Gastroenterology Research and Practice The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Association of Tissue Transglutaminase Antibody Titer with Duodenal Histological Changes in Children with Celiac Disease Thu, 27 Oct 2016 11:48:13 +0000 Celiac disease is usually diagnosed by demonstrating gluten enteropathy in small bowel biopsy. Celiac specific antibodies are used as an initial screening test. The goal of this study is to test the relationship of the anti-tTG titer and severity of histological changes in Jordanian children with celiac disease. Method. The medical records of 81 children who had elevated anti-tTG titer and had duodenal biopsies available were retrospectively reviewed. Result. Assessing the association of anti-tTG titer with duodenal histopathological changes, 94% of those with high anti-tTG titer (≥180 U/mL) had histological evidence of celiac disease. There was statistically significant positive association between high anti-tTG titer and Marsh grading as 82% of patients with Marsh III had high anti-tTG titer (Chi2 18.5; P value 0.00; Odds Ratio 8.5). The fraction of patients with Marsh III who were correctly identified as positive by anti-tTG titer ≥ 180 U/mL was high (sensitivity = 81.6). Moreover, the fraction of patients with anti-tTG titer ≥ 180 U/mL who had Marsh III was also high (positive predictive value = 78.4). Conclusion. Anti-tTG titer ≥ 180 U/mL had significant positive association with Marsh III histopathological changes of celiac disease. Hasan Hawamdeh, Basim Al-Zoubi, Yasameen Al Sharqi, Ayman Qasrawi, Yousef Abdelaziz, and Maha Barbar Copyright © 2016 Hasan Hawamdeh et al. All rights reserved. Short-Term Efficacy of Laparoscopic Treatment for Colorectal Cancer in Patients with Schistosomiasis Japonica Mon, 24 Oct 2016 07:08:23 +0000 Introduction. Schistosomiasis is associated with numerous complications such as thrombocytopenia, liver cirrhosis, portal hypertension, and colitis. To the best of our knowledge, the feasibility and outcomes of laparoscopic colorectal surgery in patients with schistosomiasis have not yet been studied. Methods. In this study, the data of 280 patients with colorectal carcinoma along with schistosomiasis japonica infection who underwent laparoscopic or open colorectal surgery were retrospectively analyzed. Preoperative data, operative data, pathological outcomes, postoperative complications, and recovery were compared between patients in the laparoscopic (LAC) and open (OC) groups. Results. There were no significant differences in the preoperative data between the groups. However, fewer postoperative complications, especially severe hypoproteinemia, early postoperative feeding, and shorter postoperative hospital stay, were observed in patients in the LAC group (). The mean operative time was higher in the LAC group (180 min versus 158 min; ), while the mean blood loss was similar (95 mL versus 108 mL; ) between groups. The mean number of lymph nodes harvested was also similar in both groups (15 versus 16; ). Conclusion. Laparoscopic surgery for colorectal cancer is safe in patients with schistosomiasis japonica and has better short-term outcomes than open surgery. Zhu Yi, Jiang Hong-Gang, Chen Zhi-Heng, and Lu Bo-Hao Copyright © 2016 Zhu Yi et al. All rights reserved. Could Total Colectomy with Ileorectal Anastomosis Be an Alternative to Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Selected Ulcerative Colitis Patients? Sun, 23 Oct 2016 11:16:36 +0000 Purpose. To evaluate ileorectal anastomosis (IRA) in selected ulcerative colitis patients. Methods. Early and late complications after IRA and IPAA were investigated. Bowel function and quality of life were assessed. Functional and QoL studies were performed as a matched pair analysis, comparing 98 patients who underwent IRA versus 98 patients who underwent IPAA. Results. In IRA group, 2 patients (1.6%) developed anastomotic l dysplasia (HGD) developed in 3 patients dysplasia (HGD) developed in 3 patients eakage, 1 patient (0.8%) had intestinal obstruction, and 2 patients (1.6%) had abdominal hematoma. Mean follow-up was 11.5 (range: 2–24.3) years. Failure of IRA occurred in 19 patients (15.1%); in 12 patients (9.5%), failure was related to severe proctitis, in 3 patients (2.4%), it was related to the development of high-grade dysplasia, and in 4 patients (3.2%), it was related to the development of rectal cancer. About functional results, stool consistency [liquid (6.7% of IRA patients versus 29% of IPAA patients; )], daily soiling (0% versus 6%; ), and nocturnal soiling (6% versus 25.5%; ) were statistically different. Only 1% of IRA patients versus 11% of IPAA patients had episodes of perianal inflammation (). CGQoL was 0.72 (, SD) in IRA patients and 0.75 (, SD) in IPAA patients (). Conclusion. In selected patients, IRA is an appropriate surgical option, with low morbidity, comparable quality of life, and better functional results than IPAA. Francesco Tonelli, Carmela Di Martino, and Francesco Giudici Copyright © 2016 Francesco Tonelli et al. All rights reserved. The Role of H. pylori CagA in Regulating Hormones of Functional Dyspepsia Patients Thu, 20 Oct 2016 11:43:32 +0000 Helicobacter pylori (H. pylori, Hp) colonizes the stomachs of approximately 20%–80% of humans throughout the world. The Word Healthy Organization (WHO) classified H. pylori as a group 1 carcinogenic factor in 1994. Recently, an increasing number of studies has shown an association between H. pylori infection and various extragastric diseases. Functional dyspepsia (FD) is considered a biopsychosocial disorder with multifactorial pathogenesis, and studies have shown that infection with CagA-positive H. pylori strains could explain some of the symptoms of functional dyspepsia. Moreover, CagA-positive H. pylori strains have been shown to affect the secretion of several hormones, including 5-HT, ghrelin, dopamine, and gastrin, and altered levels of these hormones might be the cause of the psychological disorders of functional dyspepsia patients. This review describes the mutual effects of H. pylori and hormones in functional dyspepsia and provides new insight into the pathogenesis of functional dyspepsia. Wang-Ping Meng, Zhong-Qiong Wang, Jia-Qi Deng, Yi Liu, Ming-Ming Deng, and Mu-Han Lü Copyright © 2016 Wang-Ping Meng et al. All rights reserved. Phase I Clinical Research of Jejunal Interposition in Adenocarcinoma of the Esophagogastric Junction II/III Proximal Gastrectomy Wed, 19 Oct 2016 13:12:01 +0000 Objective. To investigate the feasibility and specific methods of single-tract jejunal interposition between esophagus and remnant stomach (ers-STJI) in adenocarcinoma of the esophagogastric junction (AEG) II/III proximal gastrectomy. Methods. 15 AEG II/III gastric cancer (GC) patients in phase T1-3N0M0 with tumor size <5 cm were selected and they underwent proximal gastrectomy with ers-STJI from August 2013 to August 2014. Results. All of the 15 patients successfully completed GC R0 proximal gastrectomy with ers-STJI and no operative death or no significant complication occurred; one patient had anastomotic inflammatory granuloma. The digestive tract reconstruction time was 29.5 ± 5.7 min; the intraoperative blood loss was 96.7 ± 20.2 mL, and the number of lymph node dissections was 21.3 ± 3.0; the postoperative flatus time was 48.2 ± 11.9 h; the average length of hospital stay was 10.7 ± 2.3 d, and the average hospital stay cost was 60 ± 3 thousands. All of the patients were followed up for 12 months, and their postoperative single food intake, body weight, hemoglobin, and albumin were all recovered to the preoperative levels. Conclusions. The applications of ers-STJI in proximal gastrectomy were safe and feasible, and the length of jejunal interposition could be 15–25 cm. Kai Tao and Jian-Hong Dong Copyright © 2016 Kai Tao and Jian-Hong Dong. All rights reserved. Members of the Cyr61/CTGF/NOV Protein Family: Emerging Players in Hepatic Progenitor Cell Activation and Intrahepatic Cholangiocarcinoma Tue, 18 Oct 2016 14:40:37 +0000 Hepatic stem/progenitor cells (HPC) reside quiescently in normal biliary trees and are activated in the form of ductular reactions during severe liver damage when the replicative ability of hepatocytes is inhibited. HPC niches are full of profibrotic stimuli favoring scarring and hepatocarcinogenesis. The Cyr61/CTGF/NOV (CCN) protein family consists of six members, CCN1/CYR61, CCN2/CTGF, CCN3/NOV, CCN4/WISP1, CCN5/WISP2, and CCN6/WISP3, which function as extracellular signaling modulators to mediate cell-matrix interaction during angiogenesis, wound healing, fibrosis, and tumorigenesis. This study investigated expression patterns of CCN proteins in HPC and cholangiocarcinoma (CCA). Mouse HPC were induced by the biliary toxin 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC). Differential expression patterns of CCN proteins were found in HPC from DDC damaged mice and in human CCA tumors. In addition, we utilized reporter mice that carried Ccn2/Ctgf promoter driven GFP and detected strong Ccn2/Ctgf expression in epithelial cell adhesion molecule (EpCAM)+ HPC under normal conditions and in DDC-induced liver damage. Abundant CCN2/CTGF protein was also found in cytokeratin 19 (CK19)+ human HPC that were surrounded by α-smooth muscle actin (α-SMA)+ myofibroblast cells in intrahepatic CCA tumors. These results suggest that CCN proteins, particularly CCN2/CTGF, function in HPC activation and CCA development. Qunfeng Wu, Marda Jorgensen, Joanna Song, Junmei Zhou, Chen Liu, and Liya Pi Copyright © 2016 Qunfeng Wu et al. All rights reserved. Diagnosis and Management of Gastrointestinal Foreign Bodies Sun, 16 Oct 2016 14:10:04 +0000 Kenya Kamimura, David C. Evans, Ken-ichi Mizuno, and Juan E. Sola Copyright © 2016 Kenya Kamimura et al. All rights reserved. Somatic Comorbidity in Chronic Constipation: More Data from the GECCO Study Sun, 16 Oct 2016 13:42:58 +0000 Background. Comorbidity in chronic constipation has rarely been investigated, despite the fact that constipation can occur as one symptom in a number of neurological, systemic, and other nonintestinal and intestinal disorders. Methods. Of 1037 individuals with constipation identified during a telephone survey, 589 returned a postal questionnaire with valid data, asking for sociographic data, clinical symptoms, comorbid conditions, medication intake, and health care behavior related to constipation. Among them, 245 reported some somatic diagnoses and another 120 regular medication intake. They were compared to individuals without comorbid condition and presumed functional constipation (). Results. Individuals reporting a somatic comorbid condition and/or regular medication were significantly older than those with functional constipation ( and years, resp., ) and had lower health and social status (both ), but similar general life satisfaction (n.s.). Their quality-of-life was lower for the physical () but not for the mental health domain (n.s.), while among those with functional constipation, the mental health domain distinguished IBS-C individuals from those with functional constipation but without pain (). Conclusion. In an unselected population sample with constipated individuals, those with a somatic comorbid condition outnumber those with functional constipation alone and are distinctly different with respect to age and health status. Paul Enck, Johannes Leinert, Menno Smid, Thorsten Köhler, and Juliane Schwille-Kiuntke Copyright © 2016 Paul Enck et al. All rights reserved. Prophylactic Mesh Application during Colostomy to Prevent Parastomal Hernia: A Meta-Analysis Wed, 12 Oct 2016 13:59:51 +0000 Background. Parastomal hernia is a common complication after stoma formation, especially in permanent colostomy. The present meta-analysis aimed to evaluate the effectiveness of prophylactic mesh application during permanent colostomy for preventing parastomal hernia. Methods. Randomized controlled trials comparing outcomes in patients who underwent colostomy with or without prophylactic mesh application were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Libraries. Results. This meta-analysis included 8 randomized controlled trials with 522 participants. Our pooled results showed that prophylactic mesh application (mesh group) reduced the incidence of clinically detected parastomal hernia (risk ratio [RR]: 0.22; 95% confidence interval [CI]: 0.13–0.38; ), radiologically detected parastomal hernia (RR: 0.62; 95% CI: 0.47–0.82; ), and surgical repair for herniation (RR: 0.34; 95% CI: 0.14–0.83; ) when compared with conventional permanent colostomy formation (control group). The incidence of complications, including wound infection, peristomal infection, mesh infection, stomal necrosis and stenosis, stoma site pain, and fistula, was not higher in the mesh group than in the control group. Conclusions. Our meta-analysis demonstrated that prophylactic mesh application at the time of primary colostomy formation is a promising method for the prevention of parastomal herniation. JunJia Zhu, YuWei Pu, XiaoDong Yang, DeBao Zhang, Kui Zhao, Wei Peng, and ChunGen Xing Copyright © 2016 JunJia Zhu et al. All rights reserved. Identifying Risk Factors Associated with Inappropriate Use of Acid Suppressive Therapy at a Community Hospital Wed, 12 Oct 2016 08:28:05 +0000 Purpose. By examining the prescribing patterns and inappropriate use of acid suppressive therapy (AST) during hospitalization and at discharge we sought to identify the risk factors associated with such practices. Methods. In this retrospective observational study, inpatient records were reviewed from January 2011 to December 2013. Treatment with AST was considered appropriate if the patient had a known specific indication or met criteria for stress ulcer prophylaxis. Results. In 2011, out of 58 patients who were on AST on admission, 32 were newly started on it and 23 (72%) were inappropriate cases. In 2012, out of 97 patients on AST, 61 were newly started on it and 51 (84%) were inappropriate cases. In 2013, 99 patients were on AST, of which 48 were newly started on it and 36 (75%) were inappropriate cases. 19% of the patients inappropriately started on AST were discharged on it in three years. Younger age, female sex, and 1 or more handoffs between services were significantly associated with increased risk of inappropriate AST. Conclusion. Our findings reflect inappropriate prescription of AST which leads to increase in costs of care and unnecessarily puts the patient at risk for potential adverse events. The results of this study emphasize the importance of examining the patient’s need for AST at each level of care especially when the identified risk factors are present. Amandeep Singh, Vijay Bodukam, Kirit Saigal, Jaya Bahl, Yvette Wang, Alexandra Hanlon, Yinghui Lu, and Michael Davis Copyright © 2016 Amandeep Singh et al. All rights reserved. Identification of the Key Genes and Pathways in Esophageal Carcinoma Wed, 12 Oct 2016 06:42:58 +0000 Objective. Esophageal carcinoma (EC) is a frequently common malignancy of gastrointestinal cancer in the world. This study aims to screen key genes and pathways in EC and elucidate the mechanism of it. Methods. 5 microarray datasets of EC were downloaded from Gene Expression Omnibus. Differentially expressed genes (DEGs) were screened by bioinformatics analysis. Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, and protein-protein interaction (PPI) network construction were performed to obtain the biological roles of DEGs in EC. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to verify the expression level of DEGs in EC. Results. A total of 1955 genes were filtered as DEGs in EC. The upregulated genes were significantly enriched in cell cycle and the downregulated genes significantly enriched in Endocytosis. PPI network displayed CDK4 and CCT3 were hub proteins in the network. The expression level of 8 dysregulated DEGs including CDK4, CCT3, THSD4, SIM2, MYBL2, CENPF, CDCA3, and CDKN3 was validated in EC compared to adjacent nontumor tissues and the results were matched with the microarray analysis. Conclusion. The significantly DEGs including CDK4, CCT3, THSD4, and SIM2 may play key roles in tumorigenesis and development of EC involved in cell cycle and Endocytosis. Peng Su, Shiwang Wen, Yuefeng Zhang, Yong Li, Yanzhao Xu, Yonggang Zhu, Huilai Lv, Fan Zhang, Mingbo Wang, and Ziqiang Tian Copyright © 2016 Peng Su et al. All rights reserved. Comment on “Lack of Association Found between Helicobacter pylori Infection and Diarrhea-Predominant Irritable Bowel Syndrome: A Multicenter Retrospective Study” Tue, 11 Oct 2016 08:37:30 +0000 Amin Talebi Bezmin Abadi Copyright © 2016 Amin Talebi Bezmin Abadi. All rights reserved. Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract: A Review of the Literature Tue, 11 Oct 2016 07:19:31 +0000 Foreign body ingestion is a common diagnosis that presents in emergency departments throughout the world. Distinct foreign bodies predispose to particular locations of impaction in the gastrointestinal tract, commonly meat boluses in the esophagus above a preexisting esophageal stricture or ring in adults and coins in children. Several other groups are at high risk of foreign body impaction, mentally handicapped individuals or those with psychiatric illness, abusers of drugs or alcohol, and the geriatric population. Patients with foreign body ingestion typically present with odynophagia, dysphagia, sensation of having an object stuck, chest pain, and nausea/vomiting. The majority of foreign bodies pass through the digestive system spontaneously without causing any harm, symptoms, or necessitating any further intervention. A well-documented clinical history and thorough physical exam is critical in making the diagnosis, if additional modalities are needed, a CT scan and diagnostic endoscopy are generally the preferred modalities. Various tools can be used to remove foreign bodies, and endoscopic treatment is safe and effective if performed by a skilled endoscopist. Mikhael Bekkerman, Amit H. Sachdev, Javier Andrade, Yitzhak Twersky, and Shahzad Iqbal Copyright © 2016 Mikhael Bekkerman et al. All rights reserved. Analysis of Predictors for Lymph Node Metastasis in Patients with Superficial Esophageal Carcinoma Wed, 05 Oct 2016 14:25:36 +0000 In order to predict related risk factors for lymph node metastasis (LNM) in patients with superficial esophageal carcinoma (SEC) and provide reference for endoscopic minimally invasive treatment, we included a total of 93 patients with superficial esophageal carcinoma who have underwent esophagectomy and lymph node dissection from 2010 to 2015. The depth of invasion was remeasured and classified into 6 groups according to their wall penetration. The prediction model was founded based on the independent risk factors. The results shows that lymph node metastasis of m1, m2, m3, sm1, sm2, and sm3 of superficial esophageal carcinoma was 0%, 0%, 5.3%, 8.7%, 17.6%, and 37.5%, respectively. The tumor size, differentiation, and lymphvascular invasion were also significantly related to lymph node metastasis by univariate analysis. Multivariate analysis showed that the depth of invasion and lymphovascular invasion were independent risk factors of lymph node metastasis. A prediction model for lymph node metastasis was established as follows: , and = −5.469 + 0.839 × depth of invasion + 1.992 × lymphavascular metastasis. The area under ROC curve was 0.858 (95% CI: 0.757–0.959). It was also shown that the depth of invasion was related to tumor differentiation, macroscopic type, and tumor size. Ruzhen Jia, Qinsong Luan, Jing Wang, Dongsheng Hou, and Shulei Zhao Copyright © 2016 Ruzhen Jia et al. All rights reserved. CD63 and GLUT-1 Overexpression Could Predict a Poor Clinical Outcome in GIST: A Study of 54 Cases with Follow-Up Tue, 04 Oct 2016 13:38:37 +0000 Background and Goals. In light of current knowledge, it seems that alternations underlying GISTs are well explained, although all that is enhanced by various aspects on a daily basis. More recently, attention has been pointed towards exosomes as important particles able to modify healthy and also diseased tissues including cancer. The goal of the present study was an analysis of CD9, CD63, and GLUT-1 as a marker of hypoxia status within 54 cases of GIST and evaluation of their predictive value. Methods. 54 cases of patients suffering from GIST were enrolled into the study, predominantly in the gastric location. All operated cases had no Imatinib and other chemotherapies up to the day of operation. Expression of targeted proteins was performed by immunohistochemistry and, after that, the results with tabulated clinical data were compared by Kaplan-Meier method and multivariate Cox proportional hazard model of statistical analysis. Results. Our results presented a marked dependence of worsening clinical outcome with high expression CD63 () as well as with GLUT-1 (). We noted a strict correlation of GLUT-1 expression with CD63 expression (), which could confirm the thesis about the contribution of exosomes in intratumoural hypoxia status. The collected material did not confirm CD9 contribution. Conclusions. As presented here, CD63 and GLUT-1 have a prognostic value in GIST cases. The results confirm the other studies in this scope and can be used in future as an additional prognostic factor. Piotr Lewitowicz, Jarosław Matykiewicz, Dorota Koziel, Magdalena Chrapek, Agata Horecka-Lewitowicz, and Stanislaw Gluszek Copyright © 2016 Piotr Lewitowicz et al. All rights reserved. Prognostic Importance of Cell Cycle Regulators Cyclin D1 (CCND1) and Cyclin-Dependent Kinase Inhibitor 1B (CDKN1B/p27) in Sporadic Gastric Cancers Mon, 03 Oct 2016 14:03:33 +0000 Background. Gastric cancer is known for a notable variety in the course of the disease. Clinical factors, such as tumor stage, grade, and localization, are key in patient survival. It is expected that molecular factors such as somatic mutations and gene amplifications are also underlying tumor biological behavior and may serve as factors for prognosis estimation. Aim. The purpose of this study was to examine gene amplifications from a panel of genes to uncover potential prognostic marker candidates. Methods. A panel of gene amplifications including 71 genes was tested by multiplex ligation-dependent probe amplification (MLPA) technique in 76 gastric cancer samples from a Caucasian population. The correlation of gene amplification status with patient survival was determined by the Kaplan-Meier method. Results. The amplification of two cell cycle regulators, CCND1 and CDKN1B, was identified to have a negative prognostic role. The medial survival of patients with gastric cancer displaying amplification compared to patients without amplification was 192 versus 725 days for CCND1 () and 165 versus 611 days for CDKN1B (). Conclusion. Gene amplifications of CCND1 and CDKN1B are potential candidates to serve as prognostic markers for the stratification of patients based on the estimate of survival in the management of gastric cancer patients. Petra Minarikova, Lucie Benesova, Tereza Halkova, Barbora Belsanova, Inna Tuckova, Frantisek Belina, Ladislav Dusek, Miroslav Zavoral, and Marek Minarik Copyright © 2016 Petra Minarikova et al. All rights reserved. Laparoscopic Surgery Can Reduce Postoperative Edema Compared with Open Surgery Thu, 29 Sep 2016 09:50:00 +0000 Aim. The study aimed to investigate the impact of laparoscopic surgery and open surgery on postoperative edema in Crohn’s disease. Methods. Patients who required enterectomy were divided into open group (Group O) and laparoscopic group (Group L). Edema was measured using bioelectrical impedance analysis preoperatively (PRE) and on postoperative day 3 (POD3) and postoperative day 5 (POD5). The postoperative edema was divided into slight edema and edema by an edema index, defined as the ratio of total extracellular water to total body water. Results. Patients who underwent laparoscopic surgery had better clinical outcomes and lower levels of inflammatory and stress markers. A total of 31 patients (26.05%) developed slight edema and 53 patients (44.54%) developed edema on POD3. More patients developed postoperative edema in Group O than in Group L on POD3 (). The value of the edema index of Group O was higher than that of Group L on POD3 and POD5 ( versus , ; versus , , resp.). Conclusions. Compared with open surgery, laparoscopic surgery can reduce postoperative edema, which may contribute to the better outcomes of laparoscopic surgery over open surgery. Dong Guo, Jianfeng Gong, Lei Cao, Yao Wei, Zhen Guo, and Weiming Zhu Copyright © 2016 Dong Guo et al. All rights reserved. Evaluation of the Diagnostic Ability of Optical Enhancement System in Early Gastric Cancer Demarcation Wed, 28 Sep 2016 15:28:47 +0000 This study aimed to evaluate the utility of optical enhancement (OE) in early gastric cancer demarcation. Twenty lesions of early gastric cancer were examined by PENTAX endoscopy system with OE-1 and OE-2 functions. The areas of tumor demarcation identified by 12 evaluators (6 novice and 6 experienced) were compared to the corresponding correct areas determined by postoperative histopathology findings. The misdiagnosed scores that were the sums of false-positive and false-negative areas were compared. Color of one hundred pixels from the inside of the cancerous area and the outside of the cancerous area was expressed as three-dimensional RGB component vectors. The mean vectors and covariance matrixes were calculated and the Mahalanobis distance, indicative of color differences between two areas, was tested. Comparisons of the misdiagnosed score revealed that OE-1 was preferred over WL-1 for gastric cancer demarcation for all 12 evaluators () and in novice evaluators (). OE-2 was not significantly different from WL-2 in all cases. OE-1 images gave significantly larger Mahalanobis distances, indicative of color differences, than WL-1 images (). It was demonstrated that the OE Mode 1 has a significant advantage over the white light mode in demarcation of early gastric cancer. Misato Nagao, Jun Nishikawa, Ryo Ogawa, Sho Sasaki, Munetaka Nakamura, Junichi Nishimura, Atsushi Goto, Shinichi Hashimoto, Takeshi Okamoto, Masato Suenaga, Yoshihiko Hamamoto, and Isao Sakaida Copyright © 2016 Misato Nagao et al. All rights reserved. Knowledge, Attitudes, and Practices Related to Preoperative Chemoradiotherapy in Rectal Cancer Patients Tue, 27 Sep 2016 07:22:51 +0000 Background. The aim of this study is to assess the knowledge, attitudes, and practices related to pre-CRT in patients of stage II/III rectal cancer. Materials and Methods. Questionnaires regarding the knowledge, attitudes, and practices of pre-CRT were mailed to 145 rectal cancer patients in II/III stage between January 2012 and December 2014, and 111 agreed to participate and returned completed questionnaires to the researcher. Logistic regression model was used to compare sociodemographic characteristics, knowledge, and attitude with practice, respectively. Results. A total of 145 patients were approached for interview, of which 111 responded and 48.6% (54) had undergone pre-CRT. Only 31.5% of the participants knew that CRT is a treatment of rectal cancer and 39.6% were aware of the importance of CRT. However, the vast majority of participants (68.5%) expressed a positive attitude toward rectal cancer. Multivariate logistic regression analysis revealed that knowledge level () and attitudes () influence the actual practice significantly. Furthermore, age, gender, and income were potential predictors of practice (all ). Conclusion. This study shows that, despite the fact that participants had suboptimal level of knowledge on rectal cancer, their attitude is favorable to pre-CRT. Strengthening the professional health knowledge and realizing the importance of attitudes may deepen patients’ understanding of preoperative therapy. Xingxing Chen, Ruifang Lin, Huifang Li, Meng Su, Wenyi Zhang, Xia Deng, Ping Zhang, and Changlin Zou Copyright © 2016 Xingxing Chen et al. All rights reserved. Crosstalk between Inflammation and ROCK/MLCK Signaling Pathways in Gastrointestinal Disorders with Intestinal Hyperpermeability Mon, 26 Sep 2016 13:42:26 +0000 The barrier function of the intestine is essential for maintaining the normal homeostasis of the gut and mucosal immune system. Abnormalities in intestinal barrier function expressed by increased intestinal permeability have long been observed in various gastrointestinal disorders such as Crohn’s disease (CD), ulcerative colitis (UC), celiac disease, and irritable bowel syndrome (IBS). Imbalance of metabolizing junction proteins and mucosal inflammation contributes to intestinal hyperpermeability. Emerging studies exploring in vitro and in vivo model system demonstrate that Rho-associated coiled-coil containing protein kinase- (ROCK-) and myosin light chain kinase- (MLCK-) mediated pathways are involved in the regulation of intestinal permeability. With this perspective, we aim to summarize the current state of knowledge regarding the role of inflammation and ROCK-/MLCK-mediated pathways leading to intestinal hyperpermeability in gastrointestinal disorders. In the near future, it may be possible to specifically target these specific pathways to develop novel therapies for gastrointestinal disorders associated with increased gut permeability. Lijun Du, John J. Kim, Jinhua Shen, and Ning Dai Copyright © 2016 Lijun Du et al. All rights reserved. Blue Laser Imaging-Bright Improves Endoscopic Recognition of Superficial Esophageal Squamous Cell Carcinoma Thu, 22 Sep 2016 13:34:14 +0000 Background/Aims. The aim of this study was to evaluate the endoscopic recognition of esophageal squamous cell carcinoma (ESCC) using four different methods (Olympus white light imaging (O-WLI), Fujifilm white light imaging (F-WLI), narrow band imaging (NBI), and blue laser imaging- (BLI-) bright). Methods. We retrospectively analyzed 25 superficial ESCCs that had been examined using the four different methods. Subjective evaluation was provided by three endoscopists as a ranking score (RS) of each image based on the ease of detection of the cancerous area. For the objective evaluation we calculated the color difference scores (CDS) between the cancerous and noncancerous areas with each of the four methods. Results. There was no difference between the mean RS of O-WLI and F-WLI. The mean RS of NBI was significantly higher than that of O-WLI and that of BLI-bright was significantly higher than that of F-WLI. Moreover, the mean RS of BLI-bright was significantly higher than that of NBI. Furthermore, in the objective evaluation, the mean CDS of BLI-bright was significantly higher than that of O-WLI, F-WLI, and NBI. Conclusion. The recognition of superficial ESCC using BLI-bright was more efficacious than the other methods tested both subjectively and objectively. Akira Tomie, Osamu Dohi, Nobuaki Yagi, Hiroaki Kitae, Atsushi Majima, Yusuke Horii, Tomoko Kitaichi, Yuriko Onozawa, Kentaro Suzuki, Reiko Kimura-Tsuchiya, Tetsuya Okayama, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiro Katada, Kazuhiko Uchiyama, Takeshi Ishikawa, Tomohisa Takagi, Osamu Handa, Hideyuki Konishi, Yuji Naito, and Yoshito Itoh Copyright © 2016 Akira Tomie et al. All rights reserved. Does Extending the Waiting Time of Low-Rectal Cancer Surgery after Neoadjuvant Chemoradiation Increase the Perioperative Complications? Thu, 22 Sep 2016 12:44:48 +0000 Background. Traditionally, rectal cancer surgery is recommended 6 to 8 weeks after completing neoadjuvant chemoradiation. Extending the waiting time may increase the tumor response rate. However, the perioperative complication rate may increase. The purpose of this study was to determine the association between extending the waiting time of surgery after neoadjuvant chemoradiation and perioperative outcomes. Methods. Sixty patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by radical resection at Siriraj hospital between June 2012 and January 2015 were retrospectively analyzed. Demographic data and perioperative outcomes were compared between the two groups. Results. The two groups were comparable in term of demographic parameters. The mean time interval from neoadjuvant chemoradiation to surgery was 6.4 weeks in Group A and 11.7 weeks in Group B. The perioperative outcomes were not significantly different between Groups A and B. Pathologic examination showed a significantly higher rate of circumferential margin positivity in Group A than in Group B (30% versus 9.3%, resp.; ). Conclusions. Extending the waiting to >8 weeks from neoadjuvant chemoradiation to surgery did not increase perioperative complications, whereas the rate of circumferential margin positivity decreased. Kittinut Timudom, Natthawut Phothong, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Ananya Pongpaibul, Janjira Petsuksiri, Suthinee Ithimakin, and Atthaphorn Trakarnsanga Copyright © 2016 Kittinut Timudom et al. All rights reserved. Mixed Infections of Helicobacter pylori Isolated from Patients with Gastrointestinal Diseases in Taiwan Thu, 22 Sep 2016 11:46:37 +0000 Background. Persistent Helicobacter pylori infection may induce several upper gastrointestinal diseases. Two major virulence factors of H. pylori, vacuolating cytotoxin A (VacA) and cytotoxin-associated gene A (CagA), are thought to be associated with the severity of disease progression. The distribution of vacA and cag-pathogenicity island (cag-PAI) alleles varies in H. pylori isolated from patients in different geographic regions. Aim. To assess the association between mixed infection of H. pylori clinical isolates from Taiwanese patients and the severity of gastrointestinal diseases. Methods. A total of 70 patients were enrolled in this study. Six distinct and well-separated colonies were isolated from each patient and 420 colonies were analyzed to determine the genotypes of virulence genes. Results. The prevalence of mixed infections of all H. pylori-infected patients was 28.6% (20/70). The rate of mixed infections in patients with duodenal ulcer (47.6%) was much higher than that with other gastrointestinal diseases (). Conclusions. H. pylori mixed infections show high genetic diversity that may enhance bacterial adaptation to the hostile environment of the stomach and contribute to disease development. Chih-Ho Lai, Ju-Chun Huang, Chuan Chiang-Ni, Ju-Pi Li, Lii-Tzu Wu, Hua-Shan Wu, Yu-Chen Sun, Mei-Ling Lin, Ju-Fang Lee, and Hwai-Jeng Lin Copyright © 2016 Chih-Ho Lai et al. All rights reserved. Infliximab Combined with Enteral Nutrition for Managing Crohn’s Disease Complicated with Intestinal Fistulas Thu, 22 Sep 2016 11:01:00 +0000 Aim. This study was performed to evaluate the additional enteral nutrition (EN) in the efficacy of infliximab (IFX) compared with the conventional therapy in managing Crohn’s disease (CD) complicated with intestinal fistulas. Methods. A total of 42 CD with intestinal fistulas were randomly divided into infliximab treatment group () and conventional therapy group (). We evaluated the laboratory indexes, Crohn’s disease activity index (CDAI), Crohn’s disease simplified endoscopic score (SES-CD), and healing of fistula in the two groups before treatment, at 14 weeks, and at 30 weeks, respectively. Results. In the IFX treatment group, the CDAI score, the SES-CD, erythrocyte sedimentation rate, and C-reactive protein levels were significantly decreased during treatment compared with those before treatment. The body mass index and albumin levels were increased in both groups. Moreover, in the IFX treatment group, fistula healing was found in 8 at the 14th week and 18 at the 30th week, respectively, which was greater than that in the conventional therapy group. Conclusion. Our study suggested that infliximab combined with EN is an effective treatment for CD patients complicated with intestinal fistulas. Xiao-Li Wu, Ren-Pin Chen, Li-Ping Tao, Jian-Sheng Wu, Xiang-Rong Chen, and Wei-Chang Chen Copyright © 2016 Xiao-Li Wu et al. All rights reserved. Endoscopic Removal of Ingested Dentures and Dental Instruments: A Retrospective Analysis Thu, 22 Sep 2016 06:05:19 +0000 Background. Dentures and dental instruments are frequently encountered ingested foreign bodies. The aim of the present study was to assess the safety and efficacy of endoscopically removing ingested dental objects. Methods. Twenty-nine consecutive patients with 29 dental objects who were treated at the Niigata University Medical and Dental Hospital from August 2009 to December 2015 were retrospectively reviewed. Characteristics of the patients and the ingested dental objects, the clinical features and findings of radiological imaging tests, and outcomes of endoscopic removal were analyzed. Results. Patients’ mean age was years. The ingested dental objects included 23 dentures (13 crowns, 4 bridges, 4 partial dentures, and 2 other dentures) and 6 dental instruments. Twenty-seven upper gastrointestinal endoscopies and 2 colonoscopies were performed, and their success rates were 92.6% and 100%, respectively. There were 2 cases of removal failure; one case involved an impacted partial denture in the cervical esophagus, and this case required surgical removal. Conclusions. Endoscopic removal of ingested dentures and dental instruments is associated with a favorable success rate and acceptable complications. The immediate intervention and appropriate selection of devices are essential for managing ingested dental objects. Ken-ichi Mizuno, Kazuya Takahashi, Kentaro Tominaga, Yuki Nishigaki, Hiroki Sato, Satoshi Ikarashi, Kazunao Hayashi, Takashi Yamamoto, Yutaka Honda, Satoru Hashimoto, Kenya Kamimura, Manabu Takeuchi, Junji Yokoyama, Yuichi Sato, Masaaki Kobayashi, and Shuji Terai Copyright © 2016 Ken-ichi Mizuno et al. All rights reserved. Selective Induced Altered Coccidians to Immunize and Prevent Enteritis Sun, 18 Sep 2016 11:47:58 +0000 Microbiomic flora in digestive tract is pivotal to the state of our health and disease. Antibiotics affect GI, control composition of microbiome, and shift equilibrium from health into disease status. Coccidiosis causes gastrointestinal inflammation. Antibiotic additives contaminate animal products and enter food chain, consumed by humans with possible allergic, antibiotic resistance and enigmatic side effects. Purposed study induced nonpathogenic, immunogenic organisms to protect against disease and abolish antibiotics’ use in food animals and side effects in man. Diverse species of Coccidia were used as model. Immature organisms were treated with serial purification procedure prior to developmental stages to obtain altered strains. Chicks received oral gavage immunized with serial low doses of normal or altered organisms or sham treatment and were challenged with high infective normal organisms to compare pathogenicity and immunogenicity. Mature induced altered forms of E. tenella and E. necatrix lacked developmental stage of “sporocysts” and contained free sporozoites. In contrast, E. maxima progressed to normal forms or did not mature at all. Animals that received altered forms were considerably protected with higher weight gain and antibody titers against challenge infection compared to those that received normal organisms (). This is the first report to induce selected protective altered organisms for possible preventive measures to minimize antibiotic use in food animals. Helieh S. Oz Copyright © 2016 Helieh S. Oz. All rights reserved. Endoscopic Closure for EUS and ERCP Related Duodenal Perforation by Endoclips Thu, 15 Sep 2016 10:47:36 +0000 Objective. To investigate the therapeutic safety, feasibility, and efficacy of endoclips for closing the endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) related duodenal perforation in a retrospective study from a single center. Methods. Patients who developed EUS and ERCP related duodenal perforation between January 2012 and January 2015 were included in the study. All the cases underwent endoscopic closure by endoclips, and the efficacy, feasibility, and safety of this technique were evaluated. Results. During the study period, a total of 17,406 patients were treated by EUS and/or ERCP. EUS and ERCP related duodenal perforation occurred in 9 cases (0.05%): 2 males and 7 females. The mean age was 69 years (range: 59–79 years). The success rate of endoscopic closure by endoclips was 100%. The mean procedure time was  min. The mean number of endoclips placed for the closure of the duodenal perforation was . All the patients recovered completely without any severe complications. Conclusion. The endoscopic closure by using endoclips is recommended as the first-line treatment for duodenal perforation associated with EUS and ERCP. Yaping Liu, Dong Wang, and Zhaoshen Li Copyright © 2016 Yaping Liu et al. All rights reserved. Antiviral Therapy in Lamivudine-Resistant Chronic Hepatitis B Patients: A Systematic Review and Network Meta-Analysis Thu, 08 Sep 2016 17:38:01 +0000 The relative efficacy of different strategies for chronic hepatitis B (CHB) patients with lamivudine resistance (LAM-R) has not yet been systematically studied. Clinical trials were searched in PUBMED, MEDLINE, EMBASE, and CNKI databases up to February 15, 2016. Nine trials including 764 patients met the entry criteria. In direct meta-analysis, TDF showed a stronger antiviral effect than any one of ETV, LAM/ADV, and ADV against LAM-R hepatitis B virus. LAM/ADV therapy was superior to ADV in suppressing viral replication. ETV achieved similar rate of HBV DNA undetectable compared to ADV or LAM/ADV. In network meta-analysis, TDF had higher rates of HBV DNA undetectable compared to ETV (OR, 24.69; 95% CrI: 5.36–113.66), ADV (OR, 37.28; 95% CrI: 9.73–142.92), or LAM/ADV (OR, 21.05; 95% CrI: 5.70–77.80). However, among ETV, ADV, and LAM/ADV, no drug was clearly superior to others in HBV DNA undetectable rate. Moreover, no significant difference in the rate of ALT normalization or HBeAg loss was observed compared the four rescue strategies with each other. TDF appears to be a more effective rescue therapy than LAM/ADV, ETV, or ADV. LAM plus ADV therapy was a better treatment option than ETV or ADV alone for patients with LAM-R. Hui-Lian Wang, Xi Lu, Xudong Yang, and Nan Xu Copyright © 2016 Hui-Lian Wang et al. All rights reserved. miR-203 Expression in Exfoliated Cells of Tongue Coating Represents a Sensitive and Specific Biomarker of Gastroesophageal Reflux Disease Wed, 07 Sep 2016 08:53:47 +0000 Background and Aim. MicroRNAs (miRNAs) have been implicated in the pathophysiology of numerous human diseases including gastroesophageal reflux disease (GERD). The objective of this study was to investigate the miRNA expression of exfoliated cells of the tongue in patients with GERD versus healthy controls (Ctrls). Methods. Using quantitative reverse-transcription PCR (qRT-PCR), expression levels of six candidate miRNAs (miR-143, miR-145, miR-192, miR-194, miR-203, and miR-205) were examined across a discovery cohort of patients with GERD () versus Ctrls (). These findings were confirmed across a validation cohort (GERD, ; Ctrls, ). Differences in miRNA expression levels were evaluated using the Mann-Whitney U test while the specificity and sensitivity were obtained using receiver-operator characteristic (ROC) curves. Results. miR-203 was significantly downregulated in GERD patients as compared to Ctrls () with ROC curve of 0.94 (95% CI: 0.90–0.97). The sensitivity and the specificity of miR-203 were 91.7% and 87.3%, respectively, in the GERD and Ctrls. These results suggest that miR-203 may be a useful diagnostic marker for discriminating GERD from Ctrls. Conclusions. miR-203 testing may assist in the diagnosis of patients with symptoms suggestive of GERD. Xiuli Yan, Shengliang Zhu, and Hui Zhang Copyright © 2016 Xiuli Yan et al. All rights reserved. Colon Capsule Endoscopy: Review and Perspectives Tue, 06 Sep 2016 11:55:43 +0000 Colon capsule endoscopy utilizing PillCam COLON 2 capsule allows for visualization potentially of the entire colon and is currently approved for patients who cannot withstand the rigors of traditional optical colonoscopy (OC) and associated sedation as well as those that had an OC that was incomplete for technical reasons other than a poor preparation. We will then describe the prior experience and current status of colon capsule endoscopy. David Friedel, Rani Modayil, and Stavros Stavropoulos Copyright © 2016 David Friedel et al. All rights reserved.