that cap-assisted colonoscopy(CC)might reduce the second cecal intubation time and bring potential benefits during the TET procedure.AIM To investigate if CC can decrease the second cecal intubation time compared with regular colonoscopy(RC).METHODS This prospective multicenter,randomized controlled trial was performed at four centers.Subjects≥7 years needing colonic TET were recruited from August 2018 to January 2020.All subjects were randomly assigned to two groups.The primary outcome was the second cecal intubation time.Secondary outcomes included success rate,insertion pain score,single clip fixation time,purpose and retention time of TET tube,length of TET tube inserted into the colon,and all procedurerelated(serious)adverse events.RESULTS A total of 331 subjects were randomized to the RC(n=165)or CC(n=166)group.The median time of the second cecal intubation was significantly shorter for CC than RC(2.2 min vs 2.8 min,P<0.001).In patients with constipation,the median time of second cecal intubation in the CC group(n=50)was shorter than that in the RC group(n=43)(2.6 min vs 3.8 min,P=0.004).However,no difference was observed in the CC(n=42)and RC(n=46)groups of ulcerative colitis patients(2.0 min vs 2.5 min,P=0.152).The insertion pain score during the procedure in CC(n=14)was lower than that in RC(n=19)in unsedated colonoscopy(3.8±1.7 vs 5.4±1.9;P=0.015).Multivariate analysis revealed that only CC(odds ratio[OR]:2.250,95%confidence interval[CI]:1.161-4.360;P=0.016)was an independent factor affecting the second cecal intubation time in difficult colonoscopy.CC did not affect the colonic TET tube’s retention time and length of the tube inserted into the colon.Moreover,multivariate analysis found that only endoscopic clip number(OR:2.201,95%CI:1.541-3.143;P<0.001)was an independent factor affecting the retention time.Multiple regression analysis showed that height(OR:1.144,95%CI:1.027-1.275;P=0.014)was the only independent factor influencing the length of TET tube inserted into the colon in adults.CONCLUSION CC for colonic TET procedure is a safe and less painful technique,which can reduce cecal intubation time.
基金supported by the National Key Research and Development Program of China(2018YFC2000500)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDB29020000)+2 种基金the National Natural Science Foundation of China(31771481,91857101,and 81873548)the Primary Research&Development Plan of Jiangsu Province(BE2018751)the Jiangsu Provincial Medical Innovation Team(F.Zhang)。
文摘The human gut microbiome has primarily been studied through the use of fecal samples,a practice that has generated vital knowledge on the composition and functional capacities of gastrointestinal microbial communities.However,this reliance on fecal materials limits the investigation of microbial dynamics in other locations along the gastrointestinal tract(in situ),and the infrequent availability of fecal samples prevents analysis at finer temporal scales(e.g.,hours).In our study,we utilized colonic transendoscopic enteral tubing,a technology originally developed for fecal microbiota transplantation,to sample the ileocecal microbiome twice daily;metagenomic and metatranscriptomic analyses were then conducted on these samples.A total of 43 ileocecal and 28 urine and fecal samples were collected from five healthy volunteers.The ileocecal and fecal microbiomes,as profiled in the five volunteers,were found to be similar in metagenomic profiling,yet their active genes(metatranscriptome)were found to be highly distinct.Both microbiomes were perturbed after laxative exposure;over time,they exhibited reduced dissimilarity to their pre-treatment state,thereby demonstrating resilience as an innate property of the gut microbiome,although they did not fully recover within our observation time window.Sampling of the ileocecal microbiome during the day and at night revealed the existence of diurnal rhythms in a series of bacterial species and functional pathways,particularly those related to short-chain fatty acid production,such as Propionibacterium acnes and coenzyme A biosynthesis Ⅱ.Autocorrelation analysis and fluctuations decomposition further indicated the significant periodicity of the diurnal oscillations.Metabolomic profiling in the fecal and urine samples mirrored the perturbance and recovery in the gut microbiome,indicating the crucial contribution of the gut microbiome to many key metabolites involved in host health.This study provides novel insights into the human gut microbiome and its inner resilience and diurnal rhythms,as well as the potential consequences of these to the host.
文摘AIM:To conduct a meta-analysis to estimate the determinants of the association between erosive esophagitis (EE)and body mass index(BMI). METHODS:We identified the studies using PubMed. Studies were selected for analysis based on certain inclusion and exclusion criteria.Data were extracted from each study on the basis of predefined items.Metaanalyses were performed to verify the risk factors,such as obesity and gender. RESULTS:Twenty-one studies were included in this systematic review.These studies demonstrated an association between increasing BMI and the presence of EE[95%confidence interval(CI):1.35-1.88,overweight,odds ratio(OR)=1.60,P value homogeneity =0.003,95%CI:1.65-2.55,obese,OR=2.05,P< 0.01].The heterogeneity disappeared by stratifying for gender.No publication bias was observed in this metaanalysis by the Egger method. CONCLUSION:This analysis demonstrates a positive association between BMI and the presence of EE,especially in males.The risk seems to progressively increase with increasing weight.
基金This work was supported by publicaUy donated Intestine Initiative Jiangsu Province Medicine Creation Team and Leading Talents project （Faming Zhang） National Natural Science Foundation of China （Grant Nos. 81670495 and 81600417） and National Center for Clinical Research of Digestive System Diseases （2015BAI13B07）.
