Aim: The detection rate of gastrointestinal subepithelial tumors (SETs) has been arising. This study aimed to investigate the clinicopathological features of SETs in different gastrointestinal locations. Methods: From January 2015 to December 2021, the retrospective medical records of 1965 patients with 1998 SETs diagnosed by endoscopy and histopathology were collected from multiple endoscopic centers in Shanghai. The clinicopathological features and distribution characteristics of SETs were analyzed. Results: The current study consisted of 1965 patients (57.2 ± 12.0 years), and 1998 SETs were identified. The mean diameter of SETs was 11.2±8.0mm. Gastrointestinal stromal tumor (GIST; n=750, 37.5%) was the most common type of SETs, followed by leiomyoma (n=641, 32.1%), lipoma (n=199, 9.9%), neuroendocrine tumor (n=158,7.9%), ectopic pancreas (n=152, 7.6%), cyst (n=30, 1.5%), schwannoma (n=13, 0.7%), inflammatory fibroid polyp (n=12, 0.6%), glomus tumor (n=9, 0.5%), Bruner’s gland adenoma (n=8, 0.4%), granular cell tumor (n=6, 0.3%) and other rare type (n=20, 1.0%). Of all the SETs, 1257 SETs (62.9%) were identified in the stomach, GIST was the most frequent SETs in the stomach; 412 SETs (20.6%) in the esophagus, the majority (n=377) were leiomyomas; 55 SETs (2.8%) in the duodenum, the most common was ectopic pancreas (n=15); 274 SETs (13.7%) in the colorectum, the most common was neuroendocrine tumors, which accounted for 147 cases. Conclusions: The distribution and histopathologic characteristics of SETs in different segments of gastrointestinal tract were significantly different. Hence, the diagnosis and management of SETs can be improved by identifying their distribution characteristics.
Background: Device-measured daily steps/step cadence and other prominent behaviours occurring throughout the 24-hour day (i.e., sitting, lying, standing) have not been examined in patients with ulcerative colitis (UC). The degree to which these behaviours are associated with mental health, quality of life and clinical outcomes in this population is unknown. Aims: To explore the associations between device-based walking, step cadence, and sedentary time and clinical outcomes among UC patients. Methods: Patients with UC wore an activPALTM accelerometer for 7 days to measure daily steps, step cadence, lying, standing, and sitting time. Outcomes included total Mayo score (TMS), risk of depression (PHQ-8), risk of anxiety (GAD-7), and health-related quality of life [HRQoL (SF-12)] which included mental composite scores (MCS) and physical composite scores (PCS). Blood and stool samples were used to measure C-reactive protein (CRP) and fecal calprotectin (FCP). Results: Of 30 participants, thirteen (43.3%) had moderate to severe UC symptoms. The percentage of patients with moderate to severe depression and anxiety symptoms were 25.0% and 57.1%, respectively. Average daily steps were 7,869 3339. Step cadence ≥ 100 steps/min was positively associated with mental HRQoL and TMS, and inversely associated with FCP. Standing time was positively associated with TMS and inversely associated with depression, anxiety, and FCP. Faster walking was negatively correlated with CRP. Conclusion: This study identifies potential associations between device-measured brisk walking/running and periods of standing with HRQoL, mental health, and clinical outcomes. This study should be replicated in a larger sample to determine if these associations remain.
Aim: Abdominal drainage is believed to be prophylactic against accumulation of fluid and an early indicator of anastomotic leakage. However, evidence for this role remains equivocal. Our study aims to study the efficacy of abdominal drains in reducing post-operative complications in patients undergoing elective colorectal surgery. Method: The study is a retrospective non-interventional cohort study which involved adults undergoing elective colorectal surgery from 19 January 2021 to 22 February 2022. The main outcomes measured were fever, ileus, surgical site infections (SSI), pulmonary complications, venous thromboembolism (VTE), 30-day mortality, anastomotic leakage (AL), need for re-intervention, Post-Operative Days (POD) to pass flatus and feces and length of hospital stay (LOS). Categorical variables were analysed using Fisher's exact test and continuous variables were analysed using Mann Whitney U test. Results: 44 patients were included (38.6% female, 84.1% Chinese, mean age 74.18 years). The majority patients, 41 (93.2%), underwent surgery for cancer. 29 (65.9%) patients received abdominal drainage. There was no significant difference between the no drain and drain groups for fever (p=0.135), ileus (p=0.452), SSI (p=1.000), pulmonary complications (p=1.000), VTE (p=1.000), 30-day mortality (p=1.000), clinical AL (p=1.000), radiological AL (p=1.000), non-surgical re-intervention (p=0.488), surgical re-intervention (p=1.000), POD to pass flatus (p=0.258), POD to pass feces (p=0.984) and LOS (p=0.096). Conclusion: Abdominal drainage after elective colorectal surgery does not reduce the development of post-operative complications. The routine use of abdominal drainage can be avoided to minimise risk to patients. Further well-controlled Randomised Controlled Trials (RCTs) should be conducted to consolidate the evidence.
Objectives: The etiology of acute pancreatitis remains unclear in a significant number of patients. This study aimed to assess gallbladder dysfunction diagnosed using hepatobiliary iminodiacetic acid (HIDA) scan in patients recovering from idiopathic acute pancreatitis. Methods: This retrospective observational study included 22 consecutive patients with clinical and laboratory evidence of idiopathic acute pancreatitis. A HIDA scan was performed 8-10 weeks after the episode of pancreatitis. Results: Of the 22 patients, 14 (63.6%) were males. Their ages ranged from 18 to 79 years (mean, 47.5 ± 19.5). The co-morbid conditions observed were hypertension in eight patients, followed by diabetes in seven, ischemic heart disease in five, and miscellaneous in five. The HIDA scan revealed a gallbladder ejection fraction of less than 35% in seven (31.8%), suggesting a gallbladder dysfunction. Non-visualization of the gallbladder was observed in two patients. Biliary to the bowel transit time (BBTT) was 25.8 ± 8.7 minutes, and visualization of the gallbladder (n=20) was seen in 13.6 ± 11.4 minutes. Conclusions: Some patients with idiopathic acute pancreatitis have gallbladder dysfunction as evidenced by a decreased gallbladder ejection fraction or lack of visualization on the HIDA scan. Gallbladder dyskinesia should be checked in these patients to plan further management including cholecystectomy.
Small bowel diverticula are uncommon and usually asymptomatic. Rare complications include abdominal pain, small bowel diverticulitis, small bowel perforation, pancreaticobiliary obstruction, and related sequelae (i.e., ascending cholangitis, pancreatitis). We present a case of a 42-year-old female with peri-ampullary duodenal diverticulitis complicated by pancreaticobiliary obstruction successfully managed conservatively. Small bowel diverticula are often found in the second portion of the duodenum adjacent to the ampulla of Vater and are usually asymptomatic but can predispose to non-pancreaticobiliary or pancreaticobiliary complications. This case highlights the success of conservative management with antibiotics and endoscopic lavage upon prompt recognition and treatment avoiding invasive measures.
Helicobacter pylori (H.pylori) infection, a widespread global health concern, has traditionally been tackled with combinations of antibiotics and proton pump inhibitors (PPIs).While effective, these treatment regimens are frequently costly, complex, and replete with side effects.The rising tide of antibiotic-resistant H. pylori strains further clouds the long-term reliability of such antibiotic-focused approaches, making it imperative to explore alternative strategies.This article illuminates the promising frontier of non-antibiotic treatments, featuring exciting prospects like probiotics, herbal extracts, certain foods, antimicrobial peptides, and traditional Chinese medicine.This burgeoning field presents a fresh opportunity to circumnavigate antibiotic resistance, optimize eradication rates, and revitalize our fight against H. pylori.Our comprehensive analysis of the latest strides in non-antibiotic treatments strives to spotlight effective, safe, and patient-centric approaches that could bolster our arsenal against H. pylori.By highlighting these new-age solutions, we hope to stimulate further research and catalyse the development of personalized, innovative treatments for H. pylori infections, redefining its management in a sustainable way.
Background: Despite the availability of evidence-based testing and treatment guidelines for hepatitis B virus (HBV), there is a substantial gap in their use. As a result, chronic HBV is considerably underdiagnosed and undertreated in the US. Methods: This study examines the impact of a hepatitis B provider-training program to improve the knowledge and competence of primary care providers (PCPs) in managing hepatitis B (HBV). Project ECHO (Extension for Community Health Outcomes) seeks to bridge knowledge gaps by connecting PCPs with expert-guided education on HBV care. The HBV Project ECHO program offers monthly educational webinars focusing on key aspects of HBV care including testing, treatment, prevention, and complications. Participants self-assessed their competence in key aspects of HBV care via pre- and post-session surveys. The assessed topics included: identifying patients for screening, identifying treatment candidates, assessing liver damage, managing HBV patients, and educating others about HBV. Results: Analysis indicates a positive shift in the perceived abilities in all five areas assessed. The findings emphasize the established role of the ECHO model in decentralizing HBV management and empowering PCPs to improve their clinical practices. Ultimately, our findings suggest the program has been successful in its aim to enhance the care of patients with HBV. As the HBV landscape evolves in the US, the flexible and adaptive nature of the ECHO model proves vital in meeting the educational needs of PCPs. This study underscores the importance of continuous evaluation. Contributions to the Literature There is limited research on effective models for hepatitis B provider training programs globally, that work to decentralize hepatitis B service delivery. This program evaluation demonstrates the clear successes, impact and need for expansion of Project ECHO models in educating providers at the primary care level on hepatitis. The World Health Organization’s (WHO) elimination goals call for improved testing and management for hepatitis B, to improve testing, care delivery services should be expanded, and decentralization of care should also be expanded. Project ECHO is an opportunity to help work towards these WHO elimination goals. Study findings highlight the importance and impact of Project ECHO for hepatitis B provider training programs.
Introduction: Non-alcoholic fatty liver disease (NAFLD) is mechanistically linked to diminished insulin sensitivity, but few studies have addressed whether clinical and metabolic abnormalities related to insulin resistance (IR) predict hepatic fat accumulation assessed by magnetic resonance imaging.This study aimed to examine the association between IR-related clinical and biochemical abnormalities and hepatic fat fraction (HFF) in subjects with overweight/obesity.Materials and Methods: Adults with overweight and NAFLD detected by abdominal sonography were included and assessed demographic, clinical, anthropometric, and metabolic variables.They also underwent chemical-shift magnetic resonance imaging to determine HFF.Results: A total of 47 subjects (29 male and 18 female) were included, most (27; 72.3%) had normal glucose tolerance, and median HFF was 15.9%.Serum triglyceride levels were significantly higher among subjects with HFF above the median when compared with those with HFF below the median.Subgroup analysis indicated that fasting plasma insulin levels and HOMA-IR were significantly correlated with HFF among men but not women, and fasting plasma glucose levels were significantly correlated with HFF among women but not men.Conclusion: Our findings indicate that serum triglyceride levels predict HFF in people with overweight/obesity and that there may be a sexual dimorphic relationship between IR-related biochemical abnormalities and hepatic fat content, pointing to the complex physiopathology of the disease.
This, an Odyssey of a previously healthy, 6 years old girl who was admitted at Sidra Hospital in Doha-Qatar and was treated initially for acute mastoiditis complicated with an epidural abscess and sagittal sinus thrombossis, she was treated with a long course of Ceftriaxone and then presented abruptly with acute pancreatitis due to obstructing biliary stones. No other known risk factors were identified. Little is reported in the literature about developing this full-blown presentation in this age group and this is to serve as a word for the wise and concerned.
Gastric cancer is one of the most common cancers worldwide being the 5th most common cancer and the 4th leading cause of cancer death.The most common type of gastric cancer is adenocarcinoma and is divided into two types; cardia and non-cardia gastric cancer.The incidence of non-cardia gastric cancer is declining due to the better detection and treatment of H. pylori which is one of its main risk factors.On the other hand, the incidence of the cardia type is rising due to the increase rate of obesity and gastroesophageal reflux disease.Worldwide, mass screening for gastric cancer is not currently implemented due to its variable incidence and cost effectiveness especially in low-risk countries.However, some countries with high incidence of gastric cancer have developed national screening programs which have led to better detection and reduction in mortality.There are different modalities that are approved for screening including upper endoscopy and photofluorography.Additionally, a few serum biomarkers have also been developed for screening which have promising results.
Background: Fecal Immunochemical Test (FIT) is a screening tool used for colorectal cancer (CRC).Research has demonstrated that FIT detects the majority of CRC.Thus, the aim of the current study was to determine the specificity and the sensitivity of FIT test in detecting colonic cancerous and precancerous lesions among the Lebanese population. Subjects and Methods:This was a retrospective study carried out in two Lebanese Hospital, among asymptomatic patients who had underwent both colonoscopy and FIT between January 2016 and December 2021.The following information were collected: age, gender, lifestyle, diet, alcohol and smoking habits, physical activity, clinical symptoms, past medical history, family history of CRC, FIT results, and colonoscopy findings.The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for FIT, were calculated.Results: A total of 54 patients were included in this study.A portion of 55.6% of patients were males and 44.4% were females.Of all study participants, 20 (37.1%) patients tested positive by FIT and 15 of these patients had positive findings on colonoscopy compared to 5 patients who had no abnormal findings.The sensitivity of FIT in detecting CRC was 38.4% and the specificity was 66.6%.The calculated positive predictive value and negative predictive value were 75.0% and 29.4% respectively.When studying the association of demographic and lifestyle factors among patients with a positive FIT, we failed to find a significant association between all the studied variables and positive results of FIT (gender: p-value = 0.614, family history of CRC: p-value = 1.00, cigarette smoking: p-value = 0.66, healthy diet: p-value = 0.053, and physical activity: p-value = 0.59).Conclusion: FIT had acceptable sensitivity and high specificity in detecting CRC among asymptomatic patients.Additional research is still needed to improve the diagnostic performance of FIT in detecting CRC.
Background: This study aimed to develop a new self-report questionnaire to easily and quickly evaluate the occurrence of faecal incontinence (FI) due to functional gastrointestinal disorders (FGIDs).FGID symptoms are caused by dysfunction and do not involve organic lesions on clinical examinations.The diagnosis of FI is based on the following Roman IV criterion: "relapsed and uncontrolled stool leakage that lasts more than 3 months".FI is common in FGID patients and has a substantial adverse effect on daily life.This new questionnaire should allow patients and their families to easily and quickly evaluate FI to help reduce its impact on daily life. Summary:Recording the patient's general condition, including defecation and eating habits, and performing voluntary rehabilitation are essential.This review indicated that drafting a new self-report questionnaire would allow patients and their families to identify episodes of FI easily and quickly.In conclusion, the new questionnaire may provide education and advice regarding the patient's daily defecation habits.Preventing FI may reduce the burden on family members and caregivers.This study provided a more accurate questionnaire to identify and manage FI.
Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide, and due to substantial morbidity and mortality, has proven a significant global health-economic burden.Treatment options are broad and include surgical approaches (i.e., transplantation and resection), radiological (i.e., percutaneous ablation, and trans arterial approaches) and systemic therapies, though treatment response often remains poor.As such, clinical decision making requires a multidisciplinary approach to improve treatment strategy after consideration of the patient's tumor stage, liver function, and performance status.Current systemic cytotoxic therapies for non-surgical candidates have largely remained unchanged over the last decade.Systemic therapies have extended life expectancy by up to 3 months but not without potential notable adverse effects that often limit their use.However, even if patients have necessary access to best treatment, survival outcomes remain concerningly poor.Improved understanding of the pathogenic role of advanced liver fibrosis and wider cancer biology is spearheading the development of targeted immunogenic therapies that appear to offer real promise.Importantly, limiting progression to cirrhosis and early detection of HCC in at risk groups, alongside best use of currently accessible therapeutic options, remains key across global healthcare systems.The focus of this review is to critically assess all current published literature, encapsulating the prevalence, diagnosis, and management of HCC, whilst looking ahead to the potential future therapeutic directions in HCC management.
Background: Liver cirrhosis is an important cause of morbidity and mortality especially if associated with malnutrition and sarcopenia.The accumulation of intramuscular fat, known as myosteatosis, generates an early changes in muscle architecture, quality and function and has also been considered a concept of sarcopenia by some authors.Sarcopenia implies an increase in hospital admissions and worse outcomes after liver transplants.Identifying sarcopenia early helps prevent these outcomes.Myosteatosis has been increasingly studied and its clinical significance in liver cirrhosis is still unclear.Objective: To know the prevalence of sarcopenia and myosteatosis in cirrhotic patients.Methods: Observational, cross-sectional study performed in a tertiary gastroenterology hospital from October 2018 to October 2020 in outpatients with liver cirrhosis to identify the presence of sarcopenia and myosteatosis and correlate with variables capable of predicting these situations.The patients were submitted to a number of tests including muscle strength, computed tomography analysis with evaluation of skeletal muscle index (SMI) and muscle attenuation coefficient (HU) at the level of the third lumbar vertebra (L3) and a 6-minute walk test for sarcopenia evaluation.Results: A total of 62 patients were studied, half of them male.Most participants were classified as CHILD-PUGH A (70.9%) and mean SMI of 25.78 kg/m 2 .The median MELD score was 11.5 points.The average force measured with a dynamometer was 27.59 kgf and for this exam, eight patients had demonstrated reduced muscle strength.The distance covered in six minutes in the patients walk test was on average 418.34 m ± 59.21.The average SMI assessed by CT at the level of L3 was 113.25 cm 2 /m 2 , therefore it was not being able to identify sarcopenia in the 62 patients studied.It was observed that 19 had myosteatosis (30.6%).The mean attenuation of skeletal muscle at L3 level, used for myosteatosis evaluation, was 46.19 ± 11.73
Background: In last years, research interest increased for very early onset (VEO) inflammatory bowel disease (IBD), defined by age at diagnosis < 6 years. Previous works reported more severe disease course of VEO-IBD, compared with later-onset pediatric IBD, mainly attributed to a greater role of genetics in this age group. Otherwise, some studies questioned these results and reported comparable outcomes. Our study aimed to verify the effective role of age as a predictive factor of severity in the disease course. Methods: In this referral IBD single-center retrospective observational study, VEO-IBD was compared with IBD diagnosed between 6 and 17 years of age (ped-IBD). Patients with monogenic-IBD or IBD-like disease were excluded. We chose a minimum follow up period of 18 months since the diagnosis or any period in patients with Ulcerative Colitis (UC) who underwent surgery. The two cohorts were homogeneous for extension of disease and clinical severity at diagnosis and were compared for different clinical outcomes. Primary outcomes were the cumulative incidence of biological therapy use and the cumulative incidence of major surgery, as severity disease’ indices. Secondary outcomes were the cumulative incidence of clinical remission, steroid-dependence and the relapse free survival at the last follow up. Results: 29 VEO-IBD cases were compared with 52 ped-IBDs. Median follow up time was 4,9 years. UC were most represented in both groups (83% of VEO-IBD, 81% of ped-IBD). At the end of follow up, the surgical rate was significantly higher for VEO-UC group compared with ped-UC (p 0.018). No difference in biologic therapy use was detected (45,6% VEO-IBD vs 43,5% ped-IBD; p 0.72). Cumulative incidences of relapse free survival, steroid-dependence, use of immunosuppressive therapy and clinical remission at the end of follow up were comparable. Discussion:Our data question the evidence of a worse outcome of VEO-UC, in comparison with ped-UC. Notably, we demonstrate a higher need for surgery in VEO-UC.
Background and Aims: There are limited data on the frequency of disagreement on cirrhosis between the two methods, and the frequency of a correct diagnosis in instances of disagreement-particularly in a large sample size of patients.The objectives of this study were to access the frequency of disagreement between ultrasound (US) and shear wave elastography (SWE), and to determine each method's frequency of a correct diagnosis in instances of disagreement. Methods:Both US and SWE were prospectively performed on patients (n=2,156) referred for evaluation for liver disease.When there was disagreement between US and SWE, clinical evaluations (ascites, hepatic encephalopathy, or variceal bleeding), other imaging (CT or MRI), laboratory findings (albumin < 3.2, platelets <125 or INR >1.2), or liver biopsy data that were available or previously collected were used to reconcile disagreement.Results: The frequency of disagreement between US and SWE on cirrhosis was 13%.SWE was correct in 56% of cases and US was correct in 44% when there was disagreement.Conclusions: SWE vs. US appears to be more often correct in instances of disagreement.Other large prospective studies are needed to replicate the current study's findings.
Alagille syndrome is a rare autosomal dominant disorder that affects multiple organs and systems including liver, heart, bones, vascular system, and kidneys and also causes facial abnormalities.Majority of the cases involve mutation in one copy of the JAG1 gene while rarely some patients may have mutations in NOTCH2 gene.There is substantial variation in the extent of symptomatology with which patients may present.However, mostly patients present in infancy with symptoms concerning liver like jaundice, pruritus due to cholestasis, vitamin A, D, E and K deficiencies.Additional symptoms include specific triangular facies, back pain due vertebras involvement and kidney failure.Diagnosis is generally made up on the basis of clinical manifestations, genetic studies and liver biopsy.Additional laboratory tests concerning the affecting organs like liver function tests etc. may further aid up in the diagnosis.There is no specific treatment and may require symptomatic treatment with multiple disciplinary approach.A 7 months old boy is presented as a case of Alagille syndrome with its typical features.
Our patient was a man in his eighties who was referred to our department after a screening endoscopy indicated some abnormalities.Upper gastrointestinal endoscopy identified a 6-mm submucosal tumor in the posterior wall of the lesser curvature of the upper gastric body.Endoscopic ultrasonography (EUS) revealed a hypoechoic mass with internal heterogeneity and a heterogeneous shape, mainly situated in the second and third layers of the gastric wall.Following EUS-guided fine-needle aspiration biopsy, the patient was diagnosed with a gastric neuroendocrine tumor (NET) G1.Blood tests showed that he was negative for parietal cell and intrinsic factor antibodies; additionally, the serum gastrin level was normal.Computed tomography did not show metastatic lesions.The patient was diagnosed with a Type III Rindi classification gastric NET.However, the patient was elderly and did not wish to undergo surgery; therefore, endoscopic submucosal dissection was performed.The results of pathological examination confirmed a NET G2, T1b2 (2,000 µm).Due to prominent fibrous stroma in the tumor, we stained the specimen for serotonin and found that some of the cells were serotonin-positive.Despite further surgical resection, no lesions were found in the dissected lymph nodes or resected gastric tissue.The patient remains recurrence-free 36 months postoperatively.This is a very valuable case as there have not been any reports of a serotonergic gastric NET with fibrous stroma thus far.
Hepatocellular carcinoma (HCC) is the most common malignant tumor in the world with a high mortality rate. Liver cancer stem cells (LCSCs) are a small part of HCC cells with the abilities of self-renewal, proliferation, differentiation and tumorigenesis, which may be the main reasons for the high drug resistance and recurrence rate of HCC. Therefore, targeting LCSCs has become an effective way to cure HCC. A lot of evidences show that traditional Chinese medicine (TCM) plays an extremely important role in the prevention and treatment of HCC as an alternative or complementary therapy. In recent years, an increasing number of studies have shown that TCM monomer extracts and their derived compounds target LCSCs through a variety of pathways, providing new ideas for the treatment of liver cancer.
