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Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. During the rapid spread time, it is a great challenge for patients with inflammatory bowel disease (IBD) who use immunosuppressive drugs from vaccination and drug application. This article is intended to supplement and revise the recommendations of the Inflammatory Bowel Disease Group of the Chinese Society of Gastroenterology in 2020 on the "Management of patients with inflammatory bowel disease during epidemic of novel coronavirus pneumonia", mainly including the treatment and vaccination of IBD patients complicated with COVID-19. It is expected to guide clinicians in drug use, vaccination of IBD patients at an appropriate time, also help patients getting through the epidemic period of COVID-19.
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Patients with Crohn's disease (CD) are often complicated with malnutrition and enteral nutrition is the preferred option for nutritional support. Enteral nutrition is the first-line therapy to induce remission of CD in children, but its application in adults has not been well established. In recent years, studies have found that enteral nutrition can not only improve the nutritional status in adult CD patients, but also induce and maintain CD remission through various mechanisms. Given its favorable nutritional efficacy and safety, enteral nutrition has been considered as the basic treatment for adult CD patients and often used in combination with other treatment approaches. However, any combination therapy should be assessed in terms of benefit and risk. This review aims to describe the efficacy and safety of enteral nutrition combined with other treatment approaches in adult CD patients and enumerate common applicable clinical settings, so as to better inform clinical treatment.
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Background/Aims@#Risk of venous thrombosis is increased in patients with inflammatory bowel disease (IBD); data on Asian IBD patients is limited and status quo of thrombosis screening and prophylaxis are unknown. Therefore, we aimed to investigate the incidence, screening, prophylaxis, and risk factors for venous thrombosis among Asian IBD patients. @*Methods@#Medical files of patients with Crohn’s disease (CD) and ulcerative colitis (UC) from 17 hospitals across China between 2011 and 2016 were reviewed for venous thrombosis, use of screening and prophylaxis. A case-control study was performed among hospitalized patients with venous thrombosis and their age-, sex-matched IBD controls hospitalized around the same period; disease characteristics and known provoking factors of venous thrombosis were recorded. Risk factors were analyzed in both univariate and logistic regression analyses. @*Results@#A total of 8,459 IBD patients were followed for 12,373 person-year. Forty-six patients (0.54%) had venous thrombosis, yielding an incidence of 37.18 per 10,000 person-year. Incidence increased with age, especially among CD. Less than 20% of patients received screening tests and 35 patients (0.41%) received prophylaxis. Severe disease flare was an independent risk factor for venous thrombosis (odds ratio [95% confidence interval]: CD, 9.342 [1.813– 48.137]; UC, 5.198 [1.268–21.305]); past use of steroids and extensive involvement were 2 additional risk factors in CD and UC, respectively. @*Conclusions@#Incidence of venous thrombosis in China was 37.18 per 10,000 person-year (0.54%). Use of screening and prophylaxis were rare. Severe disease flare was an independent risk factor for thrombosis among hospitalized patients.
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Background/Aims@#Risk of venous thrombosis is increased in patients with inflammatory bowel disease (IBD); data on Asian IBD patients is limited and status quo of thrombosis screening and prophylaxis are unknown. Therefore, we aimed to investigate the incidence, screening, prophylaxis, and risk factors for venous thrombosis among Asian IBD patients. @*Methods@#Medical files of patients with Crohn’s disease (CD) and ulcerative colitis (UC) from 17 hospitals across China between 2011 and 2016 were reviewed for venous thrombosis, use of screening and prophylaxis. A case-control study was performed among hospitalized patients with venous thrombosis and their age-, sex-matched IBD controls hospitalized around the same period; disease characteristics and known provoking factors of venous thrombosis were recorded. Risk factors were analyzed in both univariate and logistic regression analyses. @*Results@#A total of 8,459 IBD patients were followed for 12,373 person-year. Forty-six patients (0.54%) had venous thrombosis, yielding an incidence of 37.18 per 10,000 person-year. Incidence increased with age, especially among CD. Less than 20% of patients received screening tests and 35 patients (0.41%) received prophylaxis. Severe disease flare was an independent risk factor for venous thrombosis (odds ratio [95% confidence interval]: CD, 9.342 [1.813– 48.137]; UC, 5.198 [1.268–21.305]); past use of steroids and extensive involvement were 2 additional risk factors in CD and UC, respectively. @*Conclusions@#Incidence of venous thrombosis in China was 37.18 per 10,000 person-year (0.54%). Use of screening and prophylaxis were rare. Severe disease flare was an independent risk factor for thrombosis among hospitalized patients.
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Background:Gastrointestinal carcinoids are prone to be neglected in clinical practice because of the poor specific symptoms in early stage. Aims:To analyze the clinicopathological characteristics,treatment modalities and prognosis of a series of cases of gastrointestinal carcinoids for strengthening the understanding of the disease. Methods:A total of 116 patients diagnosed as gastrointestinal carcinoids by pathology from Jan. 1997 to Jan. 2010 in 8 hospitals at Wuhan were enrolled in this retrospective study. Data on sex,age,major symptoms,diagnostic approaches,treatment modalities, pathological features and prognosis, etc. were collected and analyzed. Results:The most common sites of the gastrointestinal carcinoids were rectum(59. 5%)and stomach(19. 8%);the most common symptoms were abdominal pain,abdominal distention and hematochezia. The positivity rates of immunohistochemical marker NSE,Syn and CgA were 92. 7%,87. 5% and 62. 5%,respectively. The proportion of stomach carcinoids with diameter larger than 2 cm was 73. 9%, and that of rectal carcinoids was only 13. 0%(P 0. 05). Conclusions:Gastrointestinal carcinoids enrolled in this study distributed mainly in rectum and stomach. As compared with rectal carcinoids,gastric carcinoids were more advanced in disease stage with poorer prognosis. Regular health checks, strengthening the understanding of the disease,and grasping the specificities of carcinoids distributed at different sites might be helpful for the early diagnosis and treatment of gastrointestinal carcinoids,thus improving the survival rate.
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were no significant differences in the detection rate of recto-sigmoid colon,mid colon,right colon and total detection of polyps among the 3 groups (P >0.05).Conclusion 4-L split-dose PEG is better than the oth-er 2 regimens in the colon cleansing quality,so it can better reach the intestinal cleaning standards before enteroscopy,which is a more suitable regimen for bowel preparation.
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Objective To investigate the efficacy ,safety and compliance of mesalazine sustained‐release (SR) granules taking once daily or multi‐times daily in the treatment of patients with mild to moderate active ulcerative colitis .Methods Sixty patients with mild to moderate active ulcerative colitis were divided into group A ,B and C with 20 patients in each group .Group A received mesalazine SR granules 4 g once daily ,Group B with 2 g each time and twice daily ,Group C with 1 g each time and four times daily . The total course was eight weeks . The vital signs ,Mayo score ,compliance and adverse effects of patients were monitored at 0 ,4th ,8th weeks .At 0 and 8th weeks ,colonoscopy were performed . The parameters of efficacy assessment were clinical complete remission rate , clinical remission rate , efficacy rate ,mucosal healing rate ,remission time and safety .The F test ,t test or Chi‐square test was performed for comparison among groups .Results The clinical complete remission rate of group A ,B and C was 20% (4/20) ,10% (2/20) and 10% (2/20) ,respectively .The clinical complete remission rate was 70% (14/20) ,65% (13/20) and 70% (14/20) ,respectively .The efficacy rate was 95% (19/20) ,85%(17/20) and 90% (18/20) ,respectively .The mucosal healing rate was 70% (14/20) ,60% (12/20) and 50% (10/20) ,respectively .The side effects rate was 20% (4/20) ,15% (3/20) and 20% (4/20) .There was no significant difference between groups (all P > 0 .05) .The remission time of group A and B was (15 .4 ± 3 .7) days and (15 .6 ± 2 .9) days ,which were both shorter than that of group C (18 .4 ± 3 .6) days ,and the differences were statistically significant (t= 2 .661 and 2 .710 ,both P< 0 .05) .There was no significant difference among three groups in gender ,disease course , severity , location and clinical remission rate of sub‐groups .Conclusions The efficacy and safety of mesalazine SR granules taking once daily or multi‐times daily are similar in the treatment of patients with mild to moderate active ulcerative colitis .Once daily have better compliance than other regimens .
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Objective To analyze and explore the clinical features,pathological characters,treatment and prognosis of rectum carcinoid.Methods From January 1997 to January 2010,69 pathologically diagnosed rectum carcinoid cases were collected from Union Hospital of Tongji Medical College,Huazhong University of Science and Technology and other 7 hospitals.The clinical features,pathological characters,treatment and prognosis were analyzed. Results Of 69 rectum carconid cases,there were 36 males and 33 females.The average age was (49.3±12.9) years.The common symptom were hemotochezia,abdominal pain,constipation,diarrhoea and abdominal distension.There were 55 cases with lesions from the anus less than 8 cm and in other patients,lesions from the anus were all more than 8 cm.66 cases were typical carcinoid,3 cases were atypical carcinoid.40 cases underwent the immunohistochemical staining.The common markers for immunohistochemical staining were Syn,CgA and NSE,the positive percentage were 90％ (36/40),75％ (30/40) and 82.5％(33/40) respectively.A total of 24 patients received endoscopic therapy,44 patients had surgery,1 patient who refused surgery received only life support and symptomatic treatment.Conclusion No specific clinical symptoms of rectum carcinoid,and most were typical carcinoid.Lesions confined to mucosa and submucosa could be considered the endoscopic therapy.
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Objective To investigate the clinical characteristics, treatment and prognosis of gastrointestinal stromal tumors (GIST). Methods The clinical data from 110 patients with pathologically performed GIST,who were admitted to the hospital between Feb. 2002 and July 2008,were retrospectively analyzed. Results Most of the GIST originated from stomach (50.9 %) and small intestine (31.8%). The clinical signs in 103 cases (93.6%) included gastrointestinal bleeding,epigastic pain and mass in abdomen. The pathological examination showed benign lesions in 14 ( 12.7 %) patients, junctional lesions in 37 ( 33. 6 %) patients and malignant lesions in 59 ( 53. 6 %)patients. The positive rates of CD117 and CD34 in GIST patients were 98.2% and 77.3% respectively. In all patients with GIST, 81.8% had complete resections of the tumor. Twenty-one patients (15 with metastasis and 6 being relapse) were treated with imatinib with responsive rate of 80. 0%. Conclusions The diagnosis of GIST relies on histopathological and immunohistochemical examinations because of lacking specific clinical menifestaions. CD117 is an important marker for the diagnosis of GIST and radical resection of the tumor is important in treatment of GIST. Molecular target therapy of imatinib can prolong the survival time of the patients with advanced GIST.
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Objective To investigate whether gastric hypersensitivity exists in functional dyspepsia patients, and to observe the number of mast cells in proximal gastric mucosa in gastric hypersensitivity patients and the change of mast cell degranulation after stimulation so as to evaluate the role of mast cells in gastric hypersensitivity. Methods Gastric sensation threshold was determined using barostat in 40 functional dyspepsia (FD) patients and 15 controls. Twenty three patients were divided into two groups on the basis of perception threshold: hypersensitivity group (FD H) and normal sensation group (FD N). Mast cells were stained by immunohistochemistry method, mast cell number was calculated by microscopy and the average optical density valves( A ) of mast cell were obtained by microspectrophotometry (MSP). The ultrastructure of mast cell was observed under electromicroscopy. Results Gastric sensation threshold (i.e. perception, discomfort and pain threshold) was significantly lower in FD patients than in controls ( P