Biliary microbiota and mucin 4 impact the calcification of cholesterol gallstones.

BACKGROUND: Cholesterol gallstones account for over 80% of gallstones, and the pathogenesis of gallstone formation involves genetic and environmental factors. However, data on the evolution of cholesterol gallstones with various densities are limited. This study aimed to determine the roles of microbiota and mucins on the formation of calcified cholesterol gallstones in patients with cholelithiasis. METHODS: Paired gallbladder tissues and bile specimens were obtained from cholelithiasis patients who were categorized into the isodense group and calcified group according to the density of gallstones. The relative abundance of microbiota in gallbladder tissues was detected. Immunohistochemistry and enzyme-linked immunosorbent assay were performed to detect the expression levels of MUC1, MUC2, MUC3a, MUC3b, MUC4, MUC5ac and MUC5b in gallbladder tissues and bile. The correlation of microbiota abundance with MUC4 expression was evaluated by linear regression. RESULTS: A total of 23 patients with gallbladder stones were included. The density of gallstones in the isodense group was significantly lower than that of the calcified group (34.20 ± 1.50 vs. 109.40 ± 3.84 HU, P < 0.0001). Compared to the isodense group, the calcified group showed a higher abundance of gram-positive bacteria at the fundus, in the body and neck of gallbladder tissues. The concentrations of MUC1, MUC2, MUC3a, MUC3b, MUC5ac and MUC5b in the epithelial cells of gallbladder tissues showed no difference between the two groups, while the concentrations of MUC4 were significantly higher in the calcified group than that in the isodense group at the fundus (15.49 ± 0.69 vs. 10.23 ± 0.54 ng/mL, P < 0.05), in the body (14.54 ± 0.94 vs. 11.87 ± 0.85 ng/mL, P < 0.05) as well as in the neck (14.77 ± 1.04 vs. 10.85 ± 0.72 ng/mL, P < 0.05) of gallbladder tissues. Moreover, the abundance of bacteria was positively correlated with the expression of MUC4 (r = 0.569, P < 0.05) in the calcified group. CONCLUSIONS: This study showed the potential clinical relevance among biliary microbiota, mucins and calcified gallstones in patients with gallstones. Gram-positive microbiota and MUC4 may be positively associated with the calcification of cholesterol gallstones.

Hepatitis C Virus Infection Is Positively Associated with Gallstones in Liver Cirrhosis.

AIM: To elucidate the prevalence and risk factors of gallstone disease (GD) among patients with liver disease and explore their association with the aetiology and severity of hepatic injury. METHODS: We analysed 4,832 subjects of hepatic injury induced by one of the following aetiologies: hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, excessive alcohol consumption. The risk factors significantly associated with GD were analysed using stepwise logistic regression analysis, the influence of aetiology and severity of liver disease on the prevalence of GD were assessed by multiple logistic regression analysis adjusting for confounding factors. RESULTS: Three thousand forty eight patients were of positive HBV surface antigen alone with a prevalence of GD of 18.6%, 526 were tested as positive Anti-HCV alone with a prevalence of GD of 22.4%, and 1,258 were identified with excessive alcohol consumption patterns with a prevalence of GD of 13.5%. In each aetiological category, the prevalence of GD increased by age. Stepwise logistic regression analysis showed that age, female, low-density lipoprotein-cholesterol (LDL-Cho), family history of GD, HBV infection, HCV infection, chronic hepatitis and cirrhosis were independent factors associated with GD. After adjusting for age, LDL-Cho and family history of GD, the prevalence of gallstone disease was significantly associated with HCV-related cirrhosis in both genders, HBV-related cirrhosis in males and alcohol-related cirrhosis in females compared with patients with less severe liver disease [corrected]. After adjusting for gender, age, LDL-Cho and family history of GD, patients with HCV-related cirrhosis (OR 2.66, 95% CI 1.49-3.84) but not HBV-related cirrhosis (OR 1.52, 95% CI 0.73-1.82) were more likely to have GD compared with alcohol-related cirrhosis. CONCLUSION: HCV infection is positively associated with gallstone formation especially in those with cirrhosis patients.

Characteristics and Risk Factors of Functional Dyspepsia Fulfilling the Rome IV Criteria Overlapping With Gastroesophageal Reflux Disease, Irritable Bowel Syndrome, and Functional Constipation in South China.

Background/Aims: Functional dyspepsia (FD) overlapping with other gastrointestinal disorders are quite common. The characteristics of FD overlap in Chinese population with latest Rome IV criteria were unclear. This large-scale outpatient-based study assessed the characteristics of FD overlap in South China. Methods: Consecutive FD patients visited the Gastroenterology Clinic at 2 tertiary medical centers in Hangzhou, China who fulfilled the Rome IV criteria were enrolled. Complete questionnaires related to the gastrointestinal symptoms (Rome IV criteria), Reflux Disease Questionnaire, anxiety and depression, quality of sleep and life, and demographic information were collected. Results: Among the total of 3281 FD patients, 50.69% overlapped with gastroesophageal reflux disease, 21.46% overlapped with irritable bowel syndrome, 6.03% overlapped with functional constipation. FD overlap had higher proportion of single/divorced/widowed rate, high education level, being employed, drinking, night shift, unhealthy dietary habit than FD only (P < 0.05). They had higher frequency of consultation and economic burden, as well as lower scores in quality of life (P < 0.001). Multivariate logistic regression showed that increasing age, female, low body mass index, history of gastroenteritis, anxiety, depression, and poor sleep quality were independent risk factors for FD overlap. Conclusions: FD overlap was quite common in China with high economic burden and poor quality of life, FD patients with history of gastroenteritis, anxiety, depression, and poor sleep quality were more likely to have overlap disorders. Awareness of the physical and psychosocial stressors in overlapping condition would help optimize the management of FD overlap in clinical practice.

Endoscopic ultrasound-guided lauromacrogol injection for treatment of colorectal cavernous hemangioma: Two case reports.

BACKGROUND: Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage, and can be misinterpreted as colitis. Surgical resection is currently the mainstay of treatment, with an emphasis on sphincter preservation. CASE SUMMARY: We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound (EUS). Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis. CONCLUSION: Multiple sequential EUS-guided injections of lauromacrogol is a safe, effective, cost-efficient, and minimally invasive alternative for colorectal cavernous hemangioma.

Upregulation of caveolin-1 and SR-B1 in mice with non-alcoholic fatty liver disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent causes of liver diseases, with markedly increased prevalence. However, its mechanisms are not clear. The present study was undertaken to illustrate the role of caveolin-1 (cav1) and the scavenger receptor class B type 1 (SR-B1) in NAFLD. METHODS: Adult male C57BL/6 mice were fed with a normal diet or high fat and cholesterol (HFC) diet for 14 weeks. The mice were sacrificed to collect plasma and harvest the liver; their plasma lipid concentration was measured. Hepatic cav1 and SR-B1 mRNA and protein expression were determined by real-time quantitative polymerase chain reaction (qPCR) and Western blotting, respectively. In order to study cav1 and SR-B1 distribution and change in hepatocytes, immunohistochemical analysis was performed. RESULTS: HFC diet increased plasma lipids, induced NAFLD and increased the liver/body weight ratio. Compared to the control mice (n=6), the mRNA and protein levels of cav1 and SR-B1 in liver tissue of the NAFLD mice (n=12) increased significantly (cav1 mRNA: 1.536+/-0.226 vs 0.980+/-0.272, P<0.05; protein: 0.643+/-0.240 vs 0.100+/-0.130, P<0.01; SR-B1 mRNA: 1.377+/-0.125 vs 0.956+/-0.151, P<0.01; protein: 2.156+/-0.507 vs 0.211+/-0.211, P<0.01). Furthermore, both cav1 and SR-B1 immunoreactivity increased and their distribution was also changed, mainly in the plasma membrane of hepatocytes, cytoplasm and membrane of lipid droplets and around. CONCLUSION: NAFLD is associated with increased concentration of plasma lipids and upregulation of hepatic cav1 and SR-B1 gene and protein expressions, which indicate that cav1 and SR-B1 might play crucial roles in the pathogenesis of NAFLD.

Endoscopic ultrasonography for the diagnosis and selecting treatment of esophageal leiomyoma.

BACKGROUND AND AIM: To investigate the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes (MUP) for the diagnosis and treatment of esophageal leiomyoma. METHODS: A total of 229 patients with esophageal leiomyoma, diagnosed using EUS, with 12-MHz MUP and a double-cavity electronic endoscope, were enrolled. The clinical characteristics of the patients were analyzed, and those who had therapeutic indications received endoscopic resection or surgical excision. Postoperative histological diagnostic results were compared with the preoperative diagnosis of EUS. All patients, including those with or without endoscopic resection or surgical excision were periodically followed up with EUS. RESULTS: Of the 229 patients, 118 received endoscopic resection, and seven received surgical excision. Postoperative histology showed that 110 patients were completely consistent with the preoperative diagnosis of EUS, and the diagnostic accuracy of EUS was 88.6%. No treatment-related complications occurred among the patients who received endoscopic resection or surgical excision, and no recurrence was observed during the follow-up examinations. CONCLUSIONS: Esophageal leiomyoma is a benign tumor of the esophagus. EUS is a useful technique for the diagnosis of esophageal leiomyoma and for making treatment-related decisions.

[Double balloon endoscopy in diagnosis of patients with obscure gastrointestinal bleeding].

OBJECTIVE: To assess the diagnostic value of double balloon endoscopy (DBE) for obscure gastrointestinal bleeding (OGIB) METHODS: The data of 103 OGIB patients who underwent DBE from January 2007 to September 2010 in the First Affiliated Hospital, Zhejiang University School of Medicine were retrospectively analyzed. RESULTS: DBE was successfully performed in all 103 patients without complications. Of 103 patients, 66(64.1 %) had positive DBE findings and 28 had surgery procedures(27.2 %). Ninety-four patients finally acquired positive diagnosis, including small intestine tumor(31.1 %), angiodysplasia(22.3 %), exulceratio simplex(9.7 %), Crohn's disease(6.8 %), diverticulum(4.9 %), abdominal purpure(4.9 %), etc. Lesions occurred more frequently in proximal small intestine than in distal small intestine (56.3 % Compared with 30.1 %, P<0.001). CONCLUSION: DBE is a safe, effective and reliable procedure for the diagnosis of OGIB.

Coil and n-butyl-2-cyanoacrylate migration into the stomach after TIPS for gastroesophageal variceal bleeding: a case report and literature review.

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established therapeutic option for the management of variceal hemorrhage in patients with cirrhosis. The simultaneous migration of the coil and n-butyl-2-cyanoacrylate (NBCA) is an extremely rare but significant complication after TIPS. Because of its rare presentation, there are currently no definitive recommendations for the management of this condition. CASE PRESENTATION: A 46-year-old man with hepatitis B cirrhosis underwent TIPS placement for uncontrolled gastroesophageal varix (GEV) bleeding secondary to portal hypertension in August 2018. During the procedure, large GEVs were embolized using a coil and NBCA. After a year, coil and NBCA migration into the stomach was observed. Attempts to remove the coil using biopsy forceps during esophagogastroduodenoscopy failed. The patient refused further intervention on the coil to prevent further complications and received conservative therapy instead. Close surveillance with endoscopy is recommended for detecting coils and varices. CONCLUSIONS: The present case reports an extremely rare but significant complication after TIPS, which highlights the management and follow-up recommendation for such rare complications. Our experience may provide guidance for the management of future similar cases and stimulate discussion about treatment methods of similar patients.

[The diagnosis and treatment of duodenal lipoma.].

OBJECTIVE: To summarize the clinical features of the duodenal lipomas in order to explore effective diagnostic methods and appropriate treatment preoperatively. METHODS: The clinical features, laboratory results, endoscopic appearance, radiological and pathological data of 8 cases of duodenal lipoma were retrospectively analyzed. RESULTS: Four patients suffered with repeated melena, 3 cases with epigastric discomfort, sour regurgitation or hiccup, while 1 patient without any symptoms. Liver functions, serum lipids and tumor markers were normal in all patients. Six patients had been detected lesions by gastroscopy (2 cases missed diagnosed in the first examination), these lesions were appeared in duodenal bulb (2 cases) or descendant duodenum (4 cases). Abdominal CT examination revealed partial duodenal wall thickening (6 cases), partial enteric cavity narrowing (4 cases), or low-density lesions in enteric cavity (3 cases) with CT value of -85 HU and evenly intensified when enhanced. EUS showed intensive hyperechoic lesions from submucosa, with homogeneous echo and clear margin. Biopsy under endoscopy in all patients showed chronic inflammation of mucosa, while the pathologic diagnosis was lipoma after surgical excision or endoscopic resection. Pancreaticoduodenectomy performed in 1 patient, duodenal tumorectomy in 3 patients and endoscopic resection with snare in 4 patients. CONCLUSION: Common site of duodenal lipoma is descending part, and the clinical manifestations are non-specific. Imaging and endoscopic examination are the mainly methods to detect the lesion, while EUS is significantly valuable in diagnosing and differential diagnosing. It can be treated by partial tumorectomy or endoscopic trap resection.

Esophageal bronchogenic cyst excised by endoscopic submucosal tunnel dissection: A case report.

BACKGROUND: Esophageal bronchogenic cyst (EBC) is a rare congenital disease that is difficult to diagnose preoperatively, and treatment remains controversial. CASE SUMMARY: We report a 53-year-old Chinese woman hospitalized in our hospital following the discovery of a submucosal protruding mass of the esophagus by upper endoscopy. A preliminary diagnosis of EBC was made by endoscopic ultrasonography (EUS), and treatment was accomplished by endoscopic submucosal tunnel dissection (ESTD). The pathological results verified the diagnosis. No scar changes or cystic lesion within the original lesion were found under EUS after a 3-mo follow-up. CONCLUSION: EUS is valuable for the preliminary diagnosis of EBC and surveillance. ESTD is a safe and effective treatment for EBC. Further evaluation of complications and long-term follow-ups are required.

Multiple gastric angiolipomas: A case report.

BACKGROUND: Angiolipoma is a benign tumor and is generally found in subcutaneous tissues. Angiolipomas are rare in the gastrointestinal tract, including the stomach. Preoperative diagnosis of the tumor is difficult, although there are several radiological examinations such as computed tomography and endoscopic ultrasound. CASE SUMMARY: We report a 24-year-old Chinese man with multiple gastric angiolipomas, with a positive stool occult blood examination. Endoscopic biopsy only showed nonspecific inflammation. Histological examination of the specimen by endoscopic snare resection showed that the tumor consisted of adipose tissues and blood vessels. We also performed a literature review. After the use of proton pump inhibitor, the fecal occult blood test was negative. Due to the difficulty of resecting multiple lesions in the stomach completely and the benign characteristics of angiolipoma, we chose to have regular upper gastrointestinal endoscopy evaluation of the lesion. No evidence of significant change in lesion size was detected after 3-years follow-up. CONCLUSION: Gastric angiolipoma is rare, and benign neoplasm should be considered when lesions occur submucosally in the gastrointestinal tract.

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions.

OBJECTIVE: The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography (CT) and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. METHODS: Patients with duodenal protruding lesions who were indicated for EUS were examined by EUS with 12 approximately 15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of EUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of EUS. Those patients without endoscopic resection or surgical excision were periodically followed up with EUS. RESULTS: A total of 169 patients with duodenal protruding lesions were examined by EUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner's gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After EUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of EUS, with 93.33% diagnostic accuracy. The results of follow-up with EUS indicated that duodenal cyst, Brunner's gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1 approximately 3 years. No related complications occurred among all patients that received EUS examinations. CONCLUSION: EUS is an effective and reliable diagnostic method for duodenal protruding lesions.

[Diagnostic values of double-balloon enteroscopy and abdominal computed tomography in small bowel disease].

OBJECTIVE: To evaluate the diagnostic values of double-balloon enteroscopy (DBE) and abdominal computed tomography (CT) in small bowel disease. METHODS: Seventy eight DBE procedures were carried out in 70 patients, 40 males and 30 females; aged 47.7 (16 - 83) with suspected small bowel disease, all of whom received gastroscopy, colonoscopy, and abdominal CT examination at the same time. The diagnostic value of DBE was compared with that of CT. RESULTS: Seventeen kinds of small bowel lesions were detected, mainly including Crohn's disease, adenocarcinoma, gastrointestinal stroma tumor, vascular deformity, lymphoma, diverticulum, and polyp. There were no complications and all procedures were tolerated well. The mean duration of procedure was 110 min (30 - 240 min). Nineteen patients received surgical intervention. The diagnostic yield rate of DBE was 57.1% (40/70), significantly higher than that of CT (31.4%, 22/70, P < 0.01). The positive diagnosis rate of DBE combined with CT was 62.9% (44/70), not significant different from that of the DBE alone (P > 0.05). CONCLUSION: DBE shows a significantly higher diagnostic yield than CT in patients with suspected small bowel disease, and thus should be selected for the initial diagnosis. DBE Combined with CT did not increase the diagnostic yield. However, CT not only provides direction of intubation for DBE, but also clearly depicts the small bowel wall and extraenteric alterations. DBE and CT compliment each other in examining the patients with suspected small bowel disease.

Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum: Clinical experience and endoscopic management.

Heterotopic gastric mucosa (HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge. In the present study, a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia. Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum. Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum. Narrow band imaging further confirmed the histological results. Endoscopic ultrasound indicated that the lesion originated from the mucosal layer, and partially involved the submucosal layer. Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion. No bleeding, perforation or other adverse events were observed. The presence of HGM in the diverticular cavity greatly increased the surgical difficulty. A literature review was also carried out in our study.

Endoscopic Ultrasonography in the Diagnosis and Treatment Strategy Choice of Esophageal Leiomyoma.

OBJECTIVES:: Esophageal leiomyoma is the most common benign tumor of the esophagus, and it originates from mesenchymal tissue. This study analyzed the clinicopathological characteristics of esophageal leiomyoma and aimed to evaluate the role of endoscopic ultrasonography in the diagnosis and treatment selection for these lesions. METHODS:: Two hundred and twenty-five patients who had suspected esophageal leiomyomas in endoscopic ultrasonography were enrolled at the Endoscopy Center of The First Affiliated Hospital, Zhejiang University from January 1st, 2009 to May 31th, 2015. The main outcomes included the demographic and morphological characteristics, symptoms, comparisons of diagnosis and treatment methods, adverse events, and prognosis. RESULTS:: One hundred and sixty-seven patients were diagnosed as having an esophageal leiomyoma by pathological examination. The mean patient age was 50.57±9.983 years. In total, 62.9% of the lesions originated from the muscularis mucosa, and the others originated from the muscularis propria. The median distance to the incisors was 30±12 cm. The median diameter was 0.72±0.99 cm. As determined by endoscopic ultrasonography, most existing leiomyomas were homogeneous, endophytic, and spherical. The leiomyomas from the muscularis mucosa were smaller than those from the muscularis propria and much closer to the incisors (p<0.05). SMA (smooth muscle antibody) (97.2%) and desmin (94.5%) were positive in the majority of patients. In terms of treatments, patients preferred endoscopic therapies, which led to less adverse events (e.g., intraoperative bleeding, local infection, pleural effusion) than surgical operations (p<0.05). The superficial leiomyomas presented less adverse events and better recovery (p<0.05) than deep leiomyomas. CONCLUSION:: Endoscopic ultrasonography has demonstrated high accuracy in the diagnosis of esophageal leiomyomas and provides great support in selecting treatments; however, EUS cannot completely avoid misdiagnosis, so combining it with other examinations may be a good strategy to solve this problem.

Clinical manifestations of patients with chronic pancreatitis.

BACKGROUND: Recent advances in molecular and genomic technologies and pancreatic imaging techniques provided some insights into genetic, environmental, immunologic, and pathobiological factors for chronic pancreatitis (CP). This study was undertaken to investigate the clinical manifestations of patients with chronic pancreatitis at our hospital. METHODS: The data of the patients with CP who had been treated at our hospital between 1997 and 2004 were analyzed. RESULTS: The major symptoms of the patients with CP were abdominal pain, dyspepsia, loss of weight, diabetes mellitus, pancreatic pseudocyst, steatorrhea, and calcification. Biliary diseases were found to be the first cause of CP in this study; but alcohol abuse was the major cause of CP in men and biliary diseases were the first etiological factors for CP in women. The etiological difference of constituent ratio between men and women was related to alcohol consumption (P<0.01). CONCLUSIONS: During the past 8 years, biliary diseases have been the major etiological factors for CP, but their constituent ratio is decreasing, and the constituent ratio of alcohol abuse is increasing gradually. Alcohol tends to replace biliary diseases as the primary etiological factor for CP.

[Clinical characteristics of hepatic sinusoidal obstruction syndrome: analysis of 8 cases].

OBJECTIVE: To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS). METHODS: The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up. RESULTS: The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died. CONCLUSIONS: Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.

Is gallstone disease associated with inflammatory bowel diseases? A meta-analysis.

OBJECTIVE: To investigate the association between inflammatory bowel disease (IBD) and gallstone disease (GD) by performing a meta-analysis. METHODS: PubMed, Medline, Embase, Web of Science and the Cochrane Library were searched for relevant articles published between January 1980 and February 2015. All statistical analyses were performed using STATA 12.0. A fixed-effects model was adopted; heterogeneity was evaluated by χ(2) test and I(2) statistic; publication bias was assessed by Begg's and Egger's tests. RESULTS: Five studies qualified for inclusion in the meta-analysis. Patients with IBD had a significantly higher prevalence of GD than those in the control group [odds ratio (OR) 1.72, 95% confidence interval (CI) 1.40-2.12, P < 0.0001]. Subgroup analyses showed a significantly higher prevalence of GD in patients with Crohn's disease (CD) (OR 2.05, 95% CI 1.61-2.63, P < 0.0001). However, no significant difference in the prevalence of GD was observed between patients with ulcerative colitis (UC) and controls (OR 1.12, 95% CI 0.75-1.68, P = 0.585). Studies from Italy, Sweden and the UK revealed a higher prevalence of GD in patients with IBD. No heterogeneity (I(2) = 25.2%, P = 0.228) or publication bias was observed in our meta-analysis (Begg's test, P = 0.711; Egger's test, P = 0.805). CONCLUSIONS: Our meta-analysis suggests there is a trend towards higher prevalence of GD in IBD patients, and especially in patients with CD. More rigorous, large-scale multi-center studies are required to investigate the association between GD and IBD.

Endoscopic banding ligation can effectively remove the submucosal tumor.

Endoscopic band ligation for variceal bleeding in cirrhosis has been proved its safety and efficacy. We tried to treat submucosal tumors the gastrointestinal (GI) tract by endoscopic band ligation. The aim of this study was to evaluate the efficacy and safety of endoscopic band ligation in the treatment of submucosal tumors of the GI tract. There are 29 patients (15 men, 14 women, age range: 25-67 years old) with 30 submucosal lesions of the GI tract, including 15 lesions in the esophagus, 14 lesions in the of stomach and 1 lesion in the duodenal bulb. The average maximum diameter of the lesions was 7.78 mm (range: 2.4-23.6 mm). All submucosal lesions were successfully removed by band ligation. There is no bleeding and perforation in all patients. No recurrence was observed for the one month following-up. Endoscopic band ligation promises could be considered as a safe and effective for the treatment submucosal tumors of the GI tract, especially for the diameter of tumor < 25 mm.

Helicobacter pylori infection is associated with gallstones: Epidemiological survey in China.

AIM: To elucidate the prevalence and risk factors for gallstones, primarily focusing on Helicobacter pylori (H. pylori) infection. METHODS: A total of 10016 Chinese subjects, who had undergone physical examination, fasting (13)C urea breath test and abdominal ultrasonography, had sufficient blood test data, and had finished a questionnaire, were included in this cross-sectional study. Participants (n = 1122) who had previous eradication of H. pylori were studied separately. RESULTS: Gallstones were discovered in 9.10% of men and 8.58% of women, with no significant sex difference. Multivariate analyses displayed that age, aspartate aminotransferase, total cholesterol, H. pylori infection, hepatitis C virus (HCV) infection, and fatty liver had a significant association with gallstones (P < 0.05). Successive multiple logistic regression analysis including index of odds ratio (OR) and standardized coefficient (ß) indicated that older age (OR/ß = 1.056/0.055), H. pylori infection (OR/ß = 1.454/0.109), HCV infection (OR/ß = 1.871/0.123), and fatty liver (OR/ß = 1.947/0.189) had a significant positive association with gallstones. After age stratification, H. pylori infection and fatty liver still had a significant positive association with gallstones in any age-specific groups, whereas HCV infection had a significant positive association in patients aged > 40 years. The prevalence of gallstones among H. pylori-positive, H. pylori-eradicated, and H. pylori-negative subjects was 9.47%, 9.02%, and 8.46%, respectively. The matched analysis showed that gallstones among H. pylori eradicated subjects was significantly lower compared with H. pylori-positive subjects (P < 0.05). CONCLUSION: H. pylori infection and fatty liver have a significant positive association with gallstones. H. pylori eradication may lead to prevention of gallstones.