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Ear, Nose, & Throat Journal Dec 2023The primary aim was to determine the prevalence of gastrointestinal diseases in patients with chronic rhinosinusitis (CRS), utilizing the National Health Insurance...
The primary aim was to determine the prevalence of gastrointestinal diseases in patients with chronic rhinosinusitis (CRS), utilizing the National Health Insurance Research Database (NHIRD) in Taiwan. Several studies have supported the existence of distinct immune patterns between the Asian and Western populations in CRS patients. Through the population-based case-control study, we could compare the differences between various regions and provide further treatment strategies for subsequent studies in Asian CRS patients. The secondary aim was to assess whether different types of CRS influence the correlation with specific GI diseases. Understanding how different phenotypes or endotypes of CRS may relate to distinct GI disease patterns could provide valuable insights into the underlying mechanisms and potential shared pathways between these conditions. We use the NHIRD in Taiwan. Newly diagnosed patients with CRS were selected between January 1, 2001 and December 31, 2017 as the case group, and the controls were defined as individuals without a history of CRS. Patients with CRS were divided into two groups: with nasal polyps and without nasal polyps. We also separated GI tract diseases into four groups based on their different pathophysiologies. This study included 356,245 participants (CRS: 71,249 and control: 284,996). The results showed that CRS was significantly associated with some specific GI tract diseases, including acute/chronic hepatitis B, gastroesophageal reflux disease (GERD) with/without esophagitis, achalasia of cardia, peptic/gastrojejunal ulcer, Crohn's disease, and ulcerative colitis. In addition, when CRS was subcategorized into chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP), GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. A significant association between CRS and premorbid GI tract diseases has been identified. Remarkably, GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. The underlying mechanisms require further investigation and may lead to new treatments for CRS. Researchers can further investigate the mechanisms by referring to our classification method to determine the implications for diagnosis and treatment.
PubMed: 38105251
DOI: 10.1177/01455613231218143 -
Gastrointestinal Endoscopy Jan 2024
Topics: Humans; Gastroesophageal Reflux; Esophagitis, Peptic; Digestive System Surgical Procedures; Myotomy; Esophageal Achalasia; Natural Orifice Endoscopic Surgery; Treatment Outcome; Esophageal Sphincter, Lower; Esophagoscopy
PubMed: 38097303
DOI: 10.1016/j.gie.2023.08.013 -
Pediatric Pulmonology Mar 2024
Topics: Male; Humans; Child; Scimitar Syndrome; Gastroesophageal Reflux; Hernias, Diaphragmatic, Congenital; Liver Diseases; Esophagitis, Peptic
PubMed: 38088201
DOI: 10.1002/ppul.26808 -
Frontiers in Pediatrics 2023Esophageal replacement surgery in children is sometimes necessary for long-gap esophageal atresia. Ileocolic esophagoplasty in the retrosternal space can serve as a good...
INTRODUCTION
Esophageal replacement surgery in children is sometimes necessary for long-gap esophageal atresia. Ileocolic esophagoplasty in the retrosternal space can serve as a good alternative technique in case of hostile posterior mediastinum. We present two cases of successful ileocolic transposition performed at 6 months of age.
METHODS
Esophageal replacement was performed through a midline laparotomy incision associated with a left cervical approach. The ileocolic transplant was pediculized on the right superior colic artery after ligating the right colic and ileocolic vessels. A retrosternal tunnel was created, and the ileocolic transplant pulled through it to reach the cervical region. Proximally, esophageal-ileal anastomosis and, distally, colonic-gastric anastomosis were performed. Ileocolic continuity was repaired.
RESULTS
There were no early postoperative complications. In both cases, the patients presented oral feeding difficulties during the first 6 postoperative months. Thereafter, full oral feeding was achieved, and both patients were clinically asymptomatic during the following 18 and 20 years, respectively, with satisfactory oral radiological assessments, showing no redundancy or inappropriate growth of the graft and no anastomotic stricture. Currently, these patients do not complain of dysphagia, pathological reflux, or respiratory symptoms.
CONCLUSION
When native esophagus preservation in long-gap esophageal atresia is estimated unfeasible, ileocolic transposition in the retrosternal space might be considered a good and safe option, particularly in those difficult cases after multiple previous surgical attempts and mediastinitis. This technique is putatively associated with a beneficial anti-reflux effect, thanks to the presence of the ileocecal valve, in preventing cervical peptic esophagitis. Long-term follow-up confirms that the transposed colon in the retrosternal space did not suffer any abnormal modification in size and growth.
PubMed: 38078333
DOI: 10.3389/fped.2023.1300802 -
Gut Mar 2024As achalasia is a chronic disorder, long-term follow-up data comparing different treatments are essential to select optimal clinical management. Here, we report on the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
As achalasia is a chronic disorder, long-term follow-up data comparing different treatments are essential to select optimal clinical management. Here, we report on the 10-year follow-up of the European Achalasia Trial comparing endoscopic pneumodilation (PD) with laparoscopic Heller myotomy (LHM).
DESIGN
A total of 201 newly diagnosed patients with achalasia were randomised to either a series of PDs (n=96) or LHM (n=105). Patients completed symptom (Eckardt score) and quality-of-life questionnaires, underwent functional tests and upper endoscopy. Primary outcome was therapeutic success defined as Eckardt score 3 at yearly follow-up. Secondary outcomes were the need for retreatment, lower oesophageal sphincter pressure, oesophageal emptying, gastro-oesophageal reflux and the rate of complications.
RESULTS
After 10 years of follow-up, LHM (n=40) and PD (n=36) were equally effective in both the full analysis set (74% vs 74%, p=0.84) and the per protocol set (74% vs 86%, respectively, p=0.07). Subgroup analysis revealed that PD was superior to LHM for type 2 achalasia (p=0.03) while there was a trend, although not significant (p=0.05), that LHM performed better for type 3 achalasia. Barium column height after 5 min at timed barium oesophagram was significantly higher for patients treated with PD compared with LHM, while other parameters, including gastro-oesophageal reflux, were not different.
CONCLUSIONS
PD and LHM are equally effective even after 10 years of follow-up with limited risk to develop gastro-oesophageal reflux. Based on these data, we conclude that PD and LHM can both be proposed as initial treatment of achalasia.
Topics: Humans; Esophageal Achalasia; Esophageal Sphincter, Lower; Heller Myotomy; Follow-Up Studies; Dilatation; Barium; Treatment Outcome; Laparoscopy; Gastroesophageal Reflux; Esophagitis, Peptic
PubMed: 38050085
DOI: 10.1136/gutjnl-2023-331374 -
Clinical and Molecular Hepatology Jan 2024
Topics: Humans; Esophagitis, Peptic; Non-alcoholic Fatty Liver Disease; Incidence
PubMed: 38044039
DOI: 10.3350/cmh.2023.0437 -
Computers in Biology and Medicine Jan 2024Computer-aided diagnosis (CAD) assists endoscopists in analyzing endoscopic images, reducing misdiagnosis rates and enabling timely treatment. A few studies have focused...
Computer-aided diagnosis (CAD) assists endoscopists in analyzing endoscopic images, reducing misdiagnosis rates and enabling timely treatment. A few studies have focused on CAD for gastroesophageal reflux disease, but CAD studies on reflux esophagitis (RE) are still inadequate. This paper presents a CAD study on RE using a dataset collected from hospital, comprising over 3000 images. We propose an uncertainty-aware network with handcrafted features, utilizing representation and classifier decoupling with metric learning to address class imbalance and achieve fine-grained RE classification. To enhance interpretability, the network estimates uncertainty through test time augmentation. The experimental results demonstrate that the proposed network surpasses previous methods, achieving an accuracy of 90.2% and an F1 score of 90.1%.
Topics: Humans; Esophagitis, Peptic; Uncertainty; Diagnosis, Computer-Assisted; Learning
PubMed: 38016373
DOI: 10.1016/j.compbiomed.2023.107751 -
World Journal of Surgical Oncology Nov 2023The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has...
BACKGROUND
The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has persisted. Recent studies have demonstrated their efficacy, but the long-term outcomes and postoperative quality of life (QoL) among patients have yet to be evaluated. Therefore, we compared the short-term and long-term outcomes of the two procedures as well as QoL.
METHODS
The clinical data of 151 patients who underwent total laparoscopic distal gastrectomy (TLDG) at the Gastrointestinal Surgery Department of the Second Hospital of Fujian Medical University from January 2016 to December 2019 were retrospectively analyzed. Of these, 57 cases with Roux-en-Y procedure (R-Y group) and 94 cases with Billroth II with Braun procedure were included (BII + B group). Operative and postoperative conditions, early and late complications, endoscopic outcomes at year 1 and year 3 after surgery, nutritional indicators, and quality of life scores at year 3 postoperatively were compared between the two groups.
RESULTS
The R-Y group recorded a significantly longer operative time (194.65 ± 21.52 vs. 183.88 ± 18.02 min) and anastomotic time (36.96 ± 2.43 vs. 27.97 ± 3.74 min) compared to the BII + B group (p < 0.05). However, no other significant differences were observed in terms of perioperative variables, including blood loss (p > 0.05). Both groups showed comparable rates of early and late complications. Endoscopic findings indicated similar food residuals at years 1 and 3 post-surgery for both groups. The R-Y group had a lower occurrence of residual gastritis and bile reflux at year 1 and year 3 after surgery, with a statistically significant difference (p < 0.001). Reflux esophagitis was not significantly different between the R-Y and BII + B groups in year 1 after surgery (p = 0.820), but the R-Y group had a lower incidence than the BII + B group in year 3 after surgery (p = 0.023). Nutritional outcomes at 3 years after surgery did not differ significantly between the two groups (p > 0.05). Quality of life scores measured by the QLQ-C30 scale were not significantly different between the two groups. However, on the QLQ-STO22 scale, the reflux score was significantly lower in the R-Y group than in the BII + B group (0 [0, 0] vs. 5.56 [0, 11.11]) (p = 0.003). The rest of the scores were not significantly different (p > 0.05).
CONCLUSION
Both R-Y and B II + B reconstructions are equally safe and efficient for TLDG. Nevertheless, the R-Y reconstruction reduces the incidence of residual gastritis, bile reflux, and reflux esophagitis, as well as postoperative reflux symptoms, and provides a better quality of life for patients. R-Y reconstruction is superior to BII + B reconstruction for TLDG.
Topics: Humans; Retrospective Studies; Quality of Life; Bile Reflux; Stomach Neoplasms; Gastroenterostomy; Gastrectomy; Anastomosis, Roux-en-Y; Gastritis; Laparoscopy; Esophagitis, Peptic; Treatment Outcome; Postoperative Complications
PubMed: 37990273
DOI: 10.1186/s12957-023-03249-6 -
Digestive Diseases and Sciences Jan 2024The incidence of early-onset colorectal cancer (CRC) is continuously increasing worldwide. Current guidelines in China recommend average-risk individuals starting CRC...
BACKGROUND
The incidence of early-onset colorectal cancer (CRC) is continuously increasing worldwide. Current guidelines in China recommend average-risk individuals starting CRC screening at age 50.
AIMS
To investigate the relationship between the gastric histopathology and colorectal neoplasms to identify CRC risk factors which potentially guide earlier colonoscopy in individuals aged < 50 years.
METHODS
A retrospective cross-sectional study was conducted on 8819 patients younger than age 50 who underwent gastroscopy and colonoscopy simultaneously between November 7, 2020 and November 14, 2022. Multivariate logistic regression was used to evaluate whether various gastric histopathology are risk factors for different types of colorectal polyps, reporting odds ratios (ORs) with corresponding 95% confidence intervals (CIs).
RESULTS
A total of 3390 cases (38.44%) under 50 years old were diagnosed as colorectal polyps. Advanced age (OR 1.66, 95%CI 1.57-1.76), male sex (OR 2.67, 95%CI 2.33-3.08), Helicobacter pylori (H. pylori) infection (OR 1.43, 95%CI 1.24-1.65), gastric polyps (OR 1.29, 95%CI 1.10-1.52), and low-grade intraepithelial neoplasia (LGIN) (OR 2.52, 95%CI 1.39-4.57) were independent risk factors for colorectal adenomas. For non-adenomatous polyps, reflux esophagitis (OR 1.38, 95%CI 1.11-1.71) was also an independent risk factor. Besides, older age (OR 1.90, 95%CI 1.66-2.18), male sex (OR 2.15, 95%CI 1.60-2.87), and H. pylori infection (OR 1.67, 95%CI 1.24-2.24) were associated with a higher risk of advanced neoplasms (advanced adenoma and CRC).
CONCLUSIONS
Earlier colonoscopy for identification and screening may need to be considered for individuals younger than 50 years old with H. pylori infection, LGIN, gastric polyps, and reflux esophagitis. Risk-adapted CRC screening initiation age allows a personalized and precise screening.
Topics: Humans; Male; Middle Aged; Colonic Polyps; Retrospective Studies; Cross-Sectional Studies; Esophagitis, Peptic; Colonoscopy; Risk Factors; Colorectal Neoplasms; Adenoma; Carcinoma in Situ; Early Detection of Cancer
PubMed: 37989896
DOI: 10.1007/s10620-023-08158-y -
Zhongguo Zhen Jiu = Chinese Acupuncture... Sep 2023
Topics: Humans; Moxibustion; Depression; Acupuncture Therapy; Gastroesophageal Reflux; Esophagitis, Peptic
PubMed: 37986254
DOI: 10.13703/j.0255-2930.20230421-k0001