AIM:To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in pa...AIM:To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both.METHODS: Six thousand four hundred and seventy six patients presented to the Gastro-intestinal (GI) clinic with symptoms of functional dysfunction of GI tract, 1419 patients (62.0% women, 38.0% men; mean age: 37.4±11.5 years) met Rome or Rome criteria(depending on the year of diagnosis)for IBS.2658 patients were diagnosed with GERD based on clinical presentation and endoscopic findings.We assessed other functional symptoms(epigastric pain,nausea,vomiting,belching,constipation and diarrhea)in patients suffering from GERD,IBS or both.RESULTS: Among IBS subjects, 63.6% (69.0% women, 31.0% men; mean age: 36.4±10.3 years) also hadGERD, whereas 34.7% of the non-IBS patients had GERD [odds ratio (OR) =3.2, 95% confidence interval (CI): 2.9-3.7, P<0.0001]. Among patients with GERD, 33.9% of subjects met Rome criteria compared to 13.5% of non-GERD patients (OR=3.6, 95% CI: 3.1-4.3, P<0.0001). Prevalence of all functional symptoms was higher in overlapping GERD and IBS subjects, when compared with their prevalence in the IBS subjects without GERD or GERD only subjects (P<0.05).CONCLUSION: This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.展开更多
Exciting new features have been described concerning neurogenic bowel dysfunction,including interactions between the central nervous system,the enteric nervous system,axonal injury,neuronal loss,neurotransmission of n...Exciting new features have been described concerning neurogenic bowel dysfunction,including interactions between the central nervous system,the enteric nervous system,axonal injury,neuronal loss,neurotransmission of noxious and non-noxious stimuli,and the fields of gastroenterology and neurology.Patients with spinal cord injury,myelomeningocele,multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation,incontinence,gastrointestinal motor dysfunction and altered visceral sensitivity.Spinal cord injury is associated with severe autonomic dysfunction,and bowel dysfunction is a major physical and psychological burden for these patients.An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease.Multiple sclerosis is a neurodegenerative disorder in which axonal injury,neuronal loss,and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability.Parkinson's disease is a multisystem disorder involving dopaminergic,noradrenergic,serotoninergic and cholinergic systems,characterizedby motor and non-motor symptoms.Parkinson's disease affects several neuronal structures outside the substantia nigra,among which is the enteric nervous system.Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease,even before the involvement of the central nervous system.This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease,as it could represent the point of entry for a putative environmental factor to initiate the pathological process.This review covers the data related to the etiology,epidemiology,clinical expression,pathophysiology,genetic aspects,gastrointestinal motor dysfunction,visceral sensitivity,management,prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases.Embryological,morphological and experimental studies on animal models and humans are also taken into account.展开更多
Endothelial dysfunction is considered one of the etiological factors of inflammatory bowel disease(IBD). An inflammatory process leads to functional and structural changes in the vascular endothelium. An increase of l...Endothelial dysfunction is considered one of the etiological factors of inflammatory bowel disease(IBD). An inflammatory process leads to functional and structural changes in the vascular endothelium. An increase of leukocyte adhesiveness and leukocyte diapedesis, as well as an increased vascular smooth muscle tone and procoagulant activity is observed. Structural changes of the vascular endothelium comprise as well capillary and venule remodeling and proliferation of endothelial cells. Hypoxia in the inflammatory area stimulates angiogenesis by upregulation of vascular endothelial growth factor, fibroblast growth factor and tumor necrosis factor-α. Inflammatory mediators also alter the lymphatic vessel function and impair lymph flow, exacerbating tissue edema and accumulation of dead cells and bacteria. The endothelial dysfunction might be diagnosed by the use of two main methods: physical and biochemical. Physical methods are based on the assessment of large arteries vasodilatation in response to an increased flow and receptors stimulation. Flowmediated vasodilatation(FMD) is the method that is the most widely used; however, it is less sensitive in detecting early changes of the endothelium function. Most of the studies demonstrated a decrease of FMD in IBD patients but no changes in the carotic intima-media thickness. Biochemical methods of detecting the endothelial dysfunction are based on the assessment of the synthesis of compounds produced both by the normal and damaged endothelium. The endothelial dysfunction is considered an initial step in the pathogenesis of atherosclerosis in the general population. In IBD patients, the risk of cardiovascular diseases is controversial. Large, prospective studies are needed to establish the role of particular medications or dietary elements in the endothelial dysfunction as well to determine the real risk of cardiovascular diseases.展开更多
Defects in intestinal barrier function characterized by an increase in intestinal permeability contribute to intestinal inflammation.Growing evidence has shown that an increase in intestinal permeability has a pathoge...Defects in intestinal barrier function characterized by an increase in intestinal permeability contribute to intestinal inflammation.Growing evidence has shown that an increase in intestinal permeability has a pathogenic role in diseases such as inflammatory bowel disease(IBD)and celiac disease,and functional bowel disorders such as irritable bowel syndrome.Therefore,clarification of the inflammatory responses,the defense pathway and the corresponding regulatory system is essential and may lead to the development of new therapies.MicroRNAs(miRNAs)are small(19-22nt)noncoding RNA molecules that regulate genes at the post-transcriptional level by base-pairing to specific messenger RNAs for degradation to repress translation.Recent studies suggested that miRNAs are important in the immune response and mediate a critical role in multiple immune response-related disorders.Based on these discoveries,attention has been focused on understanding the role of miRNAs in regulating intestinal barrier dysfunction,especially in IBD.Here,we provide a review of the most recent state-of-the-art research on miRNAs in intestinal barrier dysfunction.展开更多
BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other function...BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.AIM To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder(FGID)in guiding endoscopic treatment of SOD.METHODS Clinical data of 79 patients with biliary-type SOD(type I and type II)treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST.The significance of relationship between FGID and biliary-type SOD was analyzed.RESULTS Seventy-nine patients with biliary-type SOD received EST,including 29 type 1 patients and 50 type 2 patients.The verbal rating scale-5(VRS-5)scores before EST were all 3 or 4 points,and the scores decreased after EST;the difference was statistically significant(P<0.05).After EST,the serum indexes of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before(P<0.05).After EST,67(84.8%)and 8(10.1%)of the 79 patients with biliary-type SOD had obviously effective(VRS-5=0 points)and effective treatment(VRS-5=1-2 points),with an overall effectiveness rate of 94.9%(75/79).There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST(P>0.05).Of 12 biliary-type SOD(with FGID)patients,11 had abdominal pain after EST;of 67 biliary-type SOD(without FGID)patients,0 had abdominal pain after EST.The difference was statistically significant(P<0.05).The 11 biliary-type SOD(with FGID)patients with recurrence of symptoms,the recurrence time was about half a year after the EST,and the symptoms were significantly relieved after regular medical treatment.There were 4 cases of postendoscopic retrograde cholangiopancreatography pancreatitis(5.1%),and no cholangitis,bleeding or perforation occurred.Patients were followed up for 1 year to 5 years after EST,with an average follow-up time of 2.34 years,and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.CONCLUSION EST is a safe and effective treatment for SOD.For patients with type I and II SOD combined with FGID,single EST or medical treatment has limited efficacy.It is recommended that EST and medicine be combined to improve the cure rate of such patients.展开更多
Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This revi...Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This review delves into the epidemiological connections between IBD and ASCVD,elucidating potential underlying mechanisms.Furthermore,it discusses the impact of current IBD treatments on cardiovascular risk.Additionally,the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated,drawing parallels with observations in patients with rheumatoid arthritis.This article aims to comprehensively evaluate the existing evidence supporting these associations.To achieve this,we conducted a meticulous search of PubMed,spanning from inception to August 2023,using a carefully selected set of keywords.The search encompassed topics related to IBD,such as Crohn’s disease and ulcerative colitis,as well as ASCVD,including coronary artery disease,cardiovascular disease,atrial fibrillation,heart failure,conduction abnormalities,heart blocks,and premature coronary artery disease.This review encompasses various types of literature,including retrospective and prospective cohort studies,clinical trials,meta-analyses,and relevant guidelines,with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.展开更多
目的:检索并整合脊髓损伤患者神经源性肠道功能障碍(Neurogenic Bowel Dysfunction,NBD)管理最佳证据,为医护人员提供参考。方法:依次检索UpToDate、BMJ Best Practice、JBI、Cochrane Library、国际指南协作网、美国国立指南库、美国...目的:检索并整合脊髓损伤患者神经源性肠道功能障碍(Neurogenic Bowel Dysfunction,NBD)管理最佳证据,为医护人员提供参考。方法:依次检索UpToDate、BMJ Best Practice、JBI、Cochrane Library、国际指南协作网、美国国立指南库、美国脊髓损伤协会、PubMed、Embase、Web of Science、中国知网、万方等数据库,关于脊髓损伤患者NBD管理文献,包括临床决策、临床实践指南、证据总结、系统评价、专家共识、随机对照试验,检索时限为建库至2022年4月15日,双人对文献质量进行评价。结果:共纳入18篇文献,从肠道功能评估、营养支持、非药物干预、药物干预、康复锻炼、教育支持6个方面归纳出22条证据。结论:该研究总结了脊髓损伤患者NBD管理最佳证据,医护人员应结合临床情景与患者意愿进行临床应用。展开更多
目的观察次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床疗效。方法将74例脊髓损伤后神经源性肠道功能障碍(便秘型)患者随机分为研究组38例和对照组36例。两组均接受常规治疗同时,研究组采用次髎穴埋线治疗,对照组采用口...目的观察次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床疗效。方法将74例脊髓损伤后神经源性肠道功能障碍(便秘型)患者随机分为研究组38例和对照组36例。两组均接受常规治疗同时,研究组采用次髎穴埋线治疗,对照组采用口服乳果糖治疗。比较两组治疗前后排便频率、排便时间、Wexner便秘评分、神经源性肠道功能障碍(neurogenic bowel dysfunction,NBD)评分及便秘患者生活质量量表(patient-assessment of constipation quality of life,PAC-QOL)各项评分,并对并发症发生率进行评价。结果两组治疗后排便频率较同组治疗前均显著提高,排便时间均显著缩短,PAC-QOL各项评分均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗后排便频率、排便时间及PAC-QOL各项评分与对照组比较,差异均具有统计学意义(P<0.05)。两组治疗2、4周后Wexner便秘评分及NBD评分较同组治疗前均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗2、4周后Wexner便秘评分及NBD评分均明显低于对照组,两组比较差异均具有统计学意义(P<0.05)。研究组治疗期间并发症发生率为5.3%,对照组为5.6%,两组比较差异无统计学意义(P>0.05)。结论对脊髓损伤后神经源性肠道功能障碍(便秘型)患者采取次髎穴埋线治疗,可提升排便频率,缩短排便时间,改善肠道功能障碍与便秘症状,提高患者生活质量,安全性好。展开更多
目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临...目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临床医学研究所、苏格兰校际指南网、安大略省注册护士协会、美国脊髓损伤学会、美国残疾退伍军人协会、医脉通临床指南库、PubMed、Web of Science、CINAHL、Cochrane Library、Ovid数据库、万方、中国知网、中华医学期刊全文数据库中的相关指南,采用AGREEⅡ对纳入的循证指南进行质量评价,采用JBI的专家共识评价标准对专家共识类指南进行质量评价,运用内容分析法整合指南的推荐意见。结果最终纳入10篇文献,其中6篇循证指南,4篇专家共识类指南。3篇循证指南的质量评价结果为A级,3篇结果为B级。10篇指南内容分析汇总为分类、护理目标、评估、基础肠道护理、药物护理、肠道灌洗、电和磁刺激、并发症预防、健康教育和护理记录10个主题27条推荐意见。结论本研究整合了脊髓损伤神经源性肠道功能障碍相关指南中护理相关内容,总结10个主题,内容丰富,整体质量较高,部分争议内容有待进一步研究。国内脊髓损伤神经源性肠道功能障碍护理指南欠缺,需组建多学科小组构建符合国内临床情境的护理指南。展开更多
AIM: To investigate the disruptions of interstitial cells of Cajal (ICC) in the remaining bowel in rats after massive small bowel resection (mSBR). METHODS: Thirty male Sprague-Dawley rats fitting entry criteria were ...AIM: To investigate the disruptions of interstitial cells of Cajal (ICC) in the remaining bowel in rats after massive small bowel resection (mSBR). METHODS: Thirty male Sprague-Dawley rats fitting entry criteria were divided randomly into three experimental groups (n = 10 each): Group A rats underwent bowel transection and re-anastomosis (sham) and tissue samples were harvested at day 7 post-surgery. Group B and C rats underwent 80% small bowel resection with tissue harvested from Group B rats at day 7 post-surgery, and from Group C rats at day 14 postsurgery. The distribution of ICC at the site of the resid-ual small bowel was evaluated by immunohistochemical analysis of small intestine samples. The ultrastructural changes of ICC in the remnant ileum of model rats 7 and 14 d after mSBR were analyzed by transmission electron microscopy. Intracellular recordings of slow wave oscillations were used to evaluate electrical pacemaking. The protein expression of c-kit, ICC phenotypic markers, and membrane-bound stem cell factor (mSCF) in intestinal smooth muscle of each group were detected by Western blotting. RESULTS: After mSBR, immunohistochemical analysis indicated that the number of c-kit-positive cells was dramatically decreased in Group B rats compared with sham tissues. Significant ultrastructural changes in ICC with associated smooth muscle hypertrophy were also observed. Disordered spontaneous rhythmic contractions with reduced amplitude (8.5 ± 1.4 mV vs 24.8 ± 1.3 mV, P = 0.037) and increased slow wave frequency (39.5 ± 2.1 cycles/min vs 33.0 ± 1.3 cycles/min, P = 0.044) were found in the residual intestinal smooth muscle 7 d post mSBR. The contractile function and electrical activity of intestinal circular smooth muscle returned to normal levels at 14 d post mSBR (amplitude, 14.9 ± 1.6 mV vs 24.8 ± 1.3 mV; frequency, 30.7 ± 1.7 cycles/min vs 33.0 ± 1.3 cycles/min). The expression of Mscf and c-kit protein was decreased at 7 d (P = 0.026), but gradually returned to normal levels at 14 d. The ICC and associated neural networks were disrupted, which was associated with the phenotype alterations of ICC. CONCLUSION: Massive small bowel resection in rats triggered damage to ICC networks and decreased the number of ICC leading to disordered intestinal rhythmicity. The mSCF/c-kit signaling pathway plays a role in the regulation and maintenance of ICC phenotypes.展开更多
Irritable bowel syndrome (IBS) is an intestinal functional disorder with the highest prevalence in the industrialized world. The intestinal microbiota (IM) plays a role in the pathogenesis of IBS and is not merely a c...Irritable bowel syndrome (IBS) is an intestinal functional disorder with the highest prevalence in the industrialized world. The intestinal microbiota (IM) plays a role in the pathogenesis of IBS and is not merely a consequence of this disorder. Previous research efforts have not revealed unequivocal microbiological signatures of IBS, and the experimental results are contradictory. The experimental methodologies adopted to investigate the complex intestinal ecosystem drastically impact the quality and significance of the results. Therefore, to consider the methodological aspects of the research on IM in IBS, we reviewed 29 relevant original research articles identified through a PubMed search using three combinations of keywords: “irritable bowel syndrome + microflora”, “irritable bowel syndrome + microbiota” and “irritable bowel syndrome + microbiome”. For each study, we reviewed the quality and significance of the scientific evidence obtained with respect to the experimental method adopted. The data obtained from each study were compared with all considered publications to identify potential inconsistencies and explain contradictory results. The analytical revision of the studies referenced in the present review has contributed to the identification of microbial groups whose relative abundance significantly alters IBS, suggesting that these microbial groups could be IM signatures for this syndrome. The identification of microbial biomarkers in the IM can be advantageous for the development of new diagnostic tools and novel therapeutic strategies for the treatment of different subtypes of IBS.展开更多
Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the cour...Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians’ awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.展开更多
Irritable bowel syndrome(IBS)is common in the society.Among the putative pathogeneses,gut dysmotility results in pain and disturbed defecation.The latter is probably caused by the effect of abnormal gut water secretio...Irritable bowel syndrome(IBS)is common in the society.Among the putative pathogeneses,gut dysmotility results in pain and disturbed defecation.The latter is probably caused by the effect of abnormal gut water secretion.The interaction between abnormal gas accumulation,abdominal pain and bloating remains controversial.Visceral hypersensitivity and its modification along with the central transmission are the characteristics of IBS patients.The identification of biologic markers based on genetic polymorphisms is undetermined.Imbalanced gut microbiota may alter epithelial permeability to activate nociceptive sensory pathways which in turn lead to IBS.Certain food constituents may exacerbate bowel symptoms.The impact of adult and childhood abuses on IBS is underestimated.Using the concept of biopsychosocial dysfunction can integrate multidimensional pathogeneses.Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are the first-line drug treatment.New drugs targeting receptors governing bowel motility,sensation and secretion can be considered,but clinicians must be aware of their potential serious side effects.Psychiatric drugs and modalities may be the final options for treating intractable subjects.Probiotics of multi-species preparations are safe and worth to be considered for the treatment.Antibiotics are promising but their longterm safety and effectiveness are unknown.Diet therapy including exclusion of certain food constituents is an economic measure.Using relatively safe complementary and alternative medicines(CAMs)may be optional to those patients who failed classical treatment.In conclusion,IBS is a heterogeneous disorder with multidimensional pathogeneses.Personalized medicines with multidisciplinary approaches using different classes of drugs,psychiatric measures,probiotics and antibiotics,dietary therapy,and finally CAMs,can be considered.展开更多
基金Supported by Digestive disease research center,Tehran University of Medical Sciences
文摘AIM:To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both.METHODS: Six thousand four hundred and seventy six patients presented to the Gastro-intestinal (GI) clinic with symptoms of functional dysfunction of GI tract, 1419 patients (62.0% women, 38.0% men; mean age: 37.4±11.5 years) met Rome or Rome criteria(depending on the year of diagnosis)for IBS.2658 patients were diagnosed with GERD based on clinical presentation and endoscopic findings.We assessed other functional symptoms(epigastric pain,nausea,vomiting,belching,constipation and diarrhea)in patients suffering from GERD,IBS or both.RESULTS: Among IBS subjects, 63.6% (69.0% women, 31.0% men; mean age: 36.4±10.3 years) also hadGERD, whereas 34.7% of the non-IBS patients had GERD [odds ratio (OR) =3.2, 95% confidence interval (CI): 2.9-3.7, P<0.0001]. Among patients with GERD, 33.9% of subjects met Rome criteria compared to 13.5% of non-GERD patients (OR=3.6, 95% CI: 3.1-4.3, P<0.0001). Prevalence of all functional symptoms was higher in overlapping GERD and IBS subjects, when compared with their prevalence in the IBS subjects without GERD or GERD only subjects (P<0.05).CONCLUSION: This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.
文摘Exciting new features have been described concerning neurogenic bowel dysfunction,including interactions between the central nervous system,the enteric nervous system,axonal injury,neuronal loss,neurotransmission of noxious and non-noxious stimuli,and the fields of gastroenterology and neurology.Patients with spinal cord injury,myelomeningocele,multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation,incontinence,gastrointestinal motor dysfunction and altered visceral sensitivity.Spinal cord injury is associated with severe autonomic dysfunction,and bowel dysfunction is a major physical and psychological burden for these patients.An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease.Multiple sclerosis is a neurodegenerative disorder in which axonal injury,neuronal loss,and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability.Parkinson's disease is a multisystem disorder involving dopaminergic,noradrenergic,serotoninergic and cholinergic systems,characterizedby motor and non-motor symptoms.Parkinson's disease affects several neuronal structures outside the substantia nigra,among which is the enteric nervous system.Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease,even before the involvement of the central nervous system.This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease,as it could represent the point of entry for a putative environmental factor to initiate the pathological process.This review covers the data related to the etiology,epidemiology,clinical expression,pathophysiology,genetic aspects,gastrointestinal motor dysfunction,visceral sensitivity,management,prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases.Embryological,morphological and experimental studies on animal models and humans are also taken into account.
文摘Endothelial dysfunction is considered one of the etiological factors of inflammatory bowel disease(IBD). An inflammatory process leads to functional and structural changes in the vascular endothelium. An increase of leukocyte adhesiveness and leukocyte diapedesis, as well as an increased vascular smooth muscle tone and procoagulant activity is observed. Structural changes of the vascular endothelium comprise as well capillary and venule remodeling and proliferation of endothelial cells. Hypoxia in the inflammatory area stimulates angiogenesis by upregulation of vascular endothelial growth factor, fibroblast growth factor and tumor necrosis factor-α. Inflammatory mediators also alter the lymphatic vessel function and impair lymph flow, exacerbating tissue edema and accumulation of dead cells and bacteria. The endothelial dysfunction might be diagnosed by the use of two main methods: physical and biochemical. Physical methods are based on the assessment of large arteries vasodilatation in response to an increased flow and receptors stimulation. Flowmediated vasodilatation(FMD) is the method that is the most widely used; however, it is less sensitive in detecting early changes of the endothelium function. Most of the studies demonstrated a decrease of FMD in IBD patients but no changes in the carotic intima-media thickness. Biochemical methods of detecting the endothelial dysfunction are based on the assessment of the synthesis of compounds produced both by the normal and damaged endothelium. The endothelial dysfunction is considered an initial step in the pathogenesis of atherosclerosis in the general population. In IBD patients, the risk of cardiovascular diseases is controversial. Large, prospective studies are needed to establish the role of particular medications or dietary elements in the endothelial dysfunction as well to determine the real risk of cardiovascular diseases.
基金Supported by Grant for Key Clinical Discipline Construction of Shanghai Municipality,China,No.ZK2012B20Phase Ⅱ Outstanding Young Medical Personnel Training Fund of Jinshan District Health Systems,Shanghai,China,No.JWKJ-RCYQ-201207
文摘Defects in intestinal barrier function characterized by an increase in intestinal permeability contribute to intestinal inflammation.Growing evidence has shown that an increase in intestinal permeability has a pathogenic role in diseases such as inflammatory bowel disease(IBD)and celiac disease,and functional bowel disorders such as irritable bowel syndrome.Therefore,clarification of the inflammatory responses,the defense pathway and the corresponding regulatory system is essential and may lead to the development of new therapies.MicroRNAs(miRNAs)are small(19-22nt)noncoding RNA molecules that regulate genes at the post-transcriptional level by base-pairing to specific messenger RNAs for degradation to repress translation.Recent studies suggested that miRNAs are important in the immune response and mediate a critical role in multiple immune response-related disorders.Based on these discoveries,attention has been focused on understanding the role of miRNAs in regulating intestinal barrier dysfunction,especially in IBD.Here,we provide a review of the most recent state-of-the-art research on miRNAs in intestinal barrier dysfunction.
文摘BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.AIM To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder(FGID)in guiding endoscopic treatment of SOD.METHODS Clinical data of 79 patients with biliary-type SOD(type I and type II)treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST.The significance of relationship between FGID and biliary-type SOD was analyzed.RESULTS Seventy-nine patients with biliary-type SOD received EST,including 29 type 1 patients and 50 type 2 patients.The verbal rating scale-5(VRS-5)scores before EST were all 3 or 4 points,and the scores decreased after EST;the difference was statistically significant(P<0.05).After EST,the serum indexes of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before(P<0.05).After EST,67(84.8%)and 8(10.1%)of the 79 patients with biliary-type SOD had obviously effective(VRS-5=0 points)and effective treatment(VRS-5=1-2 points),with an overall effectiveness rate of 94.9%(75/79).There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST(P>0.05).Of 12 biliary-type SOD(with FGID)patients,11 had abdominal pain after EST;of 67 biliary-type SOD(without FGID)patients,0 had abdominal pain after EST.The difference was statistically significant(P<0.05).The 11 biliary-type SOD(with FGID)patients with recurrence of symptoms,the recurrence time was about half a year after the EST,and the symptoms were significantly relieved after regular medical treatment.There were 4 cases of postendoscopic retrograde cholangiopancreatography pancreatitis(5.1%),and no cholangitis,bleeding or perforation occurred.Patients were followed up for 1 year to 5 years after EST,with an average follow-up time of 2.34 years,and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.CONCLUSION EST is a safe and effective treatment for SOD.For patients with type I and II SOD combined with FGID,single EST or medical treatment has limited efficacy.It is recommended that EST and medicine be combined to improve the cure rate of such patients.
文摘Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This review delves into the epidemiological connections between IBD and ASCVD,elucidating potential underlying mechanisms.Furthermore,it discusses the impact of current IBD treatments on cardiovascular risk.Additionally,the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated,drawing parallels with observations in patients with rheumatoid arthritis.This article aims to comprehensively evaluate the existing evidence supporting these associations.To achieve this,we conducted a meticulous search of PubMed,spanning from inception to August 2023,using a carefully selected set of keywords.The search encompassed topics related to IBD,such as Crohn’s disease and ulcerative colitis,as well as ASCVD,including coronary artery disease,cardiovascular disease,atrial fibrillation,heart failure,conduction abnormalities,heart blocks,and premature coronary artery disease.This review encompasses various types of literature,including retrospective and prospective cohort studies,clinical trials,meta-analyses,and relevant guidelines,with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.
文摘目的:检索并整合脊髓损伤患者神经源性肠道功能障碍(Neurogenic Bowel Dysfunction,NBD)管理最佳证据,为医护人员提供参考。方法:依次检索UpToDate、BMJ Best Practice、JBI、Cochrane Library、国际指南协作网、美国国立指南库、美国脊髓损伤协会、PubMed、Embase、Web of Science、中国知网、万方等数据库,关于脊髓损伤患者NBD管理文献,包括临床决策、临床实践指南、证据总结、系统评价、专家共识、随机对照试验,检索时限为建库至2022年4月15日,双人对文献质量进行评价。结果:共纳入18篇文献,从肠道功能评估、营养支持、非药物干预、药物干预、康复锻炼、教育支持6个方面归纳出22条证据。结论:该研究总结了脊髓损伤患者NBD管理最佳证据,医护人员应结合临床情景与患者意愿进行临床应用。
文摘目的观察次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床疗效。方法将74例脊髓损伤后神经源性肠道功能障碍(便秘型)患者随机分为研究组38例和对照组36例。两组均接受常规治疗同时,研究组采用次髎穴埋线治疗,对照组采用口服乳果糖治疗。比较两组治疗前后排便频率、排便时间、Wexner便秘评分、神经源性肠道功能障碍(neurogenic bowel dysfunction,NBD)评分及便秘患者生活质量量表(patient-assessment of constipation quality of life,PAC-QOL)各项评分,并对并发症发生率进行评价。结果两组治疗后排便频率较同组治疗前均显著提高,排便时间均显著缩短,PAC-QOL各项评分均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗后排便频率、排便时间及PAC-QOL各项评分与对照组比较,差异均具有统计学意义(P<0.05)。两组治疗2、4周后Wexner便秘评分及NBD评分较同组治疗前均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗2、4周后Wexner便秘评分及NBD评分均明显低于对照组,两组比较差异均具有统计学意义(P<0.05)。研究组治疗期间并发症发生率为5.3%,对照组为5.6%,两组比较差异无统计学意义(P>0.05)。结论对脊髓损伤后神经源性肠道功能障碍(便秘型)患者采取次髎穴埋线治疗,可提升排便频率,缩短排便时间,改善肠道功能障碍与便秘症状,提高患者生活质量,安全性好。
文摘目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临床医学研究所、苏格兰校际指南网、安大略省注册护士协会、美国脊髓损伤学会、美国残疾退伍军人协会、医脉通临床指南库、PubMed、Web of Science、CINAHL、Cochrane Library、Ovid数据库、万方、中国知网、中华医学期刊全文数据库中的相关指南,采用AGREEⅡ对纳入的循证指南进行质量评价,采用JBI的专家共识评价标准对专家共识类指南进行质量评价,运用内容分析法整合指南的推荐意见。结果最终纳入10篇文献,其中6篇循证指南,4篇专家共识类指南。3篇循证指南的质量评价结果为A级,3篇结果为B级。10篇指南内容分析汇总为分类、护理目标、评估、基础肠道护理、药物护理、肠道灌洗、电和磁刺激、并发症预防、健康教育和护理记录10个主题27条推荐意见。结论本研究整合了脊髓损伤神经源性肠道功能障碍相关指南中护理相关内容,总结10个主题,内容丰富,整体质量较高,部分争议内容有待进一步研究。国内脊髓损伤神经源性肠道功能障碍护理指南欠缺,需组建多学科小组构建符合国内临床情境的护理指南。
基金Supported by Grants from the Program for Innovative Research Team of Shanghai Municipal Education Commission and Special Foundation of Shanghai Municipal Public Health Bureau, LJ06021the National Natural Science Foundation of China, No. 30772270, 30972427the Scientific Foundation of Nantong University, No. 10Z046
文摘AIM: To investigate the disruptions of interstitial cells of Cajal (ICC) in the remaining bowel in rats after massive small bowel resection (mSBR). METHODS: Thirty male Sprague-Dawley rats fitting entry criteria were divided randomly into three experimental groups (n = 10 each): Group A rats underwent bowel transection and re-anastomosis (sham) and tissue samples were harvested at day 7 post-surgery. Group B and C rats underwent 80% small bowel resection with tissue harvested from Group B rats at day 7 post-surgery, and from Group C rats at day 14 postsurgery. The distribution of ICC at the site of the resid-ual small bowel was evaluated by immunohistochemical analysis of small intestine samples. The ultrastructural changes of ICC in the remnant ileum of model rats 7 and 14 d after mSBR were analyzed by transmission electron microscopy. Intracellular recordings of slow wave oscillations were used to evaluate electrical pacemaking. The protein expression of c-kit, ICC phenotypic markers, and membrane-bound stem cell factor (mSCF) in intestinal smooth muscle of each group were detected by Western blotting. RESULTS: After mSBR, immunohistochemical analysis indicated that the number of c-kit-positive cells was dramatically decreased in Group B rats compared with sham tissues. Significant ultrastructural changes in ICC with associated smooth muscle hypertrophy were also observed. Disordered spontaneous rhythmic contractions with reduced amplitude (8.5 ± 1.4 mV vs 24.8 ± 1.3 mV, P = 0.037) and increased slow wave frequency (39.5 ± 2.1 cycles/min vs 33.0 ± 1.3 cycles/min, P = 0.044) were found in the residual intestinal smooth muscle 7 d post mSBR. The contractile function and electrical activity of intestinal circular smooth muscle returned to normal levels at 14 d post mSBR (amplitude, 14.9 ± 1.6 mV vs 24.8 ± 1.3 mV; frequency, 30.7 ± 1.7 cycles/min vs 33.0 ± 1.3 cycles/min). The expression of Mscf and c-kit protein was decreased at 7 d (P = 0.026), but gradually returned to normal levels at 14 d. The ICC and associated neural networks were disrupted, which was associated with the phenotype alterations of ICC. CONCLUSION: Massive small bowel resection in rats triggered damage to ICC networks and decreased the number of ICC leading to disordered intestinal rhythmicity. The mSCF/c-kit signaling pathway plays a role in the regulation and maintenance of ICC phenotypes.
文摘Irritable bowel syndrome (IBS) is an intestinal functional disorder with the highest prevalence in the industrialized world. The intestinal microbiota (IM) plays a role in the pathogenesis of IBS and is not merely a consequence of this disorder. Previous research efforts have not revealed unequivocal microbiological signatures of IBS, and the experimental results are contradictory. The experimental methodologies adopted to investigate the complex intestinal ecosystem drastically impact the quality and significance of the results. Therefore, to consider the methodological aspects of the research on IM in IBS, we reviewed 29 relevant original research articles identified through a PubMed search using three combinations of keywords: “irritable bowel syndrome + microflora”, “irritable bowel syndrome + microbiota” and “irritable bowel syndrome + microbiome”. For each study, we reviewed the quality and significance of the scientific evidence obtained with respect to the experimental method adopted. The data obtained from each study were compared with all considered publications to identify potential inconsistencies and explain contradictory results. The analytical revision of the studies referenced in the present review has contributed to the identification of microbial groups whose relative abundance significantly alters IBS, suggesting that these microbial groups could be IM signatures for this syndrome. The identification of microbial biomarkers in the IM can be advantageous for the development of new diagnostic tools and novel therapeutic strategies for the treatment of different subtypes of IBS.
文摘Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians’ awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.
文摘Irritable bowel syndrome(IBS)is common in the society.Among the putative pathogeneses,gut dysmotility results in pain and disturbed defecation.The latter is probably caused by the effect of abnormal gut water secretion.The interaction between abnormal gas accumulation,abdominal pain and bloating remains controversial.Visceral hypersensitivity and its modification along with the central transmission are the characteristics of IBS patients.The identification of biologic markers based on genetic polymorphisms is undetermined.Imbalanced gut microbiota may alter epithelial permeability to activate nociceptive sensory pathways which in turn lead to IBS.Certain food constituents may exacerbate bowel symptoms.The impact of adult and childhood abuses on IBS is underestimated.Using the concept of biopsychosocial dysfunction can integrate multidimensional pathogeneses.Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are the first-line drug treatment.New drugs targeting receptors governing bowel motility,sensation and secretion can be considered,but clinicians must be aware of their potential serious side effects.Psychiatric drugs and modalities may be the final options for treating intractable subjects.Probiotics of multi-species preparations are safe and worth to be considered for the treatment.Antibiotics are promising but their longterm safety and effectiveness are unknown.Diet therapy including exclusion of certain food constituents is an economic measure.Using relatively safe complementary and alternative medicines(CAMs)may be optional to those patients who failed classical treatment.In conclusion,IBS is a heterogeneous disorder with multidimensional pathogeneses.Personalized medicines with multidisciplinary approaches using different classes of drugs,psychiatric measures,probiotics and antibiotics,dietary therapy,and finally CAMs,can be considered.
