Advances in Digestive Medicine
ISSN / EISSN : 2351-9797 / 2351-9800
Published by: Wiley-Blackwell (10.1002)
Total articles ≅ 188
Latest articles in this journal
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13304
Background Advances in the last two decades have resulted in better long term remissions in patients with ulcerative colitis (UC), which is defined as an idiopathic, chronic inflammatory disorder of the colonic mucosa. This better remission has not transformed into a better quality of life. Almost one-third of these patients have mild to moderate anaemia, which is one of the main factors leading to decreased quality of life; hence we aimed to determine the prevalence of iron deficiency anaemia (IDA) in UC during remission and its impact on the quality of life in this subpopulation. Methods In this prospective study, all consecutive patients of UC in remission for the last three months were evaluated for disease activity by Simple Clinical Colitis Activity Index (SCCAI), IDA by blood parameters and quality of life by Short Inflammatory Bowel Disease Questionnaire (SIBDQ). All patients with proven IDA were given oral iron supplements (Ferrous Ascorbate elemental iron 100 mg) for three months. Blood parameters, SCCAI and SIBDQ scores were evaluated at the end of therapy to compare them before iron supplementation. Results Out of 125 patients of UC seen during the study period, 69 were in remission. IDA was seen in 34 patients (49.27%). Median pre-intervention and post-intervention quality of life scores-SIBDQ [4.9 (4.2-5.8) vs 5.4 (5.0-6.1)] and blood parameters [Haemoglobin 10.7 (9.8-11.4) gm% vs 13.2 (12.8-13.7) gm%] showed significant improvement after iron supplementation. Conclusion Prevalence of IDA in UC during remission is common (49.27%). Oral iron supplementation improves the quality of life and anaemia significantly without increasing disease activity in UC under remission.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13300
Background/Purpose There are few studies on the treatment outcomes of adalimumab therapy in Taiwanese patients with ulcerative colitis (UC). Methods A total of 102 patients with ulcerative colitis were identified from the electronic clinical database of the Changhua Christian Hospital. The demographic data and clinical features of the disease pattern of the UC patients receiving adalimumab therapy were retrospectively reviewed. Results Between January 2015 and June 2020, 18 patients with UC received adalimumab therapy. Due to the absence of a response, 5 of the 18 patients (27.7%) only received the induction therapy. Of the 13 patients who received maintenance adalimumab therapy, 4 discontinued the therapy: 3 (23.1%) stopped due to a loss of response, and one (7.7%) stopped due to a cutaneous reaction to adalimumab. Because of Taiwan's 1-year limit on the use of adalimumab, 7 patients relapsed and required a 2nd course of therapy. The median period between course completion and relapse was 31 weeks. Two (20%) of the ten patients who finished the 1st course of therapy did not experience a relapse. Conclusions The treatment response of patients with UC to adalimumab therapy appears to be comparable to those in previously published Western studies. The majority of patients who responded to adalimumab will relapse following a limited duration of adalimumab therapy in Taiwan.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13301
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13302
Background Data regarding the patient characteristics of hepatitis C virus (HCV) reinfection following viral eradication by a prior course of direct-acting antivirals (DAAs) and the clinical performance of pangenotypic DAAs to retreat such patients are lacking. Methods The demographics and potential routes of transmission were shown in 22 patients with confirmed reinfection following HCV clearance by a prior course of DAAs. Twenty patients received retreatment with pangenotypic sofosbuvir/velpatasvir (SOF/VEL) or glecaprevir/pibrentasvir (GLE/PIB) according to label recommendations. The sustained virologic response (SVR12) rates and the tolerance following treatment were reported. Results The incidence rates of reinfection among human immunodeficiency virus (HIV)-positive and HIV-negative patients were 8.33 per 100 person-years (95% CI: 5.33-12.78) and 0.30 per 100 person-years (95% CI: 0.12-0.77), respectively. Eighteen (81.8%) patients had HIV coinfection. The elapsed time between SVR12 and reinfection ranged from 3 to 36 months. Twenty (90.9%) patients had different viral genotypes/subtypes before and after HCV reinfection. Prior to reinfection, 15 (68.2%) patients achieved SVR12 using SOF/VEL or GLE/PIB. Twelve and eight patients were retreated with SOF/VEL for 12 weeks and GLE/PIB for 8 weeks, respectively, in whom SVR12 was all achieved. All patients completed the assigned course of retreatment without interruption and all had excellent tolerance. Conclusions The risk of HCV reinfection is higher in HIV-positive patients than HIV-negative patients following DAA-induced SVR. Treating reinfected patients with SOF/VEL or GLE/PIB as DAA-naïve patients has excellent effectiveness and tolerance, irrespective of the type of prior DAA exposure or viral genotypes/subtypes.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13307
A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half-broken during a diagnostic test for SARS-CoV-2. Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS-CoV-2 test.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13306
A low-residue diet (LRD) is recommended as part of bowel preparation before a colonoscopy. However, the optimal duration of the LRD is unclear. A retrospective cross-sectional study was therefore conducted at E-Da Dachang hospital. We compared bowel preparations using the Aronchick score and other quality metrics during two consecutive periods: May 2019 to December 2019 (3-day LRD) and January 2020 to August 2020 (1-day LRD). A total of 2823 patients were enrolled (1592 in the 3-day LRD group and 1231 in the 1-day LRD group). The most common bowel cleansing agent was sodium picosulfate and magnesium citrate (SPMC, 84.2%), followed by polyethylene glycol (PEG, 10.0%) and sodium phosphate (5.8%). Compared with patients in the 3-day LRD group, patients in the 1-day LRD group had higher SPMC use (88.1% vs. 81.3%, P < .001) and supplemental laxative use (25.9% vs. 19.3%, P < .001). The proportion of adequate bowel preparation (84.2% vs. 85.1%, P = .563), cecal intubation rate, adenoma detection rate, and right-side adenoma detection rate were not significantly different between 1-day LRD and 3-day LRD groups. More advanced adenomas (5.9% vs. 3.4%, P = .002) and sessile serrated lesions (8.9% vs. 6.3%, P = .014) were observed in the 1-day LRD group. In addition, the types of laxatives (SPMC, sodium phosphate, and PEG) and the use of supplemental laxatives did not affect bowel preparation scores. In conclusion, a 1-day LRD led to bowel preparation similar to that achieved through a 3-day LRD regardless of the type of primary cleansing agent or the use of supplemental laxatives.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13305
Background Hepatitis after transarterial chemoembolization (TACE) is common. Stronger Neo-Minophagen C (SNMC) has demonstrated benefits in patients with hepatitis. We aimed to determine its usefulness in post-TACE hepatitis in patients with hepatomas. Methods Overall, 60 patients with hepatomas who were treated with TACE were prospectively analyzed; of these, 30 patients underwent SNMC treatment after TACE. Daily serial changes in the liver function tests (serum levels of aspartate aminotransferase [AST], alanine aminotransferase [ALT], total bilirubin, prolonged prothrombin time, and international normalized ratio [PT/INR]) were compared between the two groups. Common complications, such as fever, nausea, and emesis, were also compared. Results There were no significant differences in baseline characteristics between the groups (p > 0.05). Although the absolute value of AST/ALT was lower in the SNMC treatment group, differences between the groups were nonsignificant. Total bilirubin and PT/INR levels were significantly different between the groups (p = 0.03 and 0.02, respectively), thus indicating potential SNMC effects on hepatocyte regeneration. Significant differences were also observed between the groups with respect to fever and nausea/emesis (both p = 0.002). Side effects of SNMC, such as hyperkalemia or hypertension, were not significantly different between the groups. Conclusion SNMC demonstrated some benefits in patients with hepatomas after TACE.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13299
Background Pancreatic divisum is a common congenital anomaly that can cause chronic pancreatitis or abdominal pain. Endoscopic retrograde cholangiopancreatography with pancreas duct stenting is the treatment of choice, but sometimes it is very difficult for minor papilla cannulation. Methods We presented a difficult case in which pancreas duct stenting was performed successfully by endoscopic ultrasonography–guided rendezvous method. Results The patient was free from symptoms for several years after months of pancreas duct stenting. Conclusion While it is difficult to approach the minor papilla, endoscopic ultrasonography–guided rendezvous method is a good choice.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13297
Inverted colonic diverticula (ICD) are infrequent colonoscopy findings and usually can be misdiagnosed as colon polyps. Further endoscopic intervention including biopsy or polypectomy is dangerous and might lead to severe complications. We report a case of inverted colonic diverticulum mimic colon polyp, characteristics with Aurora rings surrounding the lesion and these rings were enhanced by narrow-band imaging. Besides, the polypoid lesion was reverted to typical diverticular appearance after direct water jet. Endoscopists should be aware of the possibility of ICD and be familiar with the endoscopic characteristics and maneuvers for different diagnosis of ICD from colon polyps to avoid unnecessary dangerous intervention.
Advances in Digestive Medicine; https://doi.org/10.1002/aid2.13296
Background/Objective Although surgical resection is a curative treatment for early hepatocellular carcinoma (HCC), the incidence of recurrence is still high. The factors associated with HCC recurrence are unclear and deserve investigation. Methods The early HCC patients receiving surgical resection in Taipei Tzu Chi Hospital were enrolled retrospectively. Those with histologically micro-vascular invasion and largest tumor size > 5 cm were excluded. Aggressive recurrence was defined as multiple recurrence (>3), invasion to vessel or extra-hepatic metastasis at the first time of recurrence. Results A total of 125 HCC patients (86 male; mean age 68.74±11.57 year-old) were included for final analysis. The survival rate was 96%, 91.2% and 89.6%, at year 1, 3 and 5, respectively. 61 (48.8%) patients had HCC recurrence during the median follow-up duration of 4.4 years. Of them, aggressive recurrence was present in 17 (27.4%) patients. Among patients with recurrent HCC, those with aggressive recurrence had worse survival rates than those without (p=0.008). Multifocal tumor was the predictor associated with HCC recurrence using logistic regression analysis; tumor size was associated with earlier recurrence in aggressive recurrence of HCC using stepwise method (p=0.042). Conclusion Although early HCC patients had satisfactory 5-year survival rates after surgical resection, the incidence of HCC recurrence was still high. The presence of aggressive recurrence had a negative impact on overall survival. Multifocal tumor in histology has higher risk of HCC recurrence, but not the pathologic grade of differentiation. Tumor size was associated with early recurrence in HCC patients with aggressive recurrence.