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1.
Biomed Phys Eng Express ; 10(1)2023 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-38100789

RESUMO

Purpose. The objectives of the proposed work are twofold. Firstly, to develop a specialized light weight CRPU-Net for the segmentation of polyps in colonoscopy images. Secondly, to conduct a comparative analysis of the performance of CRPU-Net with implemented state-of-the-art models.Methods. We have utilized two distinct colonoscopy image datasets such as CVC-ColonDB and CVC-ClinicDB. This paper introduces the CRPU-Net, a novel approach for the automated segmentation of polyps in colorectal regions. A comprehensive series of experiments was conducted using the CRPU-Net, and its performance was compared with that of state-of-the-art models such as VGG16, VGG19, U-Net and ResUnet++. Additional analysis such as ablation study, generalizability test and 5-fold cross validation were performed.Results. The CRPU-Net achieved the segmentation accuracy of 96.42% compared to state-of-the-art model like ResUnet++ (90.91%). The Jaccard coefficient of 93.96% and Dice coefficient of 95.77% was obtained by comparing the segmentation performance of the CRPU-Net with ground truth.Conclusion. The CRPU-Net exhibits outstanding performance in Segmentation of polyp and holds promise for integration into colonoscopy devices enabling efficient operation.


Assuntos
Pólipos do Colo , Aprendizado Profundo , Humanos , Pólipos do Colo/diagnóstico por imagem , Semântica , Trato Gastrointestinal Inferior , Projetos de Pesquisa
2.
Gut Microbes ; 15(1): 2223332, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37340735

RESUMO

Escherichia coli (E. coli) is an important commensal in the human gut; however, it is unknown whether strains show site-specificity in the lower gut. To investigate this, we assessed genotypic and phenotypic differences in 37 clone pairs (two strains with very similar multiple locus variable-number-tandem-repeat analysis [MLVA] profiles) of E. coli isolated from mucosal biopsies of two different gut locations (terminal ileum and rectum). The clone pairs varied at the genomic level; single nucleotide polymorphisms (SNPs) were common, multiple nucleotide polymorphisms (MNPs) were observed but less common, and few indels (insertions and deletions) were detected. The variation was higher in clone pairs that are associated with non-human-associated sequence types (ST) compared to human-associated STs, such as ST95, ST131, and ST73. No gene(s) with non-synonymous mutations were found to be commonly associated with either the terminal ileum or the rectal strains. At the phenotypic level, we identified the metabolic signatures for some STs. Rectum strains of some STs showed consistently higher metabolic activity with particular carbon sources. Clone pairs belonging to specific STs showed distinct growth patterns under different pH conditions. Overall, this study showed that E. coli may exhibit genomic and phenotypic variability at different locations in the gut. Although genomics did not reveal significant information suggesting the site-specificity of strains, some phenotypic studies have suggested that strains may display site-specificity in the lower gut. These results provide insights into the nature and adaptation of E. coli in the lower gut of humans. To the best of our knowledge, no study has investigated or demonstrated the site-specificity of commensal E. coli in the human gut.


Assuntos
Infecções por Escherichia coli , Microbioma Gastrointestinal , Humanos , Escherichia coli/metabolismo , Microbioma Gastrointestinal/genética , Genômica/métodos , Trato Gastrointestinal Inferior
3.
Bone Marrow Transplant ; 58(9): 991-999, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37202544

RESUMO

Involvement of lower gastrointestinal tract (LGI) occurs in 60% of patients with graft-versus-host-disease (GVHD). Complement components C3 and C5 are involved in GVHD pathogenesis. In this phase 2a study, we evaluated the safety and efficacy of ALXN1007, a monoclonal antibody against C5a, in patients with newly diagnosed LGI acute GVHD receiving concomitant corticosteroid. Twenty-five patients were enrolled; one was excluded from the efficacy analysis based upon negative biopsy. Most patients (16/25, 64%) had acute leukemia; 52% (13/25) had an HLA-matched unrelated donor; and 68% (17/25) received myeloablative conditioning. Half the patients (12/24) had a high biomarker profile, Ann Arbor score 3; 42% (10/24) had high-risk GVHD per Minnesota classification. Day-28 overall response was 58% (13/24 complete response, 1/24 partial response), and 63% by Day-56 (all complete responses). Day-28 overall response was 50% (5/10) in Minnesota high-risk and 42% (5/12) in high-risk Ann Arbor patients, increasing to 58% (7/12) by Day-56. Non-relapse mortality at 6-months was 24% (95% CI 11-53). The most common treatment-related adverse event was infection (6/25, 24%). Neither baseline complement levels (except for C5), activity, nor inhibition of C5a with ALXN1007 correlated with GVHD severity or responses. Further studies are needed to evaluate the role of complement inhibition in GVHD treatment.


Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Humanos , Inativadores do Complemento/uso terapêutico , Complemento C5a/uso terapêutico , Estudos Prospectivos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Enxerto-Hospedeiro/etiologia , Trato Gastrointestinal Inferior/patologia
4.
Diagn Cytopathol ; 51(7): 434-440, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37021663

RESUMO

BACKGROUND: The aim of this study is to compare the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) versus endoscopic biopsy for the diagnosis of gastrointestinal (GI) subepithelial lesions (SELs) using surgical resection as the gold standard. METHODS: All patients who underwent EUS-FNA of upper and lower GI SELs over a 10-year period (2010 through 2019) were retrospectively reviewed. The medical records of all patients were reviewed and data extracted from the endoscopy, pathology, and surgical reports were analyzed. RESULTS: In total, 283 patients with ages ranging from 21 to 92 years underwent EUS-FNA for evaluation of GI SELs, 117 (41%) patients underwent endoscopic biopsy and 82 (29%) patients had concurrent surgical resection specimen. EUS-FNA was obtained from the stomach in 167 (59%) patients, duodenum in 51 (18%) patients, esophagus in 38 (13%) patients, and colorectum in 27 (10%) patients. It was found that the largest percentage of lesions originated in the muscularis propria (36%), followed by the submucosa (26%), deep mucosa (13%), and not specified in 21%. The concordance between EUS-FNA and endoscopic biopsy was good (correlation coefficient of 0.631, p < .001). EUS-FNA versus endoscopic biopsy in resected cases showed sensitivity and specificity of 78% versus 68% and 84% versus 100%, respectively. The EUS-FNA has an accuracy of 80% compared to 74% in biopsy. The diagnostic yield of EUS-FNA and endoscopic biopsy was 64% versus 55%. CONCLUSION: EUS-FNA is more sensitive and more accurate than endoscopic biopsy for diagnosing GI SELs with a good concordance between the two techniques.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Trato Gastrointestinal Inferior , Humanos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade
5.
Rheum Dis Clin North Am ; 49(2): 319-336, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37028837

RESUMO

Lower gastrointestinal (GI) symptoms are a frequently encountered problem for clinicians managing patients with systemic sclerosis. The current management practices are focused on the treatment of symptoms with little information available on how to use GI investigations in daily practice. This review demonstrates how to integrate the objective assessment of common lower GI symptoms into clinical care with the aim of guiding clinical decision making. Understanding the type of abnormal GI function that is affecting a patient and determining which parts of the gut are impacted can help clinicians to target therapy more precisely.


Assuntos
Gastroenteropatias , Escleroderma Sistêmico , Humanos , Reumatologistas , Trato Gastrointestinal , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Gastroenteropatias/terapia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/terapia , Trato Gastrointestinal Inferior
8.
Sci Rep ; 13(1): 1284, 2023 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690652

RESUMO

Postoperative arrhythmias (PAs) are common events and have been widely investigated in cardiothoracic surgery. Within visceral surgery, a recent study revealed a significant occurrence of PA in esophageal resections. In contrast, PA in lower gastrointestinal surgery is rarely investigated and has been rudimentary described in the medical literature. The present work is a retrospective cohort study of 1171 patients who underwent surgery of lower gastrointestinal tract between 2012 and 2018. All included patients were treated and monitored in the intensive care unit (ICU) or intermediate care unit (IMC) after surgery. Follow-up, performed between January and May 2021, was obtained for the patients with PA investigating the possible persistence of PA and complications such as permanent arrhythmia or thromboembolic events after discharge. In total, n = 1171 patients (559 female, 612 male) without any history of prior arrhythmia were analyzed. Overall, PA occurred in n = 56 (4.8%) patients after surgery of the lower GI. The highest incidence of PA was seen in patients undergoing bowel surgery after mesenteric ischaemia (26.92%), followed by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC; 16.67%). PA was significantly associated with higher age (72 years (IQR 63-78 years) vs. 64 years (IQR 55-73.5 years), p < 0.001) and longer length of stay in the ICU (median 15 days (IQR 5-25 days) vs. median 2 days (IQR 1-5 days), p < 0.001). PA was independently associated with organ failure (OR = 4.62, 95% CI 2.11-10.11, p < 0.001) and higher in-house mortality (OR = 3.37, 95% CI 1.23-9.28, p < 0.001). In median, PA occurred 66.5 h after surgery. In follow-up, 31% of all the patients with PA showed development of permanent arrhythmia. The incidence of PA after lower GI surgery is comparatively low. Its occurrence, however, seems to have severe implications since it is significantly associated with higher rates of organ failure and in-house mortality. Also, compared to the general population, the development of permanent arrhythmia is significantly higher in patients who developed new-onset PA.


Assuntos
Hipertermia Induzida , Neoplasias Peritoneais , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Incidência , Estudos Retrospectivos , Neoplasias Peritoneais/tratamento farmacológico , Quimioterapia do Câncer por Perfusão Regional , Arritmias Cardíacas/tratamento farmacológico , Trato Gastrointestinal Inferior , Terapia Combinada
9.
Chirurgie (Heidelb) ; 94(4): 382-390, 2023 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-36066592

RESUMO

Even when wide-ranging measures for avoidance of complications by improved techniques, training and many other activities are undertaken, postoperative and postinterventional complications still represent a daily problem in clinical medicine. The outcome of the patient is not uncommonly decided by the management of the complications. The failure to rescue or to control complications is increasingly recognized as being decisive for the success of treatment. This article therefore provides a current overview of the endoscopic management of complications of the upper and lower gastrointestinal tract. It describes when endoscopy can be used to detect or exclude a complication. The most important principles of treatment including the indications, limits of performance and technique are presented.


Assuntos
Fístula Anastomótica , Trato Gastrointestinal Superior , Humanos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Trato Gastrointestinal/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Trato Gastrointestinal Superior/cirurgia , Trato Gastrointestinal Inferior
10.
Int J Biol Macromol ; 225: 615-624, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36395944

RESUMO

Controlled release is often preferred for orally administrated bioactive compounds and drugs. In this study, a nanocellulose (NC) incorporated oleogel encapsulation system was developed for controlled release of active agents. 5-Aminosalicylic acid (5-ASA), an anti-inflammatory drug to treat inflammatory bowel diseases, was used as an example core ingredient for demonstrating the efficacy of the system. Oleogels with/without NC incorporation encapsulating 5-ASA were prepared and tested by in vitro digestion study, and 5-ASA released from the matrix was quantified by a novel UV-Vis spectrometric method developed in this study. The oleogel encapsulation system was characterized by assessing the encapsulation efficiency, oxidative stability, gel hardness, microstructure, and thermal stability. Results showed that sorbitan tristearate-induced oleogel system successfully protected 5-ASA during GI digestion. The incorporation of NC solutions with different NC types, concentrations and volumes further modified the release rate. Specifically, the release of 5-ASA in NC incorporated matrix was <6 % in the gastric phase, and ranged between 17.42 % - 38.28 % in the small intestine depending on the added NC type and concentration. Additionally, the incorporation of NC improved physicochemical stability of the gel matrix. The new 5-ASA quantification method developed in this study is simpler and faster compared with currently available methods.


Assuntos
Mesalamina , Compostos Orgânicos , Preparações de Ação Retardada , Compostos Orgânicos/química , Trato Gastrointestinal Inferior
11.
Blood ; 141(12): 1389-1401, 2023 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-36399701

RESUMO

Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality following allogeneic hematopoietic transplantation. In experimental models, interleukin-22 promotes epithelial regeneration and induces innate antimicrobial molecules. We conducted a multicenter single-arm phase 2 study evaluating the safety and efficacy of a novel recombinant human interleukin-22 dimer, F-652, used in combination with systemic corticosteroids for treatment of newly diagnosed lower gastrointestinal acute GVHD. The most common adverse events were cytopenias and electrolyte abnormalities, and there were no dose-limiting toxicities. Out of 27 patients, 19 (70%; 80% confidence interval, 56%-79%) achieved a day-28 treatment response, meeting the prespecified primary endpoint. Responders exhibited a distinct fecal microbiota composition characterized by expansion of commensal anaerobes, which correlated with increased overall microbial α-diversity, suggesting improvement of GVHD-associated dysbiosis. This work demonstrates a potential approach for combining immunosuppression with tissue-supportive strategies to enhance recovery of damaged mucosa and promote microbial health in patients with gastrointestinal GVHD. This trial was registered at www.clinicaltrials.gov as NCT02406651.


Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Humanos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/etiologia , Trato Gastrointestinal Inferior , Corticosteroides/uso terapêutico
12.
Toxicol Lett ; 374: 19-30, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36473683

RESUMO

This discourse attempts to capture a few important dimensions of gut physiology like microbial homeostasis, short chain fatty acid (SCFA) production, occludin expression, and gut permeability in post-natal life of mice those received arsenic only during pre-natal life. Adult Balb/c mice were fed with 4 ppm arsenic trioxide in drinking water during breeding and gestation. After the birth of the pups, the arsenic water was withdrawn and replaced with clean drinking water. The pups were allowed to grow for 28 days (pAs-mice) and age matched Balb/c mice which were never exposed to arsenic served as control The pAs-mice showed a striking reduction in Firmicutes to Bacteroidetes (F/B) ratio coupled with a decrease in tight junction protein, occludin resulting in an increase in gut permeability, increased infiltration of inflammatory cells in the colon and decrease in common SCFAs in which butyrate reduction was quite prominent in fecal samples as compared to normal control. The above phenotypes of pAs-mice were mostly reversed by supplementing 5% sodium butyrate (w/w) with food from 21st to 28th day. The ability of butyrate in enhancing occludin expression, in particular, was dissected further. As miR122 causes degradation of Occludin mRNA, we transiently overexpressed miR122 by injecting appropriate plasmids and showed reversal of butyrate effects in pAs-mice. Thus, pre-natal arsenic exposure orchestrates variety of effects by decreasing butyrate in pAs-mice leading to increased permeability due to reduced occludin expression. Our research adds a new dimension to our understanding that pre-natal arsenic exposure imprints in post-natal life while there was no further arsenic exposure.


Assuntos
Arsênio , Trato Gastrointestinal Inferior , MicroRNAs , Ocludina , Efeitos Tardios da Exposição Pré-Natal , Animais , Camundongos , Arsênio/efeitos adversos , Arsênio/toxicidade , Ácido Butírico/metabolismo , Água Potável/química , Trato Gastrointestinal/metabolismo , Trato Gastrointestinal Inferior/metabolismo , MicroRNAs/genética , MicroRNAs/metabolismo , Ocludina/genética , Ocludina/metabolismo , Permeabilidade , Efeitos Tardios da Exposição Pré-Natal/metabolismo
13.
J Gastroenterol Hepatol ; 37(8): 1554-1560, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35506307

RESUMO

BACKGROUND AND AIM: The standard therapies for benign gastrointestinal stenosis are endoscopic balloon dilation or surgery; each have their advantages and disadvantages. In contrast, radial incision and cutting (RIC) is a novel approach for such stenosis. This study aimed to investigate the feasibility, safety, and effectiveness of RIC. METHODS: We enrolled 20 patients with benign stenosis of the lower gastrointestinal tract developed by various causes and conducted RIC. We evaluated the re-intervention free rate 52 weeks after RIC, technical success rate, adverse events, procedure time, and improvement of symptoms using a visual analog scale. RESULTS: We performed 20 sessions of first RIC for 20 lesions and seven sessions of additional RIC due to re-stenosis. The cumulative re-intervention-free survival rate 52 weeks after the first RIC was 55.8%. The technical success rate of the first RIC was 100% (20/20) while that of the additional RIC was 85.7% (6/7). One case developed perforation during the additional RIC and urgent surgery was performed. The additional RIC tended to show worse results in adverse events and procedure time compared with the first RIC. The patients' symptoms including abdominal bloating and dyschezia were significantly improved. CONCLUSIONS: Although RIC demonstrated a higher technical success rate for lower gastrointestinal stricture and subsequent improvement of patient symptoms, several issues including preventing delayed bleeding, perforation, and the long-term prognosis should be solved and clarified in further investigations.


Assuntos
Endoscopia , Ferida Cirúrgica , Cateterismo/métodos , Constrição Patológica/etiologia , Dilatação , Endoscopia/métodos , Humanos , Trato Gastrointestinal Inferior , Resultado do Tratamento
14.
Korean J Radiol ; 23(7): 732-741, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35434980

RESUMO

OBJECTIVE: To determine the impact of dedicated subspecialized radiologists in multidisciplinary team (MDT) discussions on the management of lower gastrointestinal (GI) tract malignancies. MATERIALS AND METHODS: We retrospectively analyzed the data of 244 patients (mean age ± standard deviation, 61.7 ± 11.9 years) referred to MDT discussions 249 times (i.e., 249 cases, as five patients were discussed twice for different issues) for lower GI tract malignancy including colorectal cancer, small bowel cancer, GI stromal tumor, and GI neuroendocrine tumor between April 2018 and June 2021 in a prospective database. Before the MDT discussions, dedicated GI radiologists reviewed all imaging studies again besides routine clinical reading. The referring clinician's initial diagnosis, initial treatment plan, change in radiologic interpretation compared with the initial radiology report, and the MDT's consensus recommendations for treatment were collected and compared. Factors associated with changes in treatment plans and the implementation of MDT decisions were analyzed. RESULTS: Of the 249 cases, radiologic interpretation was changed in 73 cases (29.3%) after a review by dedicated GI radiologists, with 78.1% (57/73) resulting in changes in the treatment plan. The treatment plan was changed in 92 cases (36.9%), and the rate of change in the treatment plan was significantly higher in cases with changes in radiologic interpretation than in those without (78.1% [57/73] vs. 19.9% [35/176], p < 0.001). Follow-up records of patients showed that 91.2% (227/249) of MDT recommendations for treatment were implemented. Multiple logistic regression analysis revealed that the nonsurgical approach (vs. surgical approach) decided through MDT discussion was a significant factor for patients being managed differently than the MDT recommendations (Odds ratio, 4.48; p = 0.017). CONCLUSION: MDT discussion involving additional review of radiology examinations by dedicated GI radiologists resulted in a change in the treatment plan in 36.9% of cases. Changes in treatment plans were significantly associated with changes in radiologic interpretation.


Assuntos
Neoplasias Gastrointestinais , Equipe de Assistência ao Paciente , Idoso , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/terapia , Humanos , Trato Gastrointestinal Inferior , Pessoa de Meia-Idade , Radiologistas , Estudos Retrospectivos
15.
Surg Endosc ; 36(10): 7219-7224, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35122148

RESUMO

BACKGROUND: Management of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis (LGTP) is not a standardized procedure. A monocentric study was carried out in 2016 in our centre. (PI study) to evaluate the interest of drainage. Our objective was to revaluate, our actual use of abdominal drainage after peritonitis (PII study). STUDY DESIGN: We examined retrospectively patients who underwent surgery for secondary sub-mesocolic community-acquired peritonitis (January 2016-December 2019). Study exclusion criteria were primary peritonitis, peritoneal dialysis, nosocomial peritonitis, postoperative peritonitis, upper gastrointestinal tract peritonitis, peritonitis due to appendicitis, peritonitis requiring the implementation of Mikulicz's drain, and peritonitis in which the peritoneum was not described in the surgical report (i.e., the same criteria that the PI study which included 141 patients from January 2009 to January 2012). The primary endpoint was the rate of abdominal drainage. The secondary endpoints were the patient rate without a peritoneum description, major complications rate (Clavien ≥III), abscess rate, mortality rate and the length of stay in the non-drain group (D - ) and in the drain group (D + ) in PII study. Primary and secondary endpoints were also compared between PI and PII studies. Risk factors for post-operative abscess were also research. RESULTS: Of the 150 patients included 33% were drained vs 84% of the 141 patients included in PI study (p < 0.001). In PII study peritoneum was described in 80.3% of patients vs 69% in PI study (NS, p = 0.06). Comparing the two groups D - and D + , no significant differences were found in major complications (respectively 45% vs 32%, p = 0.1), reoperation rate (respectively 25% vs 22%, p = 0.7), death rate (respectively 25% vs 14%; p = 0.1) and mean length of stay (respectively 12 days vs 13 days, p = 0.9). The abscess rate was significantly lower in the D - group (10% vs 30%, p = 0.002). Comparing PI and PII studies, there was no difference about major complications (35% vs 35%, p = 0.1), reoperation (16% vs 17.5%, p = 0.5), abscess rate (15% vs 8.5%, p = 0.1) and mortality (14.5% vs 17.5%, p = 0.7). The length of stay was longer in PI study than in P II (14 days vs 9 days, p = 0.03). Drainage (p = 0.005; OR = 4.357; CI [1.559-12.173]) and peritonitis type (p = 0.032; OR = 3.264; CI [1.106-9.630]) were abscess risk factors. CONCLUSION: This study therefore showed that drainage after surgery for LGTP may not be necessary and that, at least at the local level, surgeons seem to be inclined to discontinue it systematically. It may therefore be worthwhile to conduct a randomised control trial to establish recommendations on drainage after surgery for LGTP.


Assuntos
Abscesso , Peritonite , Drenagem/métodos , Humanos , Tempo de Internação , Trato Gastrointestinal Inferior , Peritônio , Peritonite/etiologia , Peritonite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
16.
Curr Opin Clin Nutr Metab Care ; 25(2): 110-115, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35026804

RESUMO

PURPOSE OF REVIEW: The goal of this report is to delineate the correlation between constipation as a manifestation of impaired gastrointestinal transit with adverse clinical outcomes, to identify risk factors, which predispose to this condition, and outline a management scheme for prophylactic treatment. RECENT FINDINGS: Constipation is common in the ICU, affecting upwards of 60-85% of critically ill patients. As suggested by case series and observational studies, constipation may be an independent prognostic factor identifying patients with greater disease severity, higher likelihood of organ dysfunction, longer duration of mechanical ventilation, prolonged hospital length of stay, and possibly reduced survival. Treating constipation is a low priority for intensivists often relegated to the nursing service, and few ICUs have well designed protocols in place for a bowel regimen. Small randomized controlled trials show improvement in certain outcome parameters in response to a daily lactulose therapy; hospital length of stay, sequential organ failure assessment scores, and duration of mechanical ventilation. However, aggregating the data from these studies in two separate meta-analyses showed that the effect of a bowel regimen on these three endpoints were not statistically different. SUMMARY: No causal relationship can be determined between constipation and adverse outcomes. Nonetheless, a clinical correlation seems to exist. Whether constipation is an epiphenomenon or simply a reflection of greater severity of critical illness, at some point it may contribute to worsening morbidity in the ICU. A graded prophylactic bowel regimen should help reverse impairment of the gastrointestinal transit and aid in reducing its deleterious impact on the hospital course of the critically ill patient.


Assuntos
Estado Terminal , Defecação , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Trato Gastrointestinal Inferior , Respiração Artificial
17.
Pediatr Clin North Am ; 68(6): 1255-1271, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34736588

RESUMO

Functional and motility gastrointestinal disorders are the most common complaints to the pediatric gastroenterologist. Disorders affecting the small intestine carry a significant morbidity and mortality due to the severe limitation of therapeutic interventions available and the complications associated with such interventions. Congenital colorectal disorders are rare but also carry significant morbidity and poor quality of life plus the social stigma associated with its complications. In this review, we summarize the clinical presentation, diagnostic evaluations, and the therapeutic interventions available for the most common and severe gastrointestinal functional and motility disorders of the small bowel, colon, and anorectum.


Assuntos
Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Motilidade Gastrointestinal , Trato Gastrointestinal Inferior/patologia , Adolescente , Malformações Anorretais/diagnóstico , Malformações Anorretais/terapia , Biópsia/métodos , Criança , Pré-Escolar , Doenças do Colo/diagnóstico , Doenças do Colo/mortalidade , Doenças do Colo/terapia , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Eritromicina/uso terapêutico , Feminino , Gastroenteropatias/mortalidade , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/terapia , Humanos , Lactente , Pseudo-Obstrução Intestinal/diagnóstico , Pseudo-Obstrução Intestinal/terapia , Intestino Delgado/patologia , Masculino , Manometria/métodos , Estado Nutricional , Qualidade de Vida
18.
Pathobiology ; 88(6): 434-442, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34814148

RESUMO

INTRODUCTION: Little information about clinical presentation of mesenchymal tumors of the lower gastrointestinal (GI) tract due to their extreme heterogeneity is available for clinical management. Usually, small solitary asymptomatic polyps are accidently found during a screening colonoscopy performed for hematochezia, abdominal pain, constipation, diarrhea, and bowel obstruction. In this case series, we illustrate our experience with mesenchymal tumors of the lower GI tract, which are a group of unusual and quite challenging lesions. CASE PRESENTATION: We retrospectively collected mesenchymal tumors of the lower GI tract in our institution (Fondazione IRCSS Ca' Granda - Ospedale Maggiore Policlinico di Milano) during the last 10 years. We reviewed the histological slides, and, when necessary, we performed immunohistochemical analyses to better characterize the tumors. A total of 99 cases were identified: 45 GISTs, 42 lipomas, 4 leiomyomas, 3 Kaposi sarcomas, 1 schwannoma, 1 ganglioneuroma, 1 hemangioma, 1 inflammatory fibroid polyp, and 1 challenging case of spindle cell melanoma. We focused on the most rare entities excluding therefore all GISTs and lipomas from re-evaluation. CONCLUSION: Mesenchymal tumors of the lower GI tract represent a highly heterogeneous group of lesions encompassing GISTs, lipomas, smooth muscle tumors (leiomyoma and leiomyosarcoma), GI schwannomas, inflammatory fibroid polyps, solitary fibrous tumors, and other unusual spindle cell tumors. Immunohistochemistry and, in selected cases, molecular biology remain a useful tool which, in addition to a meticulous study of the morphology, helps the pathologist in the tangled jungle of differential diagnosis.


Assuntos
Neoplasias Gastrointestinais , Tumores do Estroma Gastrointestinal , Diagnóstico Diferencial , Neoplasias Gastrointestinais/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Trato Gastrointestinal Inferior , Proteínas Proto-Oncogênicas c-kit , Estudos Retrospectivos
19.
Dig Liver Dis ; 53(10): 1327-1333, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34120857

RESUMO

BACKGROUND: There is limited evidence on the efficacy of hemostatic powders in the management of lower gastrointestinal bleeding. AIMS: to revise our series of patients with lower gastrointestinal bleeding treated with hemostatic powders and to provide a pooled estimate of their efficacy based on the current literature. METHODS: Sixty-five patients underwent topical endoscopic application of hemostatic powder between 2016 and 2020. The primary endpoint was treatment success, with 7- and 30-day rebleeding rate, adverse events and mortality as secondary outcomes. Literature review was based on computerized bibliographic search on the main databases through December 2020. Pooled effects were calculated using a random-effects model. RESULTS: Overall, the powder was applied as monotherapy in 37 patients (56.9%), as combination therapy in 15 patients (23.4%), and as rescue therapy in 13 cases (19.9%). Hemostasis was achieved in 100% of patients. Rebleeding rate at 7- and 30-day was 7.7% and 9.2%, respectively. A total of 10 studies with 259 patients were included in the meta-analysis. Immediate hemostasis was achieved in 96.3% (93.4%-99.2%) patients, whereas pooled 7- and 30-day rebleeding rates were 9.6% (4.5%-14.6%) and 12.9% (7.2%-18.5%), respectively. CONCLUSION: Novel hemostatic powders represent a user-friendly and effective tool in the management of lower gastrointestinal bleeding.


Assuntos
Hemorragia Gastrointestinal/tratamento farmacológico , Hemostase Endoscópica/métodos , Hemostáticos/administração & dosagem , Pós/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Trato Gastrointestinal Inferior , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
J Am Coll Radiol ; 18(5S): S139-S152, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33958109

RESUMO

Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient for most patients, followed by elective diagnostic tests. However, if acute lower GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Colonoscopy can identify the site and cause of bleeding and provide effective treatment. CTA is a noninvasive diagnostic tool that is better tolerated by patients, can identify actively bleeding site or a potential bleeding lesion in vast majority of patients. RBC scan can identify intermittent bleeding, and with single-photon emission computed tomography, can more accurately localize it to a small segment of bowel. If patients are hemodynamically unstable, CTA and transcatheter arteriography/embolization can be performed. Colonoscopy can also be considered in these patients if rapid bowel preparation is feasible. Transcatheter arteriography has a low rate of major complications; however, targeted transcatheter embolization is only feasible if extravasation is seen, which is more likely in hemodynamically unstable patients. If bleeding site has been previously localized but the intervention by colonoscopy and transcatheter embolization have failed to achieve hemostasis, surgery may be required. Among patients with obscure (nonlocalized) recurrent bleeding, capsule endoscopy and CT enterography can be considered to identify culprit mucosal lesion(s). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Radiologia , Sociedades Médicas , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Humanos , Trato Gastrointestinal Inferior/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
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