关键词： 胃肠疾病   小儿   益生菌   临床疗效   不良反应  

摘要： 目的观察益生菌辅助治疗小儿胃肠疾病的临床疗效及安全性。方法采用回顾性的方式选取2017年4月-2019年4月辽宁省朝阳市双塔区妇幼保健院收治的胃肠疾病患儿100例,采用随机数字表法分为试验组和对照组各50例。对照组采用常规治疗,试验组在对照组治疗的基础上采用益生菌治疗。比较2组患儿的治疗效果、治疗满意度、复发情况及不良反应。结果试验组治疗效果较对照组明显更好,差异有统计学意义(χ^(2)=5.263,P=0.022);试验组治疗满意度为100.0%,高于对照组的90.0%(χ^(2)=5.263,P=0.022);随访3个月,试验组复发率为0,低于对照组的10.0%(5/50)(χ^(2)=5.263,P=0.022);2组不良反应总发生率均为4.0%,差异无统计学意义(χ^(2)=0.000,P=1.000)。结论益生菌辅助治疗小儿胃肠疾病的临床效果较好,可有效改善患儿的症状,降低复发率,提高生活质量,应用价值较高。

关键词： 多形性日光疹   胃肠疾病  

摘要： 目的通过分析40例多形性日光疹合并胃肠疾病的临床特征,探究多形性日光疹与胃肠疾病的相关性。方法2019年1月至2020年10月符合纳入条件的40例多形性日光疹患者,设为试验组;选取同期进行健康体检者40例,设为健康对照组,行胃镜、肠镜、尿素14C呼气试验等检查。结果多形性日光疹合并糜烂性胃炎患者高于健康对照组,差异有统计学意义(P<0.05),多形性日光疹合并肠息肉患者高于健康对照组,差异有统计学意义(P<0.05)。结论40例多形性日光疹与胃肠疾病可能存在一定的相关性,因果关系有待进一步研究。

关键词： 阴部神经   肛管   直肠   临床应用  

摘要： 神经调控是指通过各种形式的刺激对神经元或神经信号转导发挥兴奋、抑制或调节作用,以强化神经连接、增强神经可塑性的治疗方法。神经调节在肛门直肠疾病中应用广泛,包括骶神经刺激、胫神经刺激、迷走神经刺激、阴部神经刺激等治疗方法。目前对阴部神经刺激的研究尚少,认识尚不清晰,故本文围绕阴部神经调节在肛门直肠疾病中的应用及研究现状进行综述。

关键词： Inflammatory bowel disease   Thrombosis   Coagulation   Bacterial components   Prophylaxis   Post-thrombotic syndrome  

摘要： The risk of thromboembolism(TE)is increased in patients with inflammatory bowel disease(IBD),mainly due to an increased risk of venous TE(VTE).The risk of arterial TE(ATE)is less pronounced,but an increased risk of cardiovascular diseases needs to be addressed in IBD *** predisposes to arterial and venous thrombosis through similar prothrombotic mechanisms,including triggering activation of coagulation,in part mediated by impairment of the intestinal barrier and released bacterial *** in IBD has clinical specificities,i.e.,an earlier first episode in life,high rates during both active and remission stages,higher recurrence rates,and poor *** increased likelihood of VTE in IBD patients may be related to surgery,the use of medications such as corticosteroids or tofacitinib,whereas infliximab is ***-term complications of VTE can include post-thrombotic syndrome and high recurrence rate during post-hospital discharge.A global clot lysis assay may be useful in identifying patients with IBD who are at risk for *** VTEs occur in IBD outpatients;therefore,outpatient prophylaxis in high-risk patients is *** is crucial to continue focusing on prevention and adequate treatment of VTE in patients with IBD.

关键词： Therapeutic drug monitoring   Inflammatory bowel disease   Biologic therapies   Loss of response   Reactive   Proactive  

摘要： Inflammatory bowel disease(IBD)is a chronic condition that significantly affects the quality of life of its *** drugs have been the mainstay treatment in the management of IBD patients but despite their significant contribution,there remains a proportion of patients that do not respond or lose response to *** drug monitoring(TDM)involves measuring levels of serum drug concentrations and anti-drug *** of biologic drugs initially emerged to understand treatment failure in other immune mediated inflammatory *** was then introduced in IBD to rationalize primary non-response or secondary loss of response,given that low serum drug concentrations or the formation of anti-drug antibodies are variably associated with treatment *** aim of this narrative review is to provide an overview regarding the current use of TDM in clinical practice and to present the evidence available regarding its use in both proactive and reactive clinical settings in preventing and managing treatment *** review also presents the existing evidence regarding the association of various clinical outcomes with specific thresholds of drug concentrations,in everyday practice.A narrative review of published articles and conference abstracts regarding the use of TDM in IBD management,through an electronic search using PubMed and *** has proven to be superior and more cost effective in guiding management of patients with treatment failure compared to empiric dose escalation or change in *** a trend towards an association between clinical outcomes and drug concentrations,proactive TDM based strategies have not been shown to achieve clear benefit in long-term *** the clinical setting,TDM has proven to be useful in managing IBD patients,and its use in the reactive setting,as an additional tool to help manage patients with treatment failure,is being promoted as newer guidelines and consensus groups implement

关键词： 肌间神经丛   氮能神经元   黏膜下神经丛   胃肠疾病   胃肠道运动   ENS   兴奋性   抑制性神经递质   神经系统功能   肠神经元   发育异常   先天性巨结肠症   胃肠活动   胆碱能神经元  

摘要： 肠道神经系统(ENS)是由大量的神经元和神经纤维组成的复杂的神经网络,在参与胃肠道局部反射、维持消化系统的功能、保证人体健康等方面发挥着重要的作用。ENS分为黏膜下神经丛和肌间神经丛,肌间神经丛内不同形态的神经元可通过释放兴奋性或抑制性神经递质参与胃肠道运动的调控。当ENS内氮能神经元的NO合成障碍时便会引发贲门失迟缓症,氮能神经元的减少则在原发性胃轻瘫患者中表现的尤为显著。此外,ENS的发育异常和神经元的退行性改变分别会导致先天性巨结肠症和肠易激综合征。

关键词： Crohn disease   inflammatory bowel disease disk   patient-reported outcome   ulcerative colitis  

摘要： Objective Inflammatory bowel disease (IBD) significantly impacts on patients' well-being. Patients' preferences for treatment outcomes do not necessarily fit physicians' goals. We aimed to investigate patients' priorities and expectations from treatment. Methods A questionnaire based on the IBD Disk application was distributed to patients through social media. Patient's preferences were assessed by grading the 10 IBD Disk items on a Likert-type scale from 1 to 10. A cluster analysis was used to classify patients into homogeneous subgroups according to their preferred items, using the K-means method. Results Among the 224 patients, 69.2% had Crohn's disease (CD). Their mean age was (38.9 +/- 14.9) years and 62.9% were female. More CD patients compared with those with ulcerative colitis were treated with biologics compared with those with ulcerative colitis (71.0% vs 39.1%, P < 0.001). Most IBD Disk items ranked high in patients' preferences for treatment outcomes. Their leading preference was reducing abdominal pain, which was more prominent in CD patients, followed by regulating defecation and energy. Least important were interpersonal interactions, sexual functions, and body image. Patients were categorized into three clusters. Cluster 3 patients gave lower scores to most items and were characterized by tertiary education (P = 0.001), higher income (P < 0.001), less active disease (P = 0.02), and higher prevalence of successful treatment (P = 0.04). Conclusions Patients' preferences for treatment outcomes are influenced by higher education, higher income, rural-dwelling, and disease activity. Better understanding of individual patient's preferences and the factors that affect them might bridge the gap between patients' and physicians' priorities to achieve better teamwork in controlling disease outcomes.

关键词： Inflammatory bowel disease   Colorectal cancer   Colectomy  

摘要： Background The extent of surgical resection in inflammatory bowel disease (IBD) patients who develop colorectal cancer (CRC) is not prescribed by guidelines. We aim to evaluate, at a population level, the association of extent of surgical resection with survival outcomes. Methods Using a validated Ontario registry of Crohn's disease (CD) and ulcerative colitis (UC) patients, we identified patients who underwent colorectal cancer resection between 2007 and 2015. Patient, tumor, and treatment factors, including type of surgical resection, were collected. Resections were grouped as segmental, total colectomy, and proctocolectomy. Multivariable cox proportional hazard regression was performed to identify factors associated with survival, including extent of surgical resection. Results Between 2007 and 2015, 84,694 patients had resections for CRC in the province of Ontario, 599 had ulcerative colitis (UC), and 366 had Crohn's disease (CD). Segmental resection was the most common operation performed and was more common in CD patients compared to UC (68% vs. 45.6%, p < 0.001). Five-year survival was 63.7% (95% CI 59.5-67.7) in UC patients and 57.5% (95% CI 51.9-62.7) in CD patients (p = 0.033). Multivariable analysis showed worse survival in patients undergoing total colectomy, compared to segmental resection [HR 1.70 (95% CI 1.31-2.21), p < 0.001]. There was no significant difference in survival between patients undergoing segmental resection and proctocolectomy [HR 0.99 (95% CI 0.78-1.27)]. This pattern was similar within the subtypes of IBD. Conclusion In the setting of IBD-associated CRC, segmental resection and proctocolectomy are associated with similar survival outcomes in both UC and CD patients. Prospective study is essential to explore these findings.