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Digestive and Liver Disease : Official... Jun 2024Narrow-band imaging (NBI) is a readily accessible imaging technique that enhances mucosal visualisation, allowing for a more accurate assessment of duodenal villi.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Narrow-band imaging (NBI) is a readily accessible imaging technique that enhances mucosal visualisation, allowing for a more accurate assessment of duodenal villi. However, its role in the diagnosis of coeliac disease (CD) in clinical practice remains limited.
METHODS
We systematically searched several databases in June 2023 for studies evaluating the diagnostic accuracy of NBI for detecting duodenal villous atrophy (VA) in patients with suspected CD. We calculated the summary sensitivity, specificity, and likelihood ratios using a bivariate random-effects model. The study followed PRISMA guidelines and was registered at PROSPERO (CRD42023428266).
RESULTS
A total of 6 studies with 540 participants were included in the meta-analysis. The summary sensitivity of NBI to detect VA was 93% (95% CI, 81% - 98%), and the summary specificity was 95% (95% CI, 92% - 98%). The area under the summary receiver operating characteristic curve was 0.98 (95% CI, 96 - 99). The positive and negative predictive values of NBI were 94% (95% CI, 92% - 97%) and 92% (95% CI, 90% - 94%), respectively.
CONCLUSION
NBI is an accurate non-invasive tool for identifying and excluding duodenal VA in patients with suspected CD. Further studies using a validated classification are needed to determine the optimal role of NBI in the diagnostic algorithm for CD.
Topics: Celiac Disease; Humans; Narrow Band Imaging; Duodenum; Atrophy; Intestinal Mucosa; Sensitivity and Specificity; ROC Curve
PubMed: 37666682
DOI: 10.1016/j.dld.2023.08.053 -
Journal of Clinical Gastroenterology Jul 2024Current guidelines recommend multiple biopsies from the first (D1) and second (D2) part of duodenum to establish a diagnosis of celiac disease. In this meta-analysis we... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Current guidelines recommend multiple biopsies from the first (D1) and second (D2) part of duodenum to establish a diagnosis of celiac disease. In this meta-analysis we aimed to find whether D1 biopsy can increase the diagnostic yield of adult celiac disease.
METHODS
Literature databases were searched until January 2023 for studies reporting diagnosis of celiac disease in the adult population using D1 biopsy. Meta-analysis was done using a random-effects model. Heterogeneity was assessed by I 2 % and 95% prediction interval statistics. Measured outcomes were diagnostic yield with D1 and D2 biopsies and from 4 versus 2 biopsy samples.
RESULTS
A total of 16 studies were included in the final analysis. The pooled diagnostic rate of celiac disease from D1 biopsy was 77.4% [95% CI (64.7-86.5, I 2 94%)] and from D2 biopsy was 75.3% [60.8-85.7, I 2 96%]. The pooled rate of increase in diagnostic yield with D1 biopsy was 6.9% I [4.6-10.2, I 2 66%]. The pooled diagnosis rate with 2 biopsy samples were 77.3% [50-92, I 2 93%] and 86.4% I [58.4-96.7, I 2 87%] from D1 and D2 respectively, whereas that with 4 biopsy samples were 83.3% [49.8-96.2, I 2 76%] and 70.5% I [51-84.6, I 2 96%] from D1 and D2, respectively, the difference being non-significant.
CONCLUSION
Our study demonstrates that taking 4 biopsy samples does not incur any additional diagnostic value over taking 2 biopsy samples from each duodenum segment. Although biopsy from the D1 and D2 has similar diagnostic yield in the adult population, there was an overall increase in diagnostic yield with D1 biopsy, especially in those with a patchy disease distribution.
Topics: Celiac Disease; Humans; Biopsy; Duodenum; Adult
PubMed: 37646538
DOI: 10.1097/MCG.0000000000001913 -
Digestive and Liver Disease : Official... Apr 2024The role of small-bowel (SB) cancer surveillance by capsule endoscopy (CE) in Lynch syndrome (LS) patients has been investigated in recent years, with contradicting... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
The role of small-bowel (SB) cancer surveillance by capsule endoscopy (CE) in Lynch syndrome (LS) patients has been investigated in recent years, with contradicting results. This meta-analysis evaluates the diagnostic yield (DY) of CE as a screening tool in asymptomatic LS patients.
METHODS
A systematic literature search was performed for all studies reporting the results of SB cancer screening in patients with LS. The primary outcome was the evaluation of the DY of CE in this setting for consecutive screening rounds.
RESULTS
Five studies comprising 428 patients and CE 677 procedures were included for data extraction and statistical analysis. The estimated pooled DY for CE-identified pathological findings was 8% in the first screening round and 6% in the second. Limiting the analysis to histologically-confirmed pathological findings, the pooled DY of second-round screening dropped to 0%. The included studies showed a significantly different prevalence of pathogenic variants in mismatch repair (path_MMR) genes, which underlie different cumulative incidences of extracolonic cancers.
CONCLUSIONS
SB surveillance by CE with a 2-year interval in asymptomatic LS individuals does not appear to be an effective screening strategy. Confirmatory prospective studies in this context are needed, considering the different cumulative incidence of SB tumors according to underlying path_MMR defects.
Topics: Humans; Capsule Endoscopy; Colorectal Neoplasms, Hereditary Nonpolyposis; Prospective Studies; Intestine, Small; Intestinal Neoplasms; Duodenal Neoplasms
PubMed: 37563008
DOI: 10.1016/j.dld.2023.07.028 -
Herz Mar 2024Exercise-based cardiac rehabilitation has positive benefits for patients with chronic heart failure (CHF), but the choice of exercise intensity has been controversial.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Exercise-based cardiac rehabilitation has positive benefits for patients with chronic heart failure (CHF), but the choice of exercise intensity has been controversial. The aim of this systematic review and meta-analysis was to investigate the effects of different exercise intensities on cardiopulmonary function and quality of life (QoL) of patients with CHF.
METHODS
Randomized controlled trials (RCTs) of different exercise intensities applied to patients with CHF were searched in PubMed, Web of Science, the Cochrane Library, and Embase databases from inception to December 2021. Study selection and data extraction were performed simultaneously by two independent reviewers, using the Physiotherapy Evidence Database Scale (PEDro) for quality assessment of the included literature. The weighted mean differences (WMD) or standardized mean difference (SMD) were calculated by employing a fixed or random effects model. Other statistical analyses included subgroup analysis and sensitivity analysis. Quality of evidence was evaluated by the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) method.
RESULTS
Eight RCTs were included. Analyses reported no significant improvement in left ventricular ejection fractions (LVEF; WMD = 0.47, 95% CI [-4.10, 5.03], p = 0.841), peak oxygen uptake (peak VO) (SMD = 0.38, 95% CI [-0.03, 0.80], p = 0.069) and 6‑min walking distance (6MWD) (WMD = 14.10, 95% CI [-9.51, 37.72], p = 0.242). Exercise interventions of varying intensity produced small-to-moderate beneficial effects on QoL (WMD = -4.99, 95% CI [-8.29, -1.68], p = 0.003), which appeared to be attenuated at long-term follow-up (WMD = 2.12, 95% CI [-2.91, 7.16], p = 0.409).
CONCLUSION
High-intensity exercise does not have a significant advantage over moderate-intensity exercise in improving cardiopulmonary function and aerobic capacity in patients with CHF. Beneficial changes in QoL from high-intensity exercise also appeared to decrease during long-term follow-up, indicating a cumulative effect of the efficacy of high-intensity exercise.
Topics: Humans; Exercise Therapy; Exercise; Heart Failure; Quality of Life; Chronic Disease
PubMed: 37552242
DOI: 10.1007/s00059-023-05202-5 -
Gastrointestinal Endoscopy Dec 2023The current standard of practice is to use a duodenoscope for the evaluation of the major duodenal papilla (MDP). Recently, cap-assisted endoscopy (CAE), which uses a... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
The current standard of practice is to use a duodenoscope for the evaluation of the major duodenal papilla (MDP). Recently, cap-assisted endoscopy (CAE), which uses a transparent cap at the tip of a standard front-viewing endoscope, has emerged as an alternative.
METHODS
A systematic literature search was performed in several databases from inception to January 2023 to identify studies evaluating the efficacy of CAE for the evaluation of the MDP.
RESULTS
Nine studies including 806 patients met our inclusion criteria. The pooled rate of technical success for CAE was 93.2% (95% confidence interval, 85.6-96.9; I = 84.6%). A subgroup analysis comparing CAE with a standard endoscope showed higher odds for the evaluation of the MDP with CAE (but not a duodenoscope, which was better than CAE) with an odds ratio of 57.294 (95% confidence interval, 17.767-184.755; I = 45.303%).
CONCLUSIONS
CAE offers a significant advantage with high rates of complete MDP evaluation compared with standard forward-viewing endoscopy. However, CAE is associated with lower rates of success when compared with side-viewing endoscopes.
Topics: Humans; Ampulla of Vater; Endoscopy, Gastrointestinal; Endoscopes; Duodenoscopes
PubMed: 37544335
DOI: 10.1016/j.gie.2023.07.050 -
International Orthodontics Dec 2023The aim of this systematic review (Prospero CRD42022323188) is to investigate whether an association exists in patients with amelogenesis imperfecta (AI) between...
INTRODUCTION
The aim of this systematic review (Prospero CRD42022323188) is to investigate whether an association exists in patients with amelogenesis imperfecta (AI) between occlusal characteristics and genotype on the one hand and enamel structural phenotype on the other.
MATERIAL AND METHODS
Reports up to May 2023 assessing occlusion of individuals with AI were browsed in a systematic search using Medline, Embase, ISI Web of Science, and the grey literature. Randomised control trials, case control studies, and case series specifying both occlusion, assessed by cephalometric or clinical analysis, and genotype or dental phenotype in patients with AI were included without any age limitation. Two authors independently selected the publications and extracted the data in accordance with the PRISMA statement. The risk of bias was assessed with the Critical Appraisal Checklists from the Johanna Briggs Institute.
RESULTS
Twenty-five articles were chosen from the 261 results. Most of the included publications were case series (n=22) and case control studies (n=3). Thirteen studies reported both a genotype (ENAM, FAM83H, FAM20A, DLX3, CNMM4, WDR72) and occlusal diagnostic. The methodological quality of the studies was moderate. All AI phenotypes showed an open bite (OB) rate around 35%, except mixed form. The other malocclusions were not often mentioned. No correlation between occlusal phenotype and genotype or AI phenotype could be identified in patients with AI, as most studies had short occlusal descriptions and small sample sizes.
CONCLUSION
OB malocclusions were more frequently reported in AI. This review highlighted the need for a more accurate description of orofacial features associated with AI, to better clarify the role of amelogenesis genes in the regulation of craniofacial morphogenesis and identify patients requiring orthognathic surgery at an early stage.
Topics: Humans; Amelogenesis Imperfecta; Genotype; Phenotype; Dental Enamel; Malocclusion; Open Bite; Proteins
PubMed: 37494776
DOI: 10.1016/j.ortho.2023.100789 -
Pediatric Surgery International Jul 2023Long-term follow-up of congenital duodenal obstruction patients often falls on care providers with little experience of this condition. We performed a systematic review... (Review)
Review
PURPOSE
Long-term follow-up of congenital duodenal obstruction patients often falls on care providers with little experience of this condition. We performed a systematic review of the long-term outcomes of duodenal obstruction and provide a summary of sequelae care providers should anticipate.
METHODS
In 2022, after registering with PROSPERA, Medline (Ovid), EMBASE, PSYCHINFO, CNAHL and SCOPUS databases were searched using the title keyword 'intestinal atresia'. Abstracts were filtered for inclusion if they included the duodenum. Papers of filtered abstracts were included if they reported post-discharge outcomes. Methodological Index for Non-Randomized Studies was used to grade the papers.
RESULTS
Of the 1068 abstracts were screened, 32 papers were reviewed. Eleven studies were included. Thirty additional papers were included after reviewing references, for a total of 41 papers. The average MINORS was 7/16.
CONCLUSION
There is good evidence that children with congenital duodenal obstruction do well in terms of survival, growth and general well-being. Associated cardiac, musculoskeletal and renal anomalies should be ruled-out. Care providers should be aware of anastomotic dysfunction, blind loop syndrome, bowel obstruction and reflux. Reflux may be asymptomatic. Laparoscopic repair does not change long-term outcomes, and associated Trisomy 21 worsens neurodevelopmental outcomes.
Topics: Child; Humans; Duodenal Obstruction; Aftercare; Follow-Up Studies; Patient Discharge; Duodenum
PubMed: 37490166
DOI: 10.1007/s00383-023-05515-w -
Animal : An International Journal of... Dec 2023Methionine (Met) is an essential amino acid that can be supplied in different chemical forms: DL-Met, L-Met, and OH-Met. This study aimed (i) to model and compare the... (Meta-Analysis)
Meta-Analysis
Methionine (Met) is an essential amino acid that can be supplied in different chemical forms: DL-Met, L-Met, and OH-Met. This study aimed (i) to model and compare the utilization efficiency of Met for protein deposition (PD) from all sources and (ii) to determine the efficacy and efficiency of these three free Met sources in average daily gain (ADG) of post-weaning pigs fed at or below the Met requirement. A systematic review of the literature resulted in 1 898 papers being screened for title and abstract, with 24 papers meeting the inclusion criteria. The resulting database containing 208 treatment means was used. Prior to model development, the standardized ileal digestible (SID) Met requirements in percentage in the diet were determined using initial and final BW according to the NRC (2012). Data from piglets fed above the SID Met requirements were excluded from the database prior to statistical analysis. Linear mixed-effects regression models predicting ADG as a function of free Met source and SID methionine intake (Meti) or methionine + cysteine intake (Met + cys) were used to evaluate the efficacy and efficiency of free Met source for weight gain. Moreover, Met retention was modeled assuming that 16% of ADG is deposited as PD, and that Met accounts for 2% of PD. Met utilization efficiency was calculated as Met after maintenance divided by Met retained in PD. Met utilization efficiency was 77% for the basal diet, decreased (P < 0.01) as Met increased, and was equal among the three free Met sources. The mixed-effects models showed no difference in ADG for three free Met sources evaluated (P > 0.05). However, the efficacy (ADG per unit of SID Met) of free Met sources for weight gain differed between piglets fed L and DL-Met (P < 0.05), while there was no difference (P > 0.05) between piglets fed DL and OH-Met or OH and L-Met. On average, piglets fed L-Met gained 40.3 g/d more weight per unit of increase in SID Meti than those fed DL-Met (model 4; P = 0.05). The efficacy of free Met sources for ADG was also compared using SID Met + cysi as covariable. Piglets fed L- (+11.7 g/d; P = 0.02) or OH-Met (+11.5 g/d; P = 0.04) gained more weight per gram of SID Met + cys compared to those fed DL-Met. In conclusion, although the efficacy of DL- and L-Met for ADG differed, the efficiency for PD of L-, DL-, and OH-Met were not different in piglets fed at or below Met requirement.
Topics: Swine; Animals; Methionine; Animal Feed; Animal Nutritional Physiological Phenomena; Diet; Racemethionine; Weight Gain; Cysteine; Ileum
PubMed: 37482458
DOI: 10.1016/j.animal.2023.100894 -
The Israel Medical Association Journal... Jun 2023Mucins, heavily glycosylated glycoproteins, are synthesized by mucosal surfaces and play an important role in healthy and malignant states. Changes in mucin synthesis,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mucins, heavily glycosylated glycoproteins, are synthesized by mucosal surfaces and play an important role in healthy and malignant states. Changes in mucin synthesis, expression, and secretion may be a primary event or may be secondary to inflammation and carcinogenesis.
OBJECTIVES
To assess current knowledge of mucin expression in the small bowel of celiac disease (CD) patients and to determine possible associations between mucin profile and gluten-free diet.
METHODS
Medical literature searches of articles in English were conducted using the terms mucin and celiac. Observational studies were included. Pooled odds ratios and 95% confidence intervals were calculated.
RESULTS
Of 31 articles initially generated by a literature search, 4 observational studies that fulfilled the inclusion criteria remained eligible for meta-analysis. These studies included 182 patients and 148 controls from four countries (Finland, Japan, Sweden, United States). Mucin expression was significantly increased in small bowel mucosa of CD patients than in normal small bowel mucosa (odds ratio [OR] 7.974, 95% confidence interval [95%CI] (1.599-39.763), P = 0.011] (random-effect model). Heterogeneity was significant: Q = 35.743, df (Q) = 7, P < 0.0001, I2 = 80.416%. ORs for MUC2 and MUC5AC expression in the small bowel mucosa of untreated CD patients were 8.837, 95%CI 0.222-352.283, P = 0.247 and 21.429, 95%CI 3.883-118.255, P < 0.0001, respectively.
CONCLUSIONS
Expression of certain mucin genes in the small bowel mucosa of CD patients is increased and may serve as a diagnostic tool and assist in surveillance programs.
Topics: Humans; Mucins; Celiac Disease; Intestine, Small; Abdomen; Diet, Gluten-Free
PubMed: 37381936
DOI: No ID Found -
Surgical Endoscopy Sep 2023Motorized spiral enteroscopy (MSE) is a novel advance in small bowel examination that is characterized as fast with a deep insertion. The aim of this study was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Motorized spiral enteroscopy (MSE) is a novel advance in small bowel examination that is characterized as fast with a deep insertion. The aim of this study was to elucidate the effectiveness and safety of MSE.
METHODS
Relevant articles that were published before November 1, 2022 were identified by searching PubMed, EMBASE, Cochrane, and the Web of Science. The technical success rate (TSR), total (pan)-enteroscopy rate (TER), depth of maximum insertion (DMI), diagnostic yield, and adverse events were extracted and analyzed. Forest plots were graphed based on random effects models.
RESULTS
A total of 876 patients from 8 studies were eligible for analysis. The pooled results of the TSR were 95.0% [95% confidence interval (CI) 91.0-98.0%, I = 78%, p < 0.01] and the pooled outcome of the TER was 43.1% (95% CI 24.7-62.5%, I = 95%, p < 0.01). The pooled results of the diagnostic and therapeutic yields were 77.2% (95% CI 69.0-84.5%, I = 84%, p < 0.01) and 49.0% (95% CI 38.0-60.1%, I = 89%, p < 0.01), respectively. The pooled estimates of adverse and severe adverse events were 17.2% (95% CI 11.9-23.2%, I = 75%, p < 0.01) and 0.7% (95% CI 0.0-2.1%, I = 37%, p = 0.13), respectively.
CONCLUSION
MSE is a novel alternative approach for small bowel examination that can achieve high TER and diagnostic and therapeutic yields, and relatively low rates of severe adverse events. Head-to-head studies comparing MSE and other device-assisted enteroscopies are warranted.
Topics: Humans; Intestinal Diseases; Endoscopy, Gastrointestinal; Intestine, Small; Laparoscopy; Double-Balloon Enteroscopy
PubMed: 37349592
DOI: 10.1007/s00464-023-10179-7