关键词： Stress   Depression   Anxiety   Brain-gut axis   Vagus nerve   Gut microbiota  

摘要： The brain-gut axis serves as a circuit that incorporates the human experience, the state of mind, the gut microbiome, and the immune response that ultimately drives the phenotypic expression of inflammatory bowel disease (IBD). There are several biological pathways through which stress can play a deleterious role, including through increasing intestinal permeability, which can facilitate intestinal translocation of bacteria. Stress has an impact on symptoms in IBD;however, there is limited evidence that stress triggers increased intestinal inflammation. Although attention to stress and psychiatric comorbidity is important in the management of IBD, there are few clinical trials to direct management.

关键词： Crohn disease   Ulcerative colitis   Diet   Nutrition   Deficiency   Supplementation  

摘要： Indiscriminate use of multivitamin/mineral supplements in the general population may be misguided, but patients with chronic Inflammatory Bowel Diseases (IBD) should be monitored and compensated for nutritional deficiencies. Mechanistic links between vitamin/mineral deficiencies and IBD pathology has been found for some micronutrients and normalizing their levels is clinically beneficial. Others, like vitamin A, although instinctively desirable, produced disappointing results. Restoring normal levels of the selected micronutrients requires elevated doses to compensate for defects in absorptive or signaling mechanisms. This article describes some aspects of vitamin and mineral deficiencies in IBD, and summarizes pros and cons of supplementation.

关键词： Azathioprine   Chitosan   Inflammatory bowel disease   Colon targeting  

摘要： Azathioprine is a highly efficient immunosuppressant drug used for treatment of inflammatory bowel disease (IBD). Systemic administration of azathioprine results in delayed therapeutic effect and serious adverse reactions. In the current study, we have developed, for the first time, colon-targeted chitosan beads for delivery of azathioprine in colitis rabbit model. Several characterizations were performed for the azathioprine-loaded beads (e.g. drug encapsulation efficiency, drug loading capacity, yield, size, shape and compatibility with other ingredients). The in vitro release profiles of acid-resistant capsules filled with azathioprine-loaded beads showed that most of azathioprine was released in IBD colon simulating medium. The therapeutic effects of azathioprine-loaded beads and azathioprine crude drug were examined on acetic acid-induced colitis rabbit model. Improved therapeutic outcomes were observed in the animals treated with the azathioprine-loaded beads, as compared to the untreated animal controls and the animals treated with the azathioprine free drug, based on the clinical activity score, index of tissue edema, mortality rate, colon macroscopic score and colon histopathological features. In the animals treated with the azathioprine-loaded beads, the levels of the inflammatory mediators, myeloperoxidase enzyme and tumor necrosis factor-alpha, were significantly reduced to levels similar to those observed in the normal rabbits. Furthermore, the activities of the antioxidant enzymes, superoxide dismutase and catalase, were restored considerably in the animals treated with the drug-loaded beads. The azathioprine-loaded beads developed in the current study might have great potential in the management of IBD.

关键词： tumor necrosis factors   inflammatory bowel disease   lymphoma   thiopurine   tumor necrosis factor inhibitors  

摘要： IMPORTANCE An increased risk of lymphoma has been reported among patients receiving thiopurines for inflammatory bowel disease (IBD). The risk of lymphoma associated with anti-tumor necrosis factor (TNF) agents either alone or in combination with thiopurines is uncertain. OBJECTIVE To assess the risk of lymphoma associated with thiopurines and anti-TNF agents, used alone or in combination, for the management of IBD. DESIGN, SETTING, AND PARTICIPANTS Nationwide cohort study based on French National Health Insurance databases. Patients aged 18 years or older identified with IBD were included from January 1, 2009, through December 31, 2013, and followed up until December 31, 2015. EXPOSURES At each time of the follow-up, patients were categorized as being exposed to thiopurine monotherapy, anti-TNF monotherapy, or combination therapy, or being unexposed. MAIN OUTCOMES AND MEASURES The primary outcome was incident lymphoma. RESULTS Among the 189 289 patients included (54% women;median age, 43 years [interquartile range, 32-56 years]) and followed up for a median of 6.7 years, 123 069 were never exposed during follow-up, 50 405 were exposed to thiopurine monotherapy, 30 294 to anti-TNF monotherapy, and 14 229 to combination therapy. Overall, 336 lymphoma cases occurred: 220 in unexposed patients (incidence rate [IR] per 1000 person-years, 0.26;95% CI, 0.23-0.29), 70 in patients exposed to thiopurine monotherapy (IR, 0.54;95% CI, 0.41-0.67), 32 in patients exposed to anti-TNF monotherapy (IR, 0.41;95% CI, 0.27-0.55), and 14 in patients exposed to combination therapy (IR, 0.95;95% CI, 0.45-1.45). In a multivariable Cox model, compared with unexposed patients, the risk of lymphoma was higher among those exposed to thiopurine monotherapy (adjusted hazard ratio [aHR], 2.60;95% CI, 1.96-3.44;P < .001), anti-TNF monotherapy (aHR, 2.41;95% CI, 1.60-3.64;P < .001), or combination therapy (aHR, 6.11;95% CI, 3.46-10.8;P < .001). The risk was higher in patients exposed to combinatio

关键词： 国家发展改革委   国家中医药管理局   疾病   会诊   免费   患者   专家   社会保障部  

摘要： 结合苏州实际情况，依照国家卫生计生委、国家发展改革委、人力资源和社会保障部、国家中医药管理局、中国保监会等多部门联合发布的文件精神，特邀苏大附一院匡玉庭教授，苏州市中医院肛肠科金淳民主任、

关键词： OMOM胶囊内镜   小肠疾病   临床应用  

摘要： 目的探讨OMOM胶囊式内窥镜系统对小肠疾病的诊断价值,便于临床合理应用。方法回顾性分析2009年9月-2016年12月在宁夏医科大学总医院消化内科行OMOM胶囊内镜检查的86例患者的临床资料,并根据患者的不同症状、年龄等进行分组,分别对比不同组别间小肠疾病的检出率。结果 86例患者共发现病变81例,病变总检出率为94.2%,小肠疾病病变检出率79.1%。不明原因消化道出血(OGIB)组小肠病变检出率为91.2%,最常见的病变为小肠血管畸形;腹痛组小肠病变检出率为71.2%,以小肠炎最为多见;胶囊内镜对OGIB组患者的小肠病变检出率高于腹痛组患者(P<0.05);老年和中青年患者小肠疾病检出率差异无统计学意义(P=0.271),胶囊内镜检查出血停止2周内与2周以上患者小肠疾病检出率差异无统计学意义(P>0.05);肠道准备时肌注甲氧氯普胺(胃复安)可以促进胶囊通过幽门(P=0.028)。结论 OMOM胶囊内镜检查安全、有效,对小肠疾病有良好的诊断价值,尤其适用于不明原因消化道出血的患者。

关键词： 肛肠疾病   术后   护理  

摘要： 随着医疗技术的不断改进与提升,肛肠疾病的手术及麻醉方式也发生了很大的改变,因此病患的术后护理重点也在发生变化,本文就结合实际情况对肛肠疾病术后护理重点进行简析。

关键词： 米曲菌胰酶片   莫沙比利   消化不良   老年  

摘要： 目的观察米曲菌胰酶片联合莫沙比利治疗老年胃肠疾病相关性消化不良的有效性和安全性。方法将2015-07~2016-10期间在我院消化科就诊的胃肠疾病相关性消化不良老年(≥60岁)患者80例,分为观察组(n=42)与对照组(n=38)。观察组口服米曲菌胰酶及莫沙比利,对照组单纯口服莫沙比利,疗程2周。观察两组消化不良症状积分并对比两组疗效,记录不良反应。结果在治疗14 d后,两组症状总积分均明显降低,两组治疗前后症状总积分比较差异均有统计学意义(P<0.05),治疗后观察组总积分较对照组显著下降,两组比较差异有统计学意义(P<0.05);观察组总有效率明显高于对照组,差异有统计学意义(90.5%vs 73.7%,P<0.05)。两组患者除轻度腹泻外,治疗期间均未出现其他不良反应。结论米曲菌胰酶片联合莫沙比利可有效改善老年胃肠疾病相关性消化不良症状,安全性好。