Gastroenterology RSS : Gourt

Factors Associated with Persistant and Non-Persistant Chronic Constipation, Over 20 Years.

Factors Associated with Persistant and Non-Persistant Chronic Constipation, Over 20 Years. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Choung RS, Locke GR, Rey E, Schleck CD, Baum C, Zinsmeister AR, Talley NJ Abstract BACKGROUND & AIMS: The prevalence of chronic constipation (CC) has been reported to be as high as 20% in the general population, but little is known about its natural history. We estimated the natural history of CC and characterized features of persistent CC and non-persistent CC, compared to individuals without constipation. METHODS: In a prospective cohort study, we analyzed data collected from multiple, validated surveys (minimum of 2) of 2853 randomly selected subjects, over a 20-year period (median, 11.6 years). Based on responses, subjects were characterized as having persistent CC, non-persistent CC, or no constipation. We assessed the association between constipation status and potential risk factors using logistic regression models, adjusting for age and sex. RESULTS: Of the respondents, 84 had persistent CC (3%), 605 had non-persistent CC (21%), and 2164 had no symptoms of constipation (76%). High scores from the somatic symptom checklist (odds ratio [OR] =2.1; 95% confidence interval [CI], 1.3-3.4) and frequent doctor visits (OR=2.0; 95% CI, 1.0-3.8) were significantly associated with persistent CC, compared to subjects with no constipation symptoms. The only factor that differed was increased use of laxatives or fiber among subjects with persistent CC (OR=3.0; 95% CI, 1.9-4.9). CONCLUSION: The prevalence of constipation might be exaggerated-the proportion of the population with persistent CC is low (3%). Patients with persistent and non-persistent CC have similar clinical characteristics, although individuals with persistent CC use more laxatives or fiber. CC therefore appears and disappears among certain patients, but we do not have enough information to identify these individuals in advance. PMID: 22289877 [PubMed - as supplied by publisher]

Levels of Alanine Aminotransferase Confound Use of Transient Elastography to Diagnose Fibrosis in Patients with Chronic HCV Infection.

Levels of Alanine Aminotransferase Confound Use of Transient Elastography to Diagnose Fibrosis in Patients with Chronic HCV Infection. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Tapper EB, Cohen EB, Patel K, Bacon B, Gordon S, Lawitz E, Nelson D, Nasser IA, Challies T, Afdhal N Abstract BACKGROUND & AIMS: Hepatic elastography (HE) is a non-invasive technique that measures liver stiffness and is used to diagnose hepatic fibrosis. It can help patients thought to have early-stage disease avoid a staging liver biopsy, but only when confounding variables that increase liver stiffness are excluded. Chronic inflammation from hepatitis C virus (HCV) infection is not considered to be one of these variables. METHODS: We identified 684 patients with HCV and METAVIR fibrosis scores of 0-2 from a prospective, multi-institutional study of liver stiffness in 2880 patients with chronic liver disease. Patients were 49.6±9.0 years old, 64.3% male, and had an average body mass index of 26.7±4.1. RESULTS: In a multivariate analysis, inflammation (based on histologic analysis) and level of alanine aminotransferase (ALT) were associated with liver stiffness. The chances of a patient having a level of stiffness that indicates cirrhosis increased with grade of inflammation and level of ALT. Using a conservative, 14.5 kPa cutoff for the diagnosis of cirrhosis, grade 3 inflammation had an odds ratio (OR) of 9.10 (95% confidence interval [CI], 2.49-33.4). Likewise, levels of ALT greater than 80 IU/L and 120 IU/L had ORs of 3.84 (95% CI, 2.10-7.00) and 4.10% (95% CI, 2.18-7.69), respectively. The effect of the level of ALT persisted when analysis was restricted to patients with fibrosis scores of F0 to F1. CONCLUSION: In patients with HCV infection and early-stage fibrosis, increased levels of ALT correlate with liver stiffness among patients in the lowest strata of fibrosis (METAVIR scores 0-2). Patients without fibrosis but high levels of ALT could have liver stiffness within the range for cirrhosis. Inflammation should be considered a confounding variable in analysis of liver stiffness. PMID: 22289876 [PubMed - as supplied by publisher]

Efficacy and Safety of Anticoagulation on Patients with Cirrhosis and Portal Vein Thrombosis.

Efficacy and Safety of Anticoagulation on Patients with Cirrhosis and Portal Vein Thrombosis. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Delgado MG, Seijo S, Yepes I, Achécar L, Catalina MV, García-Criado A, Abraldes JG, de la Peña J, Bañares R, Albillos A, Bosch J, García-Pagán JC Abstract BACKGROUND & AIMS: Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis; it can be treated with anticoagulants, but there is limited data regarding safety and efficacy of this approach. We evaluated this therapy in a large series of patients with cirrhosis and non-neoplastic PVT. METHODS: We analyzed data from 55 patients with cirrhosis and PVT, diagnosed from June 2003 to September 2010, who received anticoagulant therapy for acute or subacute thrombosis (n=31) or progression of previously known PVT (n=24). Patients with cavernomatous transformation were excluded. Thrombosis was diagnosed and recanalization was evaluated using Doppler ultrasound, angio-computed tomography, and/or angio-magnetic resonance imaging analyses. RESULTS: Partial or complete recanalization was achieved in 33 patients (60%; complete in 25). Early initiation of anticoagulation was the only factor significantly associated with recanalization. Rethrombosis after complete recanalization occurred in 38.5% of patients after anticoagulation therapy was stopped. Despite similar baseline characteristics, patients who achieved recanalization developed, during the follow-up period, less-frequent liver-related events (portal hypertension-related bleeding, ascites, or hepatic encephalopathy), but this difference was not statistically significant (P=.1). Five patients developed bleeding complications that were probably related to anticoagulation. A platelet count <50x109/L was the only factor significantly associated with higher risk for experiencing a bleeding complication. There were no deaths related to anticoagulation therapy. CONCLUSIONS: Anticoagulation is a relatively safe treatment that leads to partial or complete recanalization of the portal venous axis in 60% of patients with cirrhosis and PVT; it should be maintained indefinitely to prevent rethrombosis. PMID: 22289875 [PubMed - as supplied by publisher]

Immunoglobulin E Levels And Its Significance In Patients With Primary Sclerosing Cholangitis.

Immunoglobulin E Levels And Its Significance In Patients With Primary Sclerosing Cholangitis. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Navaneethan U, Venkatesh PG, Kiran RP PMID: 22289874 [PubMed - as supplied by publisher]

Risk of Colorectal Cancer in Patients with Ulcerative Colitis: a Meta-Analysis of Population-Based Cohort Studies.

Risk of Colorectal Cancer in Patients with Ulcerative Colitis: a Meta-Analysis of Population-Based Cohort Studies. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Jess T, Rungoe C, Peyrin-Biroulet L Abstract BACKGROUND & AIMS: Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). Studies examining the magnitude of this association have yielded conflicting results. We performed a meta-analysis of population-based cohort studies to determine the risk of CRC in patients with UC. METHODS: We used Medline, Embase, Cochrane, and Cinahl to perform a systematic literature search. We included 8 studies in the meta-analysis, based on strict inclusion and exclusion criteria. We calculated pooled standardized incidence ratios (SIRs) with 95% confidence intervals (CI) for risk of CRC in patients with UC and performed meta-regression analyses of the effect of cohort size, calendar period, observation time, percentage with proctitis, and rates of colectomy on the risk of CRC. RESULTS: An average of 1.6% of patients with UC were diagnosed with CRC during 14 years of follow up. SIRs ranged from 1.05 to 3.1, with a pooled SIR of 2.4 (95% CI, 2.1-2.7). Men with UC had a greater risk of CRC (SIR, 2.6; 95% CI, 2.2-3.0) than women (SIR, 1.9; 95% CI, 1.5-2.3). Young age was a risk factor for CRC (SIR, 8.6; 95% CI, 3.8-19.5; although this might have resulted from small numbers), as was extensive colitis (SIR, 4.8; 95% CI, 3.9-5.9). In meta-regression analyses, only cohort size was associated with risk of CRC. CONCLUSIONS: In population-based cohorts, UC increases the risk of CRC 2.4-fold. Male sex, young age at diagnosis with UC, and extensive colitis increase the risk. PMID: 22289873 [PubMed - as supplied by publisher]

Gastric acid suppression and C. difficile infection: Is there a causal connection?

Gastric acid suppression and C. difficile infection: Is there a causal connection? Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Khanna S, Pardi DS PMID: 22289872 [PubMed - as supplied by publisher]

Predicting Outcomes Following Restorative Proctocolectomy for Ulcerative Colitis.

Predicting Outcomes Following Restorative Proctocolectomy for Ulcerative Colitis. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Papadakis KA PMID: 22289871 [PubMed - as supplied by publisher]

Safety of cardiac surgery in cirrhotic patients: going to the heart of the matter.

Safety of cardiac surgery in cirrhotic patients: going to the heart of the matter. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Giannini EG PMID: 22289870 [PubMed - as supplied by publisher]

Isolated jejunal varices: a cause of occult gastrointestinal hemorrhage in a cirrhotic patient with mild portal hypertension.

Isolated jejunal varices: a cause of occult gastrointestinal hemorrhage in a cirrhotic patient with mild portal hypertension. Clin Gastroenterol Hepatol. 2012 Jan 28; Authors: Shussman N, Lalazar G, Bloom AI PMID: 22289869 [PubMed - as supplied by publisher]

Increased Numbers of Eosinophils, Rather than Only Etiology, Predict Histologic Changes in Patients with Esophageal Eosinophilia.

Increased Numbers of Eosinophils, Rather than Only Etiology, Predict Histologic Changes in Patients with Esophageal Eosinophilia. Clin Gastroenterol Hepatol. 2012 Jan 27; Authors: Sridhara S, Ravi K, Smyrk TC, Kita H, Kephart GM, Weiler C, Katzka DA Abstract BACKGROUND & AIMS: It can be a challenge to differentiate individuals with eosinophilic esophagitis (EoE) from those with gastroesophageal reflux disease (GERD). We investigated differences in histologic and eosinophil patterns and numbers of mast cells between patients with these disorders. METHODS: We performed histologic analyses and immunohistochemical assays for eosinophil-derived neurotoxin (EDN), major basic protein (MBP), and tryptase, using biopsy samples from 10 patients with GERD (positive results from a pH study and response to proton-pump inhibitors), Barrett's esophagus, or EoE (negative results from a pH study and positive response to budesonide). Patients were matched for degree of eosinophilia. RESULTS: Samples from patients with EoE, GERD, or Barrett's esophagus had similar increases in concentrations of eosinophils. Patients with GERD or EoE did not differ in amount of basal zone hyperplasia, microabscesses, spongiosis, eosinophil distribution, maximum eosinophils/high-power field (HPF) or composite histologic scores. Samples from all 3 groups had high levels of EDN and MBP; the levels of eosinophil products correlated (ρ=0.93). Extracellular staining for EDN was greater than intracellular staining (2.67/3 vs 1.86/3); levels tended to be greater in samples from patients with EoE than GERD (P=.05) or Barrett's esophagus (P=.06). Detection of EDN correlated with peak numbers of eosinophils/HPF (ρ= 0.6 for intracellular and extracellular staining). Peak numbers of tryptase-positive mast cells/HPF were significantly greater in samples from patients with EoE than GERD or Barrett's esophagus (P=.01 and .005, respectively). The Spearman correlation between eosinophil and mast cell density was ρ=0.2. CONCLUSIONS: Biopsy samples from patients with GERD and EoE, matched for esophageal eosinophilia, have similar changes in histology and levels of EDN and MBP, whereas mast cells from patients with EoE have higher levels of these products. The presence of esophageal eosinophils, rather than etiology, could be the most important determinant of epithelial response. PMID: 22289868 [PubMed - as supplied by publisher]

Transplantation: Potential of intestinal microbiota profile as a diagnostic biomarker of small bowel transplant rejection

The need to identify a noninvasive marker that is predictive of intestinal allograft rejection may be a step closer to being met, thanks to the finding that small bowel transplant rejection is associated with changes in the intestinal microbiota.“The transplanted gut is a fascinating

Dyspepsia: Acotiamide can relieve symptoms of functional dyspepsia

Symptoms of functional dyspepsia can be relieved by taking acotiamide, according to researchers from Japan. Patients in a phase III clinical trial had significantly decreased symptom severity compared with controls who took a placebo.“Functional dyspepsia is one of the most common disorders seen in

Transplantation: Expression levels of iron homeostasis genes predict liver graft tolerance

Most solid organ transplant recipients require life-long administration of immunosuppressants. Occasionally, some recipients develop spontaneous graft tolerance, that is, they are able to maintain stable graft function without receiving immunosuppressive therapy. However, the mechanisms by which this tolerance occurs are not fully understood.Felix Bohne

IBD: Phase II results for IBD drugs

Current treatment guidelines do not recommend the use of antibiotics in patients with Crohn's disease. However, evidence suggests that an altered immune response to commensal gut bacteria might have a role in the development and persistence of intestinal inflammation in these patients. Thus, antibiotics might

Esophageal cancer: Matrix metalloproteinase 10 is associated with survival in patients with esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is an aggressive malignancy with a poor prognosis. A Chinese study has identified overexpression of matrix metalloproteinase 10 (MMP10) in samples of ESCC tumors. As this overexpression seems to be linked to survival, MMP10 could be used as a prognostic

IBS: Blocking the neurokinin 1 receptor reduces anxiety and pain in women with IBS

A proof of concept pilot study has shown that the areas of the brain associated with pain and anxiety have reduced activation following a painful rectal stimulus in patients treated with a neurokinin 1 receptor (NK1R) antagonist compared with control individuals given placebo.IBS is

Obesity: Reduction in hepatic left lobe volume is a good indicator of metabolic improvement after bariatric surgery

A recent study published in the International Journal of Obesity has demonstrated that a reduction in hepatic left lobe volume (HLLV) is the best predictor of improvement of various cardiometabolic risk factors in obese women undergoing gastric banding.Ferruccio Santini and colleagues previously developed

Pancreas: Cortical thickness—a useful indicator in painful chronic pancreatitis?

New findings suggest that cortical thickness is an indicator of pain system dysfunction in patients with chronic pancreatitis who experience pain. “We found reduced cortical thickness in brain areas involved in the processing of visceral pain,” explains first author Jens Brøndum Frøkjær. “The cortical thinning

Hepatitis: Brain endothelial cells support HCV entry and replication

Nicola Fletcher, Jane McKeating and colleagues have demonstrated that human brain endothelial cells express all the main receptors required for HCV entry. “This is the first report that cells of the central nervous system (CNS) support HCV entry and replication in vitro,” says McKeating.

Hepatitis: HBV infection increases risk of pancreatic cancer

A large, case–control study conducted in China has shown that HBV infection increases the risk of pancreatic ductal adenocarcinoma (PDAC). Qiwen et al. assessed hepatitis B status in 943 patients with confirmed PDAC and 1,128 matched controls. Individuals with chronic HBV infection (positive

Pancreatic cancer: Pancreatic cancer risk alleles identified in Chinese populations

No effective markers are available for screening for pancreatic cancer risk. In this genome-wide association study, Wu et al. report five new susceptibility loci—on chromsomes 21q21.3, 5p13.1, 22q13.32 and 10q26.11—for pancreatic cancer in Chinese individuals (981 patients initially, with replication of the findings

Upper gastrointestinal tract: Is lymphocytic esophagitis an emerging condition?

The true prevalence of lymphocytic esophagitis has not been thoroughly examined. Of 129,252 individuals assessed, 119 were diagnosed with lymphocytic esophagitis (∼0.1%, predominantly older women). The clinical and endoscopic characteristics of lymphocytic esophagitis overlapped considerably with those of eosinophilic esophagitis, but the clinical importance of

Ulcerative colitis: Intestinal microbiota manipulation is effective in children with ulcerative colitis

Rectal infusion of Lactobacillus reuteri ATCC 55730 could be a new therapy for children with active distal ulcerative colitis, according to work by Oliva and colleagues. 40 children with mild-to-moderate ulcerative colitis were randomly assigned to receive either a rectal enema containing L. reuteri

Ulcerative colitis: Administering infliximab after ciclosporin

A retrospective review suggests that infliximab salvage therapy can avoid colectomy in two-thirds of patients with corticosteroid-refractory ulcerative colitis who experience ciclosporin failure. 13% of 47 patients whose records were reviewed achieved remission after the first infliximab infusion; 60% of 35 patients who received a

Gut microbiota: Gut microbiota regulates host gene expression along the length of the gut

By comparing transcriptional profiles of the duodenum, jejunum, ileum and colon in germ-free and conventionally raised wild-type and Myd88−/− mice, Larsson et al. have shown that expression of a large set of genes in the small intestine (but fewer genes in

Hepatitis E: Global health burden of hepatitis E virus infection estimated

The 2005 annual disease burden of HEV genotype 1 and 2 infection has been estimated for 71% of the world's population (9 of 21 regions defined for the GBD 2010 study). Estimates include 20.1 million incident HEV infections, 3.3 million symptomatic cases, 70,000 deaths and

Celiac disease: Role for microbiota-associated factors in celiac disease?

In this study, controls, untreated and treated celiacs had comparable small intestinal microbiota, but IL-8 messenger RNA expression was significantly higher in untreated celiacs than in treated celiacs or controls. Compared with controls, untreated and treated celiacs had significantly decreased TLR2 mRNA expression, and untreated

Pediatrics: An oligosaccharide can prevent necrotizing enterocolitis in rats

Disialyllacto-N-tetraose, an oligosaccharide found in human milk, protects against necrotizing enterocolitis in a rat model of this common and often fatal illness.“Human milk oligosaccharides are complex glycans that are highly abundant in human milk, but not in infant formula,” explains corresponding author

Hepatitis C in 2011: A new standard of care and the race towards IFN-free therapy

Chronic HCV infection is a leading cause of liver-related morbidity and mortality. In 2011, treatment options for patients infected with HCV genotype 1 changed dramatically with the approval of two nonstructural protein 3 protease inhibitors—boceprevir and telaprevir—by the FDA and the European Medicines Agency.

Hepatocellular carcinoma in 2011: Genomics in hepatocellular carcinoma—a big step forward

Despite enthusiastic efforts using the latest advanced molecular technologies, no specific universal genetic alteration has been found in hepatocellular carcinoma (HCC). The application of whole-genome sequencing using next-generation sequencing technologies is starting to clarify the intraindividual and intratumoral diversity in genomic alterations in HCC. A new sequencing era in HCC has begun.

IBD in 2011: Advances in IBD management—towards a tailored approach

Important advances have been made in the management of IBD in 2011. Research has focused on optimizing the currently available therapies and taking a more tailored approach to each individual patient.

The gut microbiota in 2011: Translating the microbiota to medicine

Interest in the gut microbiota has escalated with growing appreciation of the role of indigenous microbes in the health of the host and in the pathogenesis of several intestinal and extraintestinal disorders. The microbiota has become a plausible target for drug and dietary therapy and a repository from which bioactive agents or new drugs can be mined.

Neurogastroenterology in 2011: Emerging concepts in neurogastroenterology and motility

Neurogastroenterology encompasses intrinsic and extrinsic neural processes that regulate gut functions, sensation and related behaviors such as ingestion. In 2011, key advances were made in understanding gut–brain interactions, visceral sensation, serotonin signaling, neurogenesis and neuromuscular transmission.