Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study

AIM To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.METHODS A total of 1736 patients with chronic digestive systemdiseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A selfdesigned General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient's general information, which included demographic data(including age, sex, marital status, and education) and disease characteristics(including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).RESULTS The overall detection rate was 31.11%(540/1736) for depression symptoms alone, 27.02%(469/1736) for anxiety symptoms alone, 20.68%(359/1736) for both depression and anxiety symptoms, and 37.44%(650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression(44.06%) and anxiety symptoms(33.33%). χ2 trend test showed: the higher the body mass index(BMI), the lower the detection rate of depression and anxiety symptoms(χ2trend = 13.697, P < 0.001; χ2trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms(χ2trend = 130.455, P < 0.001, χ2trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms(χ2trend = 85.759, P < 0.001; χ2trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression(57.55%) and anxiety(55.19%), followed by patients with liver cirrhosis(41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease. CONCLUSION Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.

A study of TCM master Yan Zhenghua’s medication rule in prescriptions for digestive system diseases based on Apriori and complex system entropy cluster

Objective:To explore Yan Zhenghua’s drug selection rule for treating digestive system diseases using data mining.Methods:The 609 medical records of digestive system diseases treated by Yan Zhenghua were collected and the herbs in these recipes were examined using a data mining technique.The correlativity between herb pairs and association rules was studied using an Apriori algorithm and the correlativity among multi-herbs was studied using a complex system entropy cluster technique.Results:Yan Zhenghua’s treatment of digestive system diseases featured 15 herbs prescribed at least 159 times each,22 herb pairs prescribed at least 155 times each,and eight frequently used herb core combinations.A confidence greater than 0.91 and a support level greater than 20%were achieved using the modified mutual information method.Conclusion:The data mining results conformed to findings from clinical practice.The data mining method is a valuable technique with which to study the experience of famous,elderly traditional Chinese medicine physicians.

A systematic review and meta-analysis to compare the effects of Chinese herbal pieces and granule in different diseaseherbal pieces

Objective:Compared to Chinese herbal piecesherbal pieces,the quality of TCM granule is stable and controllable,it is also a convenient alternative to decocting herbs.However,whether they are as clinically effective as Chinese herbal piecesherbal pieces is still controversial.In this study,a systematic review and meta-analysis were performed to assess the clinical efficacy of TCM granules and Chinese herbal piecesherbal pieces.Methods:A search of online databases for eligible articles was performed,including PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Internet,WanFang,and Chongqing VIP Information,searching from the inception of these databases to 2020.The Cochrane Handbook 5.1.0 was used to independently identify the trials,extract data,and assess the risk of bias.The meta-analysis was performed via RevMan 5.3 software.Results:A total of 98 eligible articles were included.After classification and statistical analysis of the related diseases,a meta-analysis was performed on 8 types of illnesses(cold,hypertension,migraine,osteoporosis,and diseases of the digestive system,such as gastritis,gastric ulcer,colitis,epigastric pain)included in 66 randomized controlled trials to compare the clinical efficacy and adverse events of TCM granules and Chinese herbal pieces.Meta-analysis showed that compared with Chinese herbal piecesherbal pieces,TCM granules had similar effectiveness and safety in treating cold,hypertension,and osteoporosis,but a higher response rate in migraines and a better effect in reducing migraine duration and higher response rate on diseases of the digestive system.Conclusion:Compared with the traditional decoctions,TCM formula granules had the same efficacy and safety,moreover,they had higher efficacy and safety in treating migraines and digestive system diseases.

Non-clostridium difficile induced pseudomembranous colitis

Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia,ischemia,endothelial damage,and toxin production.The majority of cases of pseudomembranous colitis are due to Clostridium difficile.However,other causative pathogens and agents have been responsible for causing a similar pattern of injury to the bowel with the endoscopic appearance of yellow-white plaques and membranes on the mucosal surface of the colon.Common presenting symptoms and signs include crampy abdominal pain,nausea,watery diarrhea that can progress to bloody diarrhea,fever,leukocytosis,and dehydration.Negative testing for Clostridium difficile or failure to improve on treatment should prompt evaluation for other causes of pseudomembranous colitis.Bacterial infections other than Clostridium difficile,Viruses such as cytomegalovirus,parasitic infections,medications,drugs,chemicals,inflammatory diseases,and ischemia are other differential diagnoses to look out for in pseudomembranous colitis.Complications of pseudomembranous colitis include toxic megacolon,hypotension,colonic perforation with peritonitis,and septic shock with organ failure.Early diagnosis and treatment to prevent progression are important.The central perspective of this paper is to provide a concise review of the various etiologies for pseudomembranous colitis and management per prior literature.

Gastrointestinal tract and viral pathogens

Viral gastroenteritis is the most common viral illness that affects the gastro-intestinal(GI)tract,causing inflammation and irritation of the lining of the stomach and intestines.Common signs and symptoms associated with this condition include abdominal pain,diarrhea,and dehydration.The infections commonly involved in viral gastroenteritis are rotavirus,norovirus,and adenovirus,which spread through the fecal-oral and contact routes and cause non-bloody diarrhea.These infections can affect both immunocompetent and immunocompromised individuals.Since the pandemic in 2019,coronavirus gastroenteritis has increased in incidence and prevalence.Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition,treatment with oral rehydration salts,and prompt vaccination.Improved sanitation measures have also played a key role in reducing the transmission of infection.In addition to viral hepatitis causing liver disease,herpes virus,and cytomegalovirus are responsible for ulcerative GI disease.They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals.Hepatitis viruses,Epstein-Barr virus,herpesvirus 8,and human papillomavirus have been involved in benign and malignant diseases.This mini review aims to list different viruses affecting the GI tract.It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management.This will help primary care physicians and hospitalists diagnose and treat patients more easily.

Chemical components and protective effects of Atractylodes japonica Koidz.ex Kitam against acetic acid-induced gastric ulcer in rats

BACKGROUND Atractylodes japonica Koidz.ex Kitam.(A.japonica,Chinese name:Guan-Cangzhu,Japanese name:Byaku-jutsu),a perennial herb,which is mainly distributed in northeast area of China,it’s often used to treat digestive system diseases such as gastric ulcer(GU).However,the mechanism of its potential protective effects against GU remains unclear.AIM To investigate the protective effects of A.japonica on acetic acid-induced GU rats.METHODS The chemical constituents of A.japonica were determined by ultra performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS)analysis.The rat model of GU was simulated by acetic acid method.The pathological changes of gastric tissues were evaluated by hematoxylin-eosin stain,the levels of epidermal growth factor(EGF),EGF receptor(EGFR),nuclear factor kappa-B(NF-κB),interleukin-1β(IL-1β),IL-10,Na^(+)-K^(+)-ATPase(NKA)in serum and gastric tissues were determined by enzyme-linked immunosorbent assay,and the mRNA expressions of EGFR,NF-κBp65,IkappaBalpha(IκBα)and Zonula Occludens-1(ZO-1)in gastric tissues were determined by real-time reverse transcription polymerase chain reaction,and the efficacy was observed.Then,plasma metabolomic analysis was performed by UPLC-MS/MS to screen the specific potential biomarkers,metabolic pathways and to explore the possible mechani-sms.RESULTS 48 chemical constituents were identified.Many of them have strong pharmacological activity,the results also revealed that A.japonica significantly improved the pathological damage of gastric tissues,increased the expression levels of IL-10,IκBαrelated to anti-inflammatory factors,decreased the expression levels of IL-1β,NF-κB,NF-κBp65,related to proinflammatory factors,restored the levels of factors about EGF,EGFR,ZO-1 associated with ulcer healing and the levels of factors about NKA associated with energy metabolism.Metabolomic analysis identified 10 potential differential metabolites and enriched 7 related metabolic pathways.CONCLUSION These findings contribute to the understanding of the potential mechanism of A.japonica to improve acetic acidinduced GU,and will be of great importance for the development and clinical application of natural drugs related to A.japonica.

Danish cohort of monozygotic inflammatory bowel disease twins: Clinical characteristics and inflammatory activity

AIM: To describe the establishment of a Danish inflammatory bowel diseases (IBD) twin cohort with focus on concordance of treatment and inflammatory markers.METHODS: We identified MZ twins, likely to be discordant or concordant for IBD, by merging information from the Danish Twin Register and the National Patient Register. The twins were asked to provide biological samples, questionnaires, and data access to patient files and public registries. Biological samples were collected via a mobile laboratory, which allowed for immediate centrifugation, fractionation, and storage of samples. The mean time from collection of samples to storage in the -80&#x02005;&#x000b0;C mobile freezer was less than one hour. The diagnoses where validated using the Copenhagen diagnostic criteria.RESULTS: We identified 159 MZ IBD twin pairs, in a total of 62 (39%) pairs both twins agreed to participate. Of the supposed 62 IBD pairs, the IBD diagnosis could be confirmed in 54 pairs. The cohort included 10 concordant pairs, whereof some were discordant for either treatment or surgery. The 10 concordant pairs, where both pairs suffered from IBD, included eight CD/CD pairs, one UC/UC pair and one UC/IBDU pair. The discordant pairs comprised 31 UC, 5 IBDU (IBD unclassified), and 8 CD discordant pairs. In the co-twins not affected by IBD, calprotectin was above 100 &#x003bc;g/g in 2 participants, and above 50 &#x003bc;g/g in a further 5 participants.CONCLUSION: The presented IBD twin cohorts are an excellent resource for bioinformatics studies with proper adjustment for disease-associated exposures including medication and inflammatory activity in the co-twins.

Application of deep learning in lower gastrointestinal diseases

Deep learning has made tremendous progress in diagnosis assistance and prognosis prediction along with the accumulation of abundant medical data and the improvement of computer algorithms.Many studies have focused on applying deep learning to diseases of the lower gastrointestinal tract.Studies on deep learning and digestive system diseases mainly focus on cancer and inflammatory diseases,while few studies focus on other diseases.In order to better understand the emerging interdisciplinary,this paper reviews the ways in which deep learning may help doctors make a diagnosis or establish a prognosis,revealing that further randomized controlled studies and deeper cooperation between artificial intelligence engineers and doctors will be required.