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Objective To provide clues for the study on the mechanism of autoimmune liver disease (AILD) by exploring the existence of specific bacteria in liver tissues of AILD patients.Methods From August 2017 to August 2018,at Department of Gastroenterology arnd Hepatology,Tianjin Medical University General Hospital,a total of 12 patients diagnosed as AILD (four autoimmune hepatitis (AIH),four primary biliary cirrhosis (PBC) and four PBC-AIH overlap syndrome (OS)) and four patients with hepatic cyst (control group) were enrolled and all the patients underwent liver biopsy.16S rRNA gene sequencing was carried out in the obtained aseptic liver tissues.Linear discriminant analysis effect size was used to find out the specific bacteria.Spearman correlation analysis was performed to analyze the correlation between the liver microbiota and the disease.The metabolic function of the 16S rRNA gene sequences was also predicted.Results Bacteria were detected in the liver tissues of all the 16 patients.At the species level,the abundance of Planococcus rifietoensis of AIH group was 0.100％,which was higher than those of other three groups (0),and the difference was statistically significant (linear discriminant analysis (LDA) =3.31,P =0.034).The abundance of Anoxybacillus flavithermus of PBC group was 0.200％,which was higher than those of other three groups (0.100％),and the difference was statistically significant (LDA =3.34,P =0.014).The abundance of Pseudomonas aeruginosa PAO1,Bacillus firmus,Brevibacillus agri,Acinetobacter baumannii,Sphingomonas zeae and Salmonella enterica were significantly negatively correlated with serum level of γ-glutamyl transferase (r=-0.68,-0.68,-0.67,-0.68,-0.68 and-0.66,all P ＜0.01).Compared with that of the hepatic cyst group,the lipid metabolism of AILD patients decreased.The levels of serum low density lipoprotein and total cholesterol were significantly negatively correlated with the biosynthesis of unsaturated fatty acids (r =-0.55 and-0.65,both P ＜ 0.05).Conclusions There exist specific bacteria in the liver tissues of AIH and PBC groups.The liver microbiota which is closely related with the pathogenesis of AILD might be a potential therapeutic target and diagnostic biomarker.
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Objective To evaluate the valuse of endoscopic ultrasonography ( EUS ) for upper gastrointestinal submucosal lesions and the role of Photoshop in differentiating leiomyoma and stromal tumors. Methods Data of 656 patients with upper gastrointestinal submucosal lesions evaluated by EUS and receiving endoscopic submucosal dissection ( ESD ) from April 2010 to March 2015 were collected and retrospectively analyzed. The goldern standard for lesions size and origin was the intraoperative diagnosis of ESD, and that of the type of lesions ( leiomyoma, stromal tumor, ectopic pancreas, lipoma, etc.) was pathological and immunohistochemical finding. The consistency of diagnosis of the EUS was evaluated. In addition, Photoshop was used to differentiate diagnosis of leiomyoma and stromal tumors which were confirmed by pathology and immunohistochemistry. Results The consistency in diagnosing the size and lesion origins was 92?56%(560/605) and 88?43%(535/605)between EUS and ESD intraoperative result. The consistency in pathological types of EUS was 79?34%(480/605). Photoshop was used to analyze the EUS images of 177 stromal tumor and 241 leiomyoma. The gray value of stromal tumor was significantly higher than that of leiomyoma(59?97 VS 39?39, t=43?27, P<0?05).The echo of stromal tumor was higher. The standard deviation of gray value of leiomyoma were significantly lower than that of the stromal tumor ( 4?81 VS 5?42, t = 2?83, P < 0?05 ) , indicating the echo uniformity of leiomyoma was better. Conclusion EUS shows high accuracy rate for upper gastrointestinal submucosal lesions, providing more accurate basis for endoscopic therapy. EUS combined with Photoshop is helpful for differentiating stromal tumor from leiomyoma.
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Background:The overlap of autoimmune liver disease with extrahepatic autoimmune disease adds the difficulty of diagnosis. It is essential to understand their clinical features. Aims:To analyze the clinical characteristics of primary biliary cirrhosis-autoimmune hepatitis( PBC-AIH ) overlap syndrome, and to investigate the effect of extrahepatic autoimmune disease on PBC-AIH. Methods:The clinical data including general information,clinical manifestations, biochemical parameters,immunological parameters,liver histopathological features,imaging findings and incidence of extrahepatic autoimmune disease of 81 patients with PBC-AIH were retrospectively analyzed. According to whether overlapping with extrahepatic autoimmune disease,PBC-AIH patients were divided into combination group and non-combination group. The clinical characteristics of the two groups were analyzed. Results:The ratio of male to female of 81 patients with PBC-AIH was 1 ∶ 9. 1,and the average age was(58. 1 ± 9. 9)years old. Of the patients 53. 1% had symptoms,the percentage of jaundice and pruritus was 18. 5% . Serum levels of ALT,AST,ALP,GGT,TBil and Glo were increased in all patients and IgG and IgM levels were increased in most of the patients. The positive rates of ANA, AMA and/ or AMA-M2,SMA and gp210 and/ or sp100 were 100% ,90. 1% ,1. 2% and 11. 1% ,respectively. Portal lymphoplasmacyte infiltration and interface hepatitis were the major liver histopathological features;50. 6% of the patients had both histological features of PBC and AIH. Cirrhosis was diagnosed in 28 patients(34. 6% )by imaging,and abdominal lymph nodes enlargement was found in 76 patients(93. 8% ). Twenty-three patients(28. 4% )overlapped with extrahepatic autoimmune disease;Sjogren’s syndrome and autoimmune thyroid disease were the most frequently overlapped extrahepatic autoimmune diseases. The level of GGT was significantly lower in combination group than in non-combination group(P = 0. 001). No statistically significant differences in other clinical characteristics were found between the two groups. Conclusions:It is crucial to understand the clinical characteristics of PBC-AIH and to screen the overlapped extrahepatic autoimmune disease,especially Sjogren’s syndrome and autoimmune thyroid disease.
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Objective To investigate the efficacy and safety of endoscopic submucosal dissection (ESD) for removal of gastrointestinal stromal tumors (GISTs). Methods Data of 22 patients with GISTs,who underwent ESD, were reviewed in terms of personal situation, location and size of lesions, clinical manifestation, managements, pathology, complications and follow-up findings. Results The procedure was successfully performed in all patients and all lesions were removed by one procedure. The lesion size ranged from 0. 8 to 4. 0 cm and the operation time was 35-150 min ( mean 64. 5 min). Mild bleeding occurred in all cases, which was successfully managed by argon plasma coagulation, hot biopsy probe or endoclip. Perforation occurred in 4 patients (18. 1%), which were closed with endoclip. Abdominal distension was relieved with decompression, acid suppression with proton pump inhibitors and antibiotics in 3 cases, additional trans-abdominal puncture was needed in the other case. No severe hemorrhage occurred. The average length of hospitalization was 4. 5 days (3-10 d). The patients were followed up for 3 to 18 months, and no tumor residue or recurrence was observed. Conclusion ESD is an effective and safe endoscopic procedure to remove GISTs. The main complications are bleeding and perforation, which, however, can be cured.
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Objective To evaluate endoscopic ultrasonography (EUS) for diagnosis and treatment of ectopic pancreas in upper gastrointestinal tract.Methods Data of 52 patients with ectopic pancreas diagnosed by EUS and confirmed by pathological examination were reviewed.The feature of EUS image and diagnostic accuracy were retrospectively analyzed.Results Out of 52 patients, 41 (78.85% ) were pathologically diagnosed as having ectopic pancreas, 6 were stromal tumors, 4 were leiomyoma and 1 was nerve sheath tumor.All ectopic pancreases presented as protruding lesions, in which 37 were located at gastric antrum, 2 in duodenum, 1 in gastric body and 1 in gastric fundus.Under EUS, 1 case appeared as hyperechoic, 10 as isoechoic, 18 as hypoechoic and 12 as mixed echoic.The lesion involved mucosa in 2 cases, muscularis mu-cosae in 8, submucosa in 30 and muscularis propria in 1, in which 15 cases from submucosa underwent endoscopic resection.Bleeding occurred in 2 cases and no other complications occurred.There was one relapse during the 6 months of followed-up.Conclusion EUS is valuable and safe for the diagnosis of ectopic pancreas in upper gastrointestinal tract.Depth of lesions revealed by EUS can help further treatment.
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Objects: To investigate the behavior of gastric electrical activity in patients with gastrointestinal stromal tumor(GIST) to identify the influences of GIST on the normal gastric electrical activity. Methods: The electrogastrogram (EGG) parameters of 27 patients with gastric GIST (GIST group) and 30 healthy volunteers (control group) were detected by the multi-channel electrogastrogram and the data were analyzed. Results: The values of postprandial mean frequency (MF), mean amplitude (MA) and the percentage of normal slow wave (N%) were increased, and the percentage of bradygastria (B%) was decreased than those of the fasting in control group(P 0.05). Compared with control group, the fasting MF and MA increased, the fasting N% of lead 1, 3, 4 and postprandial N% decreased, both percentages of fasting and postprandial tachygastria (T%) increased in GIST group (P < 0.01). The tachygastria incidence was significantly higher in GIST group than that of control (66.7% vs 3.3%, P <0.05). Conclusion: The gastric electrical activity was affected by the existence of GIST. The abnormal gastric electrical rhythm displayed mainly as tachygastria.