Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 7 Articles
Background. The correlation between Helicobacter pylori (H. pylori) and gastroesophageal reflux disease (GERD) is complex. Some\nstudies showed a protective role of H. pylori infection against GERD. This study was aimed at assessing the role of H. pylori infection\nin GERD utilizing a large cohort of patients diagnosed with GERD. Methods and Materials. All patients who underwent gastroscopy\nfor an indication of GERD during the study period between 2015 and 2017 at the EMMS Nazareth Hospital were considered eligible\nfor the study and therefore were included. H. pylori infection was determined by the rapid urease test or histology. Severity of\nesophagitis was assessed using the Los Angeles classification. Univariate analysis was performed to figure out differences\nbetween patients according to H. pylori infection status. Multivariate regression analysis was conducted to illustrate the\npredictors of positivity for H. pylori infection..........................
Background/Aim. Endoscopic balloon dilation (EBD) has been effective for small-bowel strictures in patients with Crohnâ??s disease\n(CD). However, its efficacy and indication for small-bowel strictures in non-CD patients have not been established. This study\nevaluated the clinical efficacy and safety of EBD for small-bowel strictures in non-CD patients compared with CD patients.\nMethods. Ninety-eight consecutive patients (mean age, 53 years; average observation period, 45 months) with small-bowel\nstrictures diagnosed by double-balloon endoscopy were retrospectively evaluated at Hiroshima University Hospital from\nAugust 2003 to April 2017. The average number of procedures, short-term and long-term EBD success rates, and safety\nprofiles between the non-CD and CD groups were examined. Results. Surgery was selected as the initial treatment in 44 cases\n(45%) (non-CD group, 27 (61%); CD group, 17 (39%)) as EBD is not indicated. Fourteen non-CD patients had strictures due\nto malignant tumors, while 13 patients had benign strictures. Twenty-three patients (non-CD, 12; CD, 11) underwent EBD.\nForty-three EBD procedures were performed for 17 stricture sites (average: 2.5 procedures/site) in non-CD patients and 41 EBD\nprocedures for 18 stricture sites (average: 2.3 procedures/site) in CD patients. The short-term success rate was 100% (23/23),\nwhereas the long-term success rate was 92% (11/12) in non-CD patients and 82% (9/11) in CD patients. No significant\ndifferences in the surgery-free rate occurred between both groups. Furthermore, one adverse event, bleeding after EBD, was\nencountered in the non-CD group (8%, 1/12). Conclusion. EBD for small-bowel strictures demonstrated good clinical outcomes\nin non-CD patients....
Aims. Soluble urokinase plasminogen activator receptor (suPAR) reflects the immune activation in circumstances of inflammation\nand infection. It has been considered as a risk biomarker associated with poor outcome in various low-grade inflammation and\ninfectious diseases. The study is aimed at investigating whether suPAR has a predictive value with short-term survival in\npatients with hepatitis B-related acute-on-chronic liver failure (HB-ACLF). Methods. Serum suPAR expression was compared\namong patients with different states of chronic hepatitis B virus infection. Sixty HB-ACLF patients were recruited as the training\ncohort and followed up for 90 days. Serum suPAR level and the clinical relevance with short-term outcome were investigated.\nThe temporal dynamics of suPAR were evaluated in 50 HB-ACLF patients with available serum sequentially at baseline, week 2\nand week 4. Another 167 HB-ACLF patients were enrolled to validate the predictive value of suPAR with respect to the\nprognosis. Results. Serum suPAR level was significantly increased in HB-ACLF patients compared to non-ACLF patients. In the\ntraining set of HB-ACLF, we observed higher suPAR level, INR, MELD score, and more complications in nonsurvivors than\nsurvivors. Longitudinal analysis revealed an increased trend of suPAR level in nonsurvivors during week 0 to week 4 and the\nmodest decline in survivors. It showed that the synchronous suPAR level was higher in nonsurvivors at all indicated time\npoints. Elevated suPAR level at baseline was identified as a strong predictor of a 90-day mortality of HB-ACLF patients. It was\nconfirmed suPAR > 16 26 ng/ml had a positive predictive value of 72.22% and a negative predictive value of 77.88% for poor\noutcome in the validation cohort. Conclusions. Serum suPAR level increases significantly in HB-ACLF patients and associated\nwith a 90-day mortality. It suggests that suPAR might be a potential biomarker to predict the prognosis of HB-ACLF patients....
Background and Aims. Magnetically guided capsule endoscopy (MGCE) offers a noninvasive method of evaluating both the gastric\ncavity and small intestine; however, few studies have evaluated MGCE in pediatric patients. We investigated the diagnostic efficacy\nof MGCE in pediatric patients with abdominal pain. Patients and Methods. We enrolled 48 patients with abdominal pain aged\n6-18 years. All patients underwent MGCE to evaluate the gastric cavity and small intestine. Results. The cleanliness of the\ngastric cardia, fundus, body, angle, antrum, and pylorus was assessed satisfactorily in 100%, 85.4%, 89.6%, 100%, 97.9%, and\n100% of patients, respectively. The subjective percentage visualization of the gastric cardia, fundus, body, angle, antrum, and\npylorus was 84.8%, 83.8%, 88.5%, 87.7%, 95.2%, and 99.6%, respectively. Eighteen (37.5%) patients had 19 gastrointestinal tract\nlesions: one esophageal, three in the gastric cavity, and 15 in the small intestine. No adverse events occurred during follow-up.\nConclusions. MGCE is safe, convenient, and tolerable for evaluating the gastric cavity and small intestine in pediatric patients.\nMGCE can effectively diagnose pediatric patients with abdominal pain....
Background. The bile infection may already exist before the administration of an interventional procedure, despite no clinical\nmanifestations of cholangitis detected. Blood cultures remained negative even in more than half of the febrile cases with\ncholangitis. Risk factors associated with bacterial growth in bile before the intervention are not well defined. To establish the\nbacterial profiles isolated from the bile samples and to identify risk factors for bacterial colonization in the bile system.\nMethods. Individuals who underwent endoscopic retrograde cholangiopancreatography (ERCP) interventions were enrolled.\nBile samples were aspirated and were immediately transferred into a sterile tube for storage. Results. Positive bile cultures were\ndetected in 363 (38.0%) of 956 patients, including 322 benign diseases and 41 malignances. Of 363 positive cases, 351 (96.7%)\nwere monoinfection and 12 (3.3%) multi-infection. Escherichia coli were the most common Gram-negative bacteria (210,\n56.0%), followed by Klebsiella pneumoniae (45, 12.0%). Enterococcus faecalis represented the most common Gram-positive\nmicroorganism (19, 5.07%), while Candida albicans (11, 2.93%) were the dominant fungi. Klebsiella pneumoniae were more\nfrequently detected in malignant diseases (P= 0 046). Age, previous ERCP history or OLT history, and CBD diameter were\nindependent risk factors for positive cultures (P<0 05) while preoperative jaundice drug therapy was the protective factor for\nbile infection (P < 0 05). Conclusion. Monomicrobial infection was dominant among all infections, and Klebsiella pneumoniae\nstrains were more frequently isolated from patients with malignant diseases. To effectively manage patients who are at a high\nrisk for bile infection, a detailed diagnosis and treatment plan for each case should be prepared....
Purposes.Mesenteric venous thrombosis (MVT) is a serious condition. Thecurrent study aimed to identify risk factors of intestinal\nnecrosis (IN) in patients with MVT to predict the onset of patients. Methods. Data pertaining to patients diagnosed with MVT\nbetween 2014 and May 2018 were reviewed. Patientsâ?? characteristics and risk factors of IN were assessed. Results. Seventy-eight\npatients were included in our study, of whom all cases were diagnosed as superior mesenteric venous thrombosis. There were\nfifty-eight cases (74%) with intestinal necrosis and twenty cases (26%) without intestinal necrosis. Multivariate analysis of factors\nassociated with IN was organ failure (odds ratio (OR): 4.1; 95% confidence interval (95%CI): 1.26-8.59; P=0.028), elevated serum\nlactate (OR:3.6; 95%CI: 1.51-5.47; P=0.024),bowel loopdilation on computerized tomography(CT) scan(OR: 2.8; 95%CI: 1.32-7.23;\nP=0.031), and the time between onset of symptoms and operation (OR: 4.8; 95% CI: 1.36-9.89; P=0.012). Area under the receiver\noperating characteristics curve for the diagnosis of IN with MVT was 0.901 (95%CI: 0.809-0.993; P=0.000) depending on the\ndifferent number of predictive factors. Conclusion. Predictive risk factors for IN with MVT were organ failure, elevated serum\nlactate level, bowel loop dilation on CT, and the time between onset of symptoms and operation. However, this result is from a\nretrospective study and further long-term, large-sample prospective studies are required to confirm this finding....
Background: Antiviral treatment for chronic hepatitis B (CHB) is largely unavailable in sub-Saharan Africa; hence,\nlittle is known about the prognosis after initiating treatment in African CHB patients. In this study we aimed to\nassess predictors of mortality in one of the largest CHB cohorts in sub-Saharan Africa.\nMethods: Two-hundred-and-seventy-six CHB patients who started treatment with tenofovir disoproxil fumarate at a\npublic hospital in Ethiopia between March 18, 2015, and August 1, 2017, were included in this analysis. Patients\nwere followed up until October 1, 2017, and deaths were ascertained through hospital records and telephone\ninterview with relatives. Decompensated cirrhosis was defined as current or past evidence of ascites, either by\nclinical examination or by ultrasonography. Cox proportional hazard models were used to identify independent\npredictors of mortality.\nResults: Thirty-five patients (12.7%) died during follow-up, 33 of whom had decompensated cirrhosis at\nrecruitment. The median duration from start of treatment to death was 110 days (interquartile range 26-276). The\nestimated survival was 90.3, 88.2 and 86.3% at 6, 12 and 24 months of follow-up, respectively. Independent\npredictors of mortality were decompensated cirrhosis (adjusted hazard ratio [AHR] 23.68; 95% CI 3.23-173.48; p = 0.\n002), body mass index < 18.5 kg/m2 (AHR 3.65; 95% CI 1.73-7.72; p = 0.001) and older age (per 1-year increment;\nAHR 1.06; 95% CI 1.02-1.10; p = 0.007).\nConclusions: Decompensated cirrhosis, low body mass index and older age were independent predictors of\nmortality. Improved access to antiviral treatment and earlier initiation of therapy could improve the survival of\nAfrican CHB patients....
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