How much helpful is the capsule endoscopy for the diagnosis of small bowel lesions?

AIM： To assess the practically usefulness and diagnostic yield of this new method in a group of patients with suspected small bowel lesions. METHODS： Capsule endoscopic （CE） examination by using M2A capsule endoscope TM （Given Imaging, Yoqneam, Israel） was performed in thirty nine patients （26 males, 13 females） with suspected small intestinal lesions. The composing of the patients was as follows： obscure gastrointestinal bleeding in twenty three patients, known Crohn＇s disease in 6 patients, in whom CE was used to evaluate the severity and extension of the diseases, chronic diarrhea in 8 patients, abdominal pain in one patient and malignancy in one patient with unknown origin. RESULTS： In two patients CE failed. Different abnormalities were revealed in 26 patients overall. Detection rate of abnormalities was highest among patients with obscure gastrointestinal bleeding and the source of bleeding was demonstrated in 17 of 23 patients with obscure bleeding （73.9%）. Entero-Behcet was diagnosed in two patients by CE as a source of obscure gastrointestinal bleeding. In 6 patients with known Crohn＇s disease, CE revealed better evaluation of the disease extension. In 3 of 8 （37.5%） patients with chronic diarrhea; CE revealed some mucosal abnormalities as the cause of chronic diarrhea. In a patient with unexplained abdominal pain and in a cancer patient with unknown origin, CE examination was normal. CONCLUSION： In our relatively small series, we found that capsule endoscopy is a useful diagnostic tool particularly in diagnosis of obscure gastrointestinal bleeding, chronic diarrhea and in estimating the extension of Crohn＇s disease.

Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

To review the role of multidisciplinary management in treating sporadic duodenal adenomas (SDA). METHODSSDA managed at North Shore Hospital between 2009-2014 were entered into a prospective database. Pathology, endoscopic and surgical management as well as follow up were reviewed. RESULTSTwenty-eight patients (14 male: Median age 68 years) presented with SDA [18 were classified as non ampullary location (NA), 10 as ampullary location (A)]. All SDA were diagnosed on upper gastrointestinal endoscopy and were imaged with a contrast enhanced CT scan of the chest, abdomen and pelvis. Of the NA adenomas 14 were located in the second part, 2 in the first part and 2 in the third part of the duodenum. Two patients declined treatment, 3 patients underwent surgical resection (2 transduodenal resections and 1 pancreaticoduodenectomy), and 23 patients were treated with endoscopic mucosal resection (EMR). The only complication with endoscopic resection was mild pancreatitis post procedure. Patients were followed with gastroduodenoscopy for a median of 22 mo (range: 2-69 mo). There were 8 recurrences treated with EMR with one patient proceeding to pancreaticodeuodenectomy because of high grade dysplasia in the resected specimen and 2 NA recurrences were managed with surgical resection (distal gastrectomy for a lesion in the first part of the duodenum and a transduodenal resection of a lesion in the third part of the duodenum). CONCLUSIONSDA can be treated endoscopically with minimal morbidity and piecemeal resection results in eradication in nearly three quarters of patients. Recurrent SDA can be treated with endoscopic reresection with surgical resection indicated when the lesions are large (> 4 cm in diameter) or demonstrate severe dysplasia or invasive cancer.

mir-3168 targeted inhibition of TP53 promotes malignant transformation and cisplatin resistance of AGS and AGS/DDP gastric cancer cells

Objective:To investigate the effect of mir-3168 on the malignant transformation and cisplatin resistance of AGS and AGS/DDP gastric cancer cells,and to verify its target gene.Methods:The expression of mir-3168 in AGS and AGS/DDP gastric cancer cells was detected by qPCR,and mir-3168 mimic,inhibitor and negative control were synthesized.They were transfected into AGS and AGS/DDP gastric cancer cells,respectively.The expression of mir-3168 and TP53 mRNA was detected by qPCR.Cell viability was detected by CCK8 under gradient cisplatin treatment and non treatment,apoptosis was detected by flow cytometry,cell invasion was detected by Transwell,and TP53 protein expression was detected by western blot,The database predicted the binding sites of mir-3168 and TP53.According to the binding sites,the double luciferase experiment was used to verify the binding of mir-3168 and TP53.Results:Compared with cisplatin sensitive gastric cancer cell AGS,mir-3168 was significantly overexpressed in cisplatin resistant gastric cancer cell AGS/DDP;mir-3168 mimic promotes cisplatin resistance,proliferation and invasion of AGS and AGS/DDP gastric cancer cells,and inhibits apoptosis of AGS and AGS/DDP gastric cancer cells;mir-3168 inhibitor inhibits cisplatin resistance,proliferation and invasion of AGS and AGS/DDP gastric cancer cells,and promotes apoptosis of AGS and AGS/DDP gastric cancer cells;mir-3168 mimic inhibits the expression of TP53 mRNA and protein,and mir-3168 inhibitor promotes the expression of TP53 mRNA and protein;Targetscan database predicted that there was a binding point between mir-3168 and TP53,and the double luciferase experiment suggested that mir-3168 was bound to TP53 through the predicted binding site.Conclusion:mir-3168 may promote the malignant transformation of AGS and AGS/DDP gastric cancer cells and cisplatin resistance by targeting TP53.

Impact of enteroscopy on diagnosis and management of small bowel tumors

Small bowel tumors(SBTs)have been increasingly diagnosed in recent decades.The pathogenesis of this increment is largely unknown,but advances in radiological and endoscopic methods facilitate the improvement of the diagnosis.Capsule endoscopy(CE)and device-assisted enteroscopy(DAE)allow the clinician to assess the entire small bowel in the search for suspicious lesions,or a cause of symptoms.In this review,we discuss the role of enteroscopy,techniques and strategies in the diagnosis and management of SBTs,and a brief description of the most common tumors.

A case of very large intrahepatic bile duct adenoma followed for 7 years

A 70-year-old man was referred to our hospital due to abnormal liver function. A tumor of 92 mm × 61 mm was detected on ultrasound screening of the left liver lobe. Although the tumor was suspected to be intrahepatic bile duct carcinoma, he had chronic heart disease and was unable to undergo surgery. Therefore, he was followed without further testing. No increase in tumor serum markers or tumor size was observed for the subsequent 7 years. We continued to suspect intrahepatic bile duct carcinoma, and we decided to perform a tumor biopsy. Tumor biopsy findings indicated intrahepatic bile duct adenoma(BDA), which is a rare benign epithelial liver tumor typically ranging from 1 mm to20 mm. We herein report a case of very large BDA followed for 7 years.

Non-classical phenotypes of autoimmune hepatitis and advances in diagnosis and treatment

Non-classical manifestations of autoimmune hepatitis can delay diagnosis and treatment. Our aims were to describe the clinical phenotypes that can confound the diagnosis, detail scoring systems that can ensure their recognition, and outline advances in treatment that can improve their outcome. Prime source and review articles in English were selected throuqh Medline from 1970-2008 and assimilated into personal libraries spanning 32 years. Acute severe or asymptomatic presentations and atypical histological findings,including centrilobular zone 3 necrosis and concurrent bile duct changes, are compatible with the diagnosis. Cholangiographic abnormalities may be present in children and adults with the disease, and autoimmune hepatitis must be considered in patients without autoantibodies or with antimitochondrial antibodies and no other cholestatic features. Asymptomatic patients frequently become symptomatic; mild disease can progress; and there are no confident indices that justify withholding treatment. Two diagnostic scoring systems with complementary virtues have been developed to evaluate patients with confusing features. Normal liver tests and tissue constitute the optimal end point of treatment, and the first relapse is an indication for long- term azathioprine therapy. Cyclosporine, tacrolimus and mycophenolate mofetil are promising salvage therapies,and budesonide with azathioprine may be a superior frontline treatment. We conclude that the non-classical phenotypes of autoimmune hepatitis can be recognized promptly, diagnosed accurately, and treated effectively.

Causative factors of discomfort in esophagogastroduodenoscopy: A large-scale cross-sectional study

BACKGROUND It is important to reduce patient discomfort in esophagogastroduodenoscopy.Remedial measures can be taken to alleviate discomfort if the causative factors are determined;however,all the factors have not been elucidated yet.AIM To clearly determine the factors influencing discomfort in transoral esophagogastroduodenoscopy using a large-size cross-sectional study with readily available data.METHODS Consecutive patients who underwent screening transoral esophagogastroduodenoscopy consecutively between August 2017 and October 2017 at a health check-up center were included.Discomfort was evaluated using a face scale between 0 and 10 with a 6-level questionnaire.Univariate and multiple regression analyses were performed to investigate the factors related to the discomfort in esophagogastroduodenoscopy.Univariate analysis was performed in both the unsedated and sedated study groups.Age,sex,height,body mass index,smoking status,alcohol intake,hiatal hernia,history of gastrectomy,biopsy during examination,Lugol’s solution usage,administration of butylscopolamine with/without a sedative(pethidine,midazolam,or both),endoscope model,history of endoscopy,and endoscopists were considered as possible factors of discomfort.RESULTS Finally,1715 patients were enrolled in this study.Overall,the median discomfort score was 2 and the interquartile range was 2-4.High discomfort(score≥6)was recorded in 18%of the participants.According to univariate analysis,in the unsedated group,young age(P<0.001),female sex(P<0.001),and no history of endoscopy(P<0.001)were factors associated with increased discomfort.Significant differences were also noted for height(P=0.007),smoking status(P=0.003),and endoscopists(P<0.001).In the sedation group,young age(P<0.001),female sex(P<0.001),and no history of endoscopy(P=0.004)were associated with increased discomfort;additionally,significant differences were found in smoking status(P<0.001),type of sedation(P<0.001),and endoscopists(P=0.027).There was also a marginal difference due to alcohol intake(P=0.055).Based on multiple regression analysis,young age,female sex,less height,current smoking status,and presence of hiatal hernia[regression coefficients of 0.08,P<0.001(for-1 years);0.45,P=0.013;0.02,P=0.024(for-1 cm);0.35,P=0.036;and 0.34,P=0.003,respectively]were factors that significantly increased discomfort in esophagogastroduodenoscopy.Alternatively,sedation significantly reduced discomfort and pethidine(regression coefficient:-1.47,P<0.001)and midazolam(regression coefficient:-1.63,P=0.001)significantly reduced the discomfort both individually and in combination(regression coefficient:-2.92,P<0.001).A difference in the endoscopist performing the procedure was also associated with discomfort.CONCLUSION Young age,female sex,and smoking are associated with esophagogastroduodenoscopy discomfort.Additionally,heavy alcohol consumption diminished the effects of sedation.These factors are easily obtained and are thus useful.

SARS-CoV-2 and bioimmunotherapy for ulcerative colitis

Novel coronavirus(SARS‑CoV‑2,SARS‑CoV‑2 for short)infection can cause a series of gastrointestinal damage.Related studies have reported that SARS‑CoV‑2 infection can lead to the occurrence and progression of ulcerative colitis,which may be related to the cytokine storm caused by SARS‑CoV‑2 infection.Recently,we have also paid attention to whether infection with SARS‑CoV‑2 will aggravate the condition of UC patients receiving biological immunotherapy and whether vaccination with SARS‑CoV‑2 is safe and effective for these patients.At present,the interaction mechanism between SARS‑CoV‑2,SARS‑CoV‑2 vaccine and ulcerative colitis is not fully understood,and more research is needed to further clarify the relationship.

Effect of erythromycin on gastric emptying

INTRODUCTIONMotility is a general term that embraces allmovements of the gastrointestinal tract,such as con-tractions of smooth muscle,the intralumunal pres-sures,and the transit of chyme throughout thebowel.These movements are modified by the actionsof specialized segments of the intestine and thesphincters,and the whole is integrated by neural andhumoral levels of control.Motility is best understoodteleologically,i.e.as a process that facilitates theother,more fundamental functions of the gut.Thestomach has three major functions:

Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

Primary sclerosing cholangitis （PSC） is a chronic progressive disorder of unknown aetiology characterised by chronic inflammation and stricture formation of the biliary tree. Symptoms include itch and lethargy and in advanced cases cholangitis and end-stage liver disease, however increasing numbers of asymptomatic individuals are being identified. The disease is rare in the general population but is strongly associated with inflammatory bowel disease （IBD） affecting up to 5% of patients with Ulcerative Colitis, with a slightly lower prevalence （up to 3.6%） in Crohns disease. The strength of this association means that the vast majority （ 〉 90%） of patients with PSC also have IBD, although many may have only mild gastro-intestinal symptoms. Usually IBD presents before PSC, although vice-versa can occur and the onset of both conditions can be separated in some cases by many years. Mean age of diagnosis of PSC is in the fitch decade of life with a strong male predominance. Risk is increased in those with a family history of PSC, suggesting a genetic predisposition and the disease is almost exclusive to non-smokers. The ulcerative colitis associated with PSC is characteristically mild, runs a quiescent course, is associated with rectal sparing, more severe right sided disease, backwash ilieitis and has a high risk of pouchitis post-colectomy. Most worrisome is the high risk of colorectal malignancy which necessitates routine colonoscopic surveillance. Cholangiocarcinoma is also a frequent complication of PSC with a 10%-15% lifetime risk of developing this condition. Treatment with high dose ursodeoxycholic acid offers some chemoprotective effects against colorectal malignancy and may decrease symptoms, biochemical and histological progression of liver disease. Small duct PSC patients characteristically have normal cholangiography, and liver biopsy is required for diagnosis, it appears to have a more favourable prognosis. Autoimmune Hepatitis （AIH） is also more prevalent in patients with IBD, with up to 16% of patients with Autoimmune Hepatitis also having ulcerative colitis. A small subgroup of patients have a AIH-PSC overlap syndrome and the management of these patients depends on liver histology, serum IgM levels, autoantibodies, degree of biochemical cholestasis and cholangiography as some of these patients may respond to immunosupression.

How helpful is capsule endoscopy to surgeons?

Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.

Biosimilars in paediatric inflammatory bowel disease

The introduction of biological treatments has changed disease outcomes for patients with inflammatory bowel disease. Biologicals have high efficacy, and can induce and maintain remission after failed responses to conventional immunosuppressive and/or steroid therapy. The increasing occurrence of severe disease at diagnosis has resulted in infliximab being more often introduced as the firstline treatment in a "top-down" approach. Besides their favourable efficacy and safety profile, biologicals have one significant disadvantage, which is their high cost. This results in many patients stopping therapy prematurely, with the maintenance phase being too short. This often leads to disease exacerbation shortly after treatment cessation. Every newly started course of biological therapy can induce production of anti-drug antibodies, which can result in treatment failure and possible allergic/anaphylactic reactions. The introduction of biological biosimilars was intended to greatly reduce therapy costs thus increasing the availability of these agents to more patients. It was also anticipated that biosimilars would prevent premature termination of therapy. Analyses of paediatric data suggest that biosimilar infliximabs are equally effective as the reference infliximab. Safety patterns also seem to be similar. Paediatric experience places costtherapy reductions at around 10%-30%.

Salivary exosomal PSMA7： a promising biomarker of inflammatory bowel disease

Inflammatory bowel disease （IBD） is an intestinal immune-dysfunctional disease worldwide whose prevalence increasing in Asia including China. It is a chronic disease of the gastrointestinal tract with unknown cause. Exosomes are small vesicles in various body fluids. They have diameters of 40-120 nm, and one of their functions is long-distance transfer of various sub- stances. In this study, we investigated the contents of salivary exosomes in patients with IBD and in healthy controls to explore a new biomarker in patients with IBD. In this study, whole saliva was obtained from patients with IBD （ulcerative colitis （UC）, n = 37; Crohn＇s disease （CD）, n = 11） and apparently healthy individuals （HC, n = 10）. Salivary exosomes were extracted from samples, and the proteins within the exosomes were iden- tified by liquid chromatograph-mass spectrometer （LC- MS/MS）. The results showed that more than 2000 proteins were detected in salivary exosomes from patients with IBD. Through gene ontology analysis, we found that proteasome subunit alpha type 7 （PSMA7） showed especially marked differences between patients with IBD and the healthy controls, in that its expression level was much higher in the CD and UC groups. This exosomal protein is related to proteasome activity and inflamma- tory responses. So we conclude that in this research,salivary exosomal PSMA7 was present at high levels in salivary exosomes from subjects with IBD. It can be a very promising biomarker to release the patients from the pain of colonoscopy.

Sticking-bacteria gel enhancing anti-multidrug-resistant microbial therapy under ultrasound

The use of antibiotic could cause severe drug-resistance and the increasing spread of pathogenic drug-resistant bacteria has brought a big threat to human health,hence,some innovative methods inspired,such as sonodynamic therapy,have become increasingly attractive for realizing the antibiotic-free methods against bacterial infection.However,many pathogens can invade normal healthy cells to establish intracellular replicative niches,which makes it more difficult to kill and remove these bacteria.Herein,inspired by respiratory mucus trapping bacteria to kill them,we developed a novel gel of amorphous TiO_(x) nanofibers dotted with Ti_(2)C(OH)_(2) nanosheets,which could capture and trap bacteria into the gel via a strong binding ability toward bacteria by forming a Ti–O–P bond between phosphate in the bacterial wall and Ti-OH in the gel,thereby,efficiently blocking the invasions of bacteria.Also,the gel has excellent ability for generating reactive oxygen species(ROS)under ultrasound irradiation,therefore,the bacteria in the gel could be effectively killed by the ROS produced under ultrasound irradiation.Moreover,Ti2C(OH)2 in the gel was able to scavenge H_(2)O_(2),and transfer it into O_(2) in the infection environment,providing enough O_(2) for sonodynamic therapy.The experimental results have demonstrated that the functional gel obviously accelerated the healing of multidrug-resistant microorganisms-infected wounds.