Influence of environmental factors on the onset and courseof inflammatory bowel disease

Numerous environmental factors have been linked with inflammatory bowel disease. These include smoking, diet, hygiene, drugs, geographical and psychosocial factors. These factors may either increase the risk of or protect against developing this condition and can also affect the course of illness in a positive or negative manner. A number of studies have examined the influence of environmental factors on inflammatory bowel diseases as a whole as well as on ulcerative colitis and Crohn's disease separately. As there are differences in the pathogenesis of ulcerative colitis and Crohn's disease, the effect of environmental factors on their onset and course is not always similar. Some factors have shown a consistent association, while reports on others have been conflicting. In this article we discuss the current evidence on the roles of these factors on inflammatory bowel disease, both as causative/protective agents and as modifiers of disease course.

Treatment of Helicobacter pylori infection in the presence of penicillin allergy

Therapy of Helicobacter pylori(H.pylori)requires a combination of antibiotics together with an acid suppressing agent;most treatment regimens include Amoxicillin as one of the antibiotics,which is an important constituent as resistance to it is low.However,allergies to the penicillin group of antibiotics are not uncommon,and treating H.pylori infection in such individuals can be challenging due to the restricted choice of regimens.The aim of this review is to summarise the evidence for therapeutic options in patients with H.pylori infection and penicillin allergy.A literature search was conducted in PubMed for English language publications using the key words‘Helicobacter’and‘treatment’or‘therapy‘and‘penicillin’or‘beta-lactam’and‘allergy’or‘anaphylaxis’.Eighteen studies were identified that specifically evaluated H.pylori treatment success in penicillin allergic patients.The number of subjects in most of them was low and many were retrospective,uncontrolled,single cohort studies.The most effective option for first-line treatment appears to be Bismuth-based quadruple therapy for 10-14 d.The evidence supports second-line treatment with Levoflaxacin-based triple therapy for 10 d.Patients with persistent H.pylori infection after 2 treatment courses should be considered for testing to confirm penicillin allergy.Further treatment should be guided by the results of H.pylori culture and sensitivity testing.

Emerging role of narrow band imaging in duodenum

Endoscopy using magnification narrow band imaging(m NBI) allows detailed assessment of mucosal surface and vascular pattern. This may help in better identification and prediction of the nature of the lesion. The role of this technology in duodenum is still evolving. Studies have shown that m NBI has high accuracy in predicting villous atrophy in the duodenum. Limited data suggests that this technique can provide additional information on duodenal polyps,nodules and ampullary tumour which can help guide their management. In this paper we describe the technique for duodenal assessment using NBI and review the existing literature evaluating its role in diagnosis of various duodenal pathologies.

Systematic review and meta-analysis of the therapeutic effect on functional dyspepsia treated with acupuncture and electroacupuncture

Objective:To review systematically the therapeutic effect and safety of acupuncture or electroacupuncture(EA)on functional dyspepsia(FD).Methods:Using computer,the randomized controlled trials(RCTs)of FD treated with acupuncture or EA were retrieved from the databases,i.e.Cochrane Library,PubMed,EMbase and Web of science,from the date of database establishment to June 1,2020.Using the assessment tool of risk of bias in Cochrane Handbook for systematic reviews of interventions,5.1.0,the quality of the included RCTs were evaluated in methodology.Meta-analysis was performed by RevMan 5.3 software.Results:A total of 10 articles were included,with 1202 cases involved.In this study,the effectiveness of EA or acupuncture on FD was analyzed in comparison with the treatment with sham-acupuncture,sham-EA or western medication.The results indicated that compared with sham-acupuncture or shamEA,acupuncture or EA greatly relieved the clinical symptoms of FD(SMD=-3.03,95%Cl[-3.56,-2.50],P<0.00001)and obtained a higher clinical response rate(OR=5.09,95%CI[3.30,7.86],P<0.00001),but the difference was not significant statistically in gastric electrical activity(P>0.05).Compared with gastric prokinetics,acupuncture or EA more effectively reduced the symptom score(MD=-3.03,95%CI[-3.56,-2.50],P=0.02),but the differences were not significant in the aspects of the improvement of clinical effective rate(OR=1.33,95%CI[0.70,2.52],P=0.39),the promotion of gastric half-emptying(MD=0.23,95%Cl[-1.94,2.40],12=0%,P=0.83),the promotion of motilin secretion(SMD=-0.06,95%CI[-0.23,0.11],I^(2)=0%,P=0.50)and the increase of gastric electrical activity(MD=-0.01,95%Cl[-0.03,0.01],I^(2)=0%,P=0.41).The three RCT studies with adverse events reported indicated that the difference in the incidence of the adverse events was not significant statistically in comparison of acupuncture with sham-acupuncture or gastric prokinetic agent(P<0.05).Conclusion:Regarding the improvement in the symptoms of FD,the effect of EA or acupuncture is superior to the sham-acupuncture group or the western medication group.Simultaneously,the clinical response rate in the treatment with EA or acupuncture is higher than the sham-acupuncture group.During the treatment with EA,some adverse reactions happened in treatment of FD with acupuncture or western medication.Even though there are the limitations in quality and quantity of the included trials,EA and acupuncture still deserve to be promoted in treatment of FD.However,more studies of RCTs with largescale sample,high quality and multiple centers are required for a further verification of the therapeutic effect.