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1.
Lieven Pouillon Anne Lamoureux Guillaume Pineton de Chambrun Lucine Vuitton Benjamin Pariente Camille Zallot Gaspard Dufour Mathurin Fumery Cédric Baumann Aurélien Amiot Stéphane Nancey Hélène Rousseau Laurent Peyrin-Biroulet 《Digestive and liver disease》2019,51(2):236-241
Background
Data about the outcomes after adalimumab dose de-escalation in inflammatory bowel disease (IBD) are scarce.Objectives
To assess the outcomes after adalimumab dose de-escalation, and to identify potential factors associated with failure.Methods
Retrospective, observational study including all IBD patients who had undergone adalimumab dose de-escalation to 40?mg every three weeks across seven GETAID centers, between June 2011 and September 2017. Failure of adalimumab dose de-escalation was defined as the need for treatment re-escalation, discontinuation of adalimumab, or clinical, biochemical and/or morphologic disease relapse.Results
Fifty-six patients were identified (n?=?46 Crohn’s disease, n?=?10 ulcerative colitis). Median (IQR) duration of follow-up after adalimumab dose de-escalation was 15.9 (7.9–30.6) months. Adalimumab dose de-escalation was a failure in 21/56 (37.5%) patients and successful in 35/56 (62.5%) patients. Median (IQR) time until failure was 8.9 (4.6–15.6) months. At multivariate analysis, inactive disease at magnetic resonance imaging and/or endoscopy in the year before adalimumab dose de-escalation decreased the risk of failure with a factor five (P?=?0.02).Conclusions
Adalimumab dose de-escalation to 40?mg every three weeks is possible in almost two thirds of IBD patients. Objective morphologic signs of active disease should be ruled out before considering a de-escalation strategy with adalimumab. 相似文献2.
Georgios Giannakopoulos Hans Verbaan Inga-Lill Friis-Liby Per Sangfelt Nils Nyhlin Sven Almer 《Digestive and liver disease》2019,51(2):253-257
Background
Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse.Aims
To report our long-term experience with mycophenolate mofetil.Methods
Retrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n?=?14, 64%), lack of remission (n?=?5, 23%) or a combination (n?=?3, 13%).Results
Mycophenolate mofetil was started at a dose of 20?mg/kg/day and increased to a maximum of 3?g/day. Follow-up was 0–6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n?=?3) or maintained (n?=?7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events. Three patients were switched to cyclosporine and one underwent liver transplantation. Successful treatment with mycophenolate mofetil continued in 10 patients (45%) for a median of 71 months (range 20–124). Of these, one stopped prednisolone, five have a prednisolone dose <5?mg daily and four patients 5–10?mg.Conclusion
Approximately one of two patients with autoimmune hepatitis that fail standard treatment benefit from long-term maintenance with mycophenolate mofetil, especially those with previous intolerance to thiopurines, where mycophenolate mofetil is effective in two thirds. 相似文献3.
Erika Monguzzi Laura Marabini Luca Elli Valentina Vaira Stefano Ferrero Francesca Ferretti Federica Branchi Gabriella Gaudioso Alice Scricciolo Vincenza Lombardo Luisa Doneda Leda Roncoroni 《Digestive and liver disease》2019,51(1):47-54
Background
Gliadins are involved in gluten-related disorders and are responsible for the alteration of the cellular redox balance. It is not clear if the gliadin-related oxidative stress can induce DNA damage in enterocytes.Aim
To investigate any possible genotoxicity caused by gliadin and to assess its relationship with oxidative stress in vitro and ex vivo.Methods
Caco-2 cells were exposed for 6–12–24?h to increasing concentrations (250?μg/mL–1000?μg/mL) of digested gliadin. We investigated: cytotoxicity, oxidative balance (reactive oxygen species, ROS), DNA damage (comet assay and γ-H2AX detection), transglutaminase type 2 (TG2) activity and annexin V expression. H2AX and 8-OHG immunohistochemistry has been evaluated on duodenal biopsies of celiac subjects and controls.Results
Gliadin induced a significant increase (+50%) of ROS after 12?h of exposition starting with a 500?μg/mL dose of gliadin. Comet assay and γ-H2AX demonstrated DNA damage, evident at the gliadin concentration of 500?μg/mL after 24?h. TG2 activity increased in chromatin and cytoskeleton cellular compartments at different gliadin doses (250/500/1000?μg/mL). The γ-H2AX and 8-OHG immunohistochemistry was altered in the duodenal biopsies of celiac patients.Conclusions
Gliadin induces cellular oxidative stress, DNA damage and pro-apoptotic stimulation in Caco-2 cells and in the duodenal mucosa of celiac patients. 相似文献4.
Ya-Chao Tao Meng-Lan Wang Ming Wang Yuan-Ji Ma Lang Bai Ping Feng En-Qiang Chen Hong Tang 《Digestive and liver disease》2019,51(3):412-418
Aims
To analyze the role of serum miR-125b-5p in reflecting liver damage and predicting outcomes in chronic hepatitis B (CHB) patients with acute-on-chronic liver failure (ACLF).Methods
CHB patients with normal hepatic function (n?=?100), moderate-to-severe liver damage (n?=?90), and ACLF (n?=?136) were included. Among hepatitis B virus (HBV)-ACLF patients, 86 and 50 were in the training and validation cohorts, respectively. Serum miR-125b-5p level was measured by quantitative real-time PCR.Results
Serum miR-125b-5p level increased with disease progression, and serum miR-125b-5p level was lower in surviving than in dead HBV-ACLF patients. Among HBV-ACLF patients, miR-125b-5p positively correlated with total bilirubin (TBil; r?=?0.214, p?<?0.05) and model for end-stage liver disease (MELD) score (r?=?0.382, p?<?0.001) and negatively correlated with prothrombin activity(PTA; r?=??0.215, p?<?0.05). MiR-122 showed a contrasting performance compared with miR-125b-5p. Cox regression analysis showed that miR-125b-5p, miR-122, and PTA were independent survival predictors for HBV-ACLF, and low miR-125b-5p and high miR-122 levels may predict a longer survival in HBV-ACLF. MiR-125b-5p (AUC?=?0.814) had a higher performance for survival prediction in HBV-ACLF compared with miR-122 (AUC?=?0.804), PTA (AUC?=?0.762), MELD score (AUC?=?0.799), and TBil (AUC?=?0.670) alone; predictive effectiveness of miR-125b-5p was increased by combination with miR-122 (AUC?=?0.898). MiR-125b-5p was an effective predictor of HBV-ACLF outcomes in the validation cohort.Conclusions
MiR-125b-5p increase is associated with severity of liver damage; high serum miR-125b-5p may serve as a predictor for poor outcomes in HBV-ACLF cases. 相似文献5.
Lucille Quénéhervé Caroline Dagouat Marianne Le Rhun Enrique Perez-Cuadrado Robles Emilie Duchalais Stanislas Bruley des Varannes Yann Touchefeu Nicolas Chapelle Emmanuel Coron 《Digestive and liver disease》2019,51(3):386-390
Background
Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery.Aim
The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus.Methods
The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: ‘elective surgery’ and ‘no surgery’.Results
Patients in the ‘no surgery’ group (n?=?42) were older and had more loss of autonomy than in the ‘elective surgery’ group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the ‘no surgery’ group versus 32% in the ‘elective surgery’ group (p?=?0.02). In the ‘no surgery’ group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery.Conclusion
Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed. 相似文献6.
Yi-Hao Yen Fang-Ying Kuo Kwong-Ming Kee Kuo-Chin Chang Ming-Chao Tsai Tsung-Hui Hu Sheng-Nan Lu Jing-Houng Wang Chao-Hung Hung Chien-Hung Chen 《Digestive and liver disease》2019,51(1):142-148
Background
Diabetes is a risk factor of fibrosis progression in chronic hepatitis C (CHC). However, only one longitudinal study exploring whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in CHC patients has been conducted.Aims
We investigated whether diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients.Methods
A cohort consisting of 976 non-genotype 3 patients histologically proven to have CHC was studied. After excluding patients with biopsy-proven or ultrasound-identified cirrhosis, there were 684 patients without cirrhosis. All 684 patients underwent hepatocellular carcinoma surveillance using ultrasound every 6 months, with a median duration of follow-up evaluation of 102.4 months. During the follow-up period, 60 patients developed cirrhosis according to ultrasound findings.Results
For the subgroup of 684 patients without cirrhosis, Kaplan–Meier survival analyses showed no significantly different cumulative incidences of cirrhosis (log-rank test; P?=?0.71) among the patients with diabetes as compared to those without. However, after making adjustments for age, gender, fibrosis, steatosis, sustained virological response status, and obesity using Cox’s proportional hazard model, diabetes was found to be an independent predictor for cirrhosis (HR?=?1.9; 95% CI?=?1.05–3.43, P?=?0.03).Conclusions
Diabetes is associated with progression from non-cirrhotic liver to cirrhosis in non-genotype 3 CHC patients. 相似文献7.
Enzo Ubaldi Ignazio Grattagliano Francesco Lapi Serena Pecchioli Claudio Cricelli 《Digestive and liver disease》2019,51(1):63-67
Background
Although very common in Western countries, poor epidemiological data on diverticular disease (DD) is available from the family practice.Aims
To evaluate the behavior of Italian General Practitioners (GPs) on approaching DD.Methods
Health Search Database was analyzed retrospectively.Results
On a population of 975,523 individuals, 33,597 patients had a registered diagnosis of DD (“lifetime” prevalence?=?3.4%, M?=?3.2%, F?=?3.7%; higher values are found in females over-65?years old; low rates of complications: diverticulitis?=?0.3%, bleeding?=?0.002%). As risk factors, NSAIDs and ASA were taken by 14.8% and 26.5% respectively, opioids by 7.5%, corticosteroids by 5.2%; as protective factors, 30.4% were under statins and 17.7% under calcium-antagonists. Approximately 13% of patients were referred to specialists. Colonoscopy and abdominal CT were prescribed to 48.5% and to 13% of already diagnosed patients. Among DD sufferers, 27% experienced hospitalization, but only 3.4% of cases were for a DD-linked problem. Treatment included rifaximin (61%), mesalazine (14.7%), probiotics (12.4%), ciprofloxacin (7.6%).Conclusion
DD has a large impact in general practice with a higher prevalence in the elderly. GPs are required to pay particular attention to risk factors both for disease development and for its complications in order to reduce the costs deriving from diagnostic procedures, referral and hospitalization. 相似文献8.
Mathurin Fumery Benjamin Pariente Helene Sarter Guillaume Savoye Claire Spyckerelle Djamal Djeddi Olivier Mouterde Guillaume Bouguen Delphine Ley Anais Peneau Jean-Louis Dupas Dominique Turck Corinne Gower-Rousseau 《Digestive and liver disease》2019,51(4):496-502
Background
Pediatric-onset Crohn’s disease (CD) may represent a more severe form of disease. The aim of this study was to describe long-term outcome and identify associated risk factors of complicated behavior in a large population-based pediatric-onset CD cohort.Patients and methods
Cases included all patients recorded in the EPIMAD registry diagnosed with definite or probable CD between January 1988 and December 2004, under the age of 17 years at the time of diagnosis, with at least two years of follow-up.Results
Five hundred and thirty-five patients were included. Median follow-up was 11.1 years [IQR, 7.3–15.0]. At the end of follow-up, 8% (n?=?44) of patients had pure ileal disease (L1), 8% (n?=?44) had pure colonic disease (L2), and 83% (n?=?439) had ileocolonic disease (L3). L4 disease and perianal disease were observed in 42% (n?=?227) and 16% (n?=?85) of patients, respectively. At the end of follow-up, 58% (n?=?308) of patients presented complicated disease behavior (B2, 39% and B3, 19%), and 42% (n?=?163) of patients with inflammatory behavior at diagnosis had evolved to complicated behavior. During follow-up, 86% of patients (n?=?466) received at least one course of corticosteroids, 67% (n?=?357) of patients had been exposed to immunosuppressants and 35% (n?=?187) of patients received at least one anti-TNF agent. Forty-three percent (n?=?230) of patients underwent at least one intestinal resection. The overall mortality rate was 0.93% and the SMR was 1.6 [0.5–3.8] (p?=?0.20). Five cancers were reported with a crude cancer incidence rate of 1.1% and an SIR of 3.3 [1.2–7.0] (p?=?0.01). In a multivariate Cox model, ileal (HR, 1.87 [1.09–3.21], p?=?0.022) or ileocolonic (HR, 1.54 [1.01–2.34], p?=?0.042) and perianal lesions at diagnosis (HR, 1.81 [1.13- 2.89], p?=?0.013) were significantly associated with complicated behavior.Conclusion
About 80% of patients with pediatric-onset CD presented extensive ileocolonic disease during follow-up. The majority of patients evolved to complicated behavior. Surgery, cancer and mortality were observed in 43%, 0.9% and 0.9% of patients, respectively. 相似文献9.
Choong-Kyun Noh Min Wook Jung Sung Jae Shin Ju Young Ahn Hyo Jung Cho Min Jae Yang Soon Sun Kim Sun Gyo Lim Dakeun Lee Young Bae Kim Jae Youn Cheong Kee Myung Lee Byung Moo Yoo Kwang Jae Lee 《Digestive and liver disease》2019,51(1):79-85
Background and aim
The histologic discrepancies between preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) specimens sometimes confuse the endoscope operator. This study aimed to analyze the limitation of the biopsy-based diagnosis before ESD and to evaluate which factors affect the discordant pathologic results between EFB and ESD.Methods
A total of 1427 patients, who were diagnosed with gastric adenoma by EFB, were enrolled. Cancer confirmed on EFB was excluded (n?=?513). We retrospectively reviewed cases and compared histologic diagnoses in the biopsy sample with the final diagnosis in the endoscopically resected specimen.Results
The diagnosis was upgraded (from low-grade dysplasia to high-grade dysplasia or adenocarcinoma, or from high-grade dysplasia to adenocarcinoma) in 328 cases (23.0%), concordant in 944 (66.1%), and downgraded (from high-grade dysplasia to low-grade dysplasia or non-neoplasia, or from low-grade dysplasia to non-neoplasia) in 155 (10.9%). Multivariate logistic regression analysis showed that surface ulceration and depressed lesions were associated with significant risk factors for upgrading. Age younger than 60 years and size <1?cm were associated with significant factors for downgrading.Conclusions
Careful endoscopic observation should consider size, ulceration, and depression to ensure accurate diagnosis when a gastric neoplasm is suspected. 相似文献10.
Marina Coletta Arianna Zefelippo Stefano Mazza Vera D’Abrosca Fiorenzo Botti Barbara Oreggia Matteo Prati Luigi Boni Maurizio Vecchi Flavio Caprioli 《Digestive and liver disease》2019,51(2):206-211
Background
Despite the improvement of medical therapies, nearly half of patients with Crohn’s disease require surgery within 10?years after diagnosis. However, intestinal resection is not curative and recurrence may occur.Aims
To evaluate post-surgical outcomes for patients with Crohn’s disease in a large monocentric cohort, and to identify variables associated with clinical and surgical relapse.Methods
Patients with Crohn’s disease who had surgery for ileal and colonic Crohn’s disease between 2004 and 2016 and on at least one-year follow-up following surgery were included.Results
One hundred ninety-three patients were included in the study. Crohn’s disease recurrence concerned 53% of patients after a median 56-month (6–158) follow-up and 29% of patients required a second surgical intervention. At logistic regression analysis, active smoking and young age at diagnosis were identified as independent risk factor for post-surgical relapse (p?=?0.01), while colonic or ileocolonic resection was recognized as a risk factor for surgical Crohn’s disease relapse (p?=?0.003).Conclusions
Post-surgery recurrence is frequent for patients with Crohn’s disease. Active smoking and young age at diagnosis are risk factors for Crohn’s disease recurrence. As compared with patients undergoing small-bowel surgery, patients with colonic resection are proner to relapse requiring a second surgical intervention. 相似文献11.
Ana Lleo Andrea Aglitti Alessio Aghemo Patrick Maisonneuve Savino Bruno Marcello Persico 《Digestive and liver disease》2019,51(2):310-317
Background
Despite the dramatic improvement in viral eradication rates that has been reached with direct antiviral agents (DAAs), the real benefit of viral eradication after DAAs on hepatocellular carcinoma (HCC) development is still controversial.Aim
To prospectively assess the risk of HCC occurrence and early recurrence in a large cohort of DAA-treated HCV-cirrhotic patients and to identify potential predictors of HCC development.Methods
We analyzed data prospectively collected from 1927 consecutive HCV-infected cirrhotic patients treated with DAA from January to December 2015 in 10 tertiary liver centers in Italy and followed-up for one year after therapy. 161 patients had a previous HCC.Results
38/161 subjects developed tumor recurrence during the follow-up (recurrence rate?=?24.8 per 100-year), patients with SVR had a significantly lower rate of recurrence. Lack of SVR and alpha-fetoprotein (AFP) were independent predictors of HCC recurrence. 50/1766 patients without a previous HCC history developed HCC during follow-up (incidence rate?=?2.4 per 100-year). Lack of SVR was the strongest predictor of HCC development. Furthermore, patients with SVR and no stigmata of portal hypertension have a lower incidence rate of HCC (1.0 per 100-year).Conclusions
SVR is associated with a significant decrease of recurrent or de novo HCC. Baseline AFP and signs of portal hypertension can help to stratify the risk of HCC. 相似文献12.
13.
A. Hamon A. Lecadet X. Amiot F. Boudghene C. Verdet J. Ohnona S. Georgin-Lavialle C. Bachmeyer 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2019,40(1):43-46
Introduction
Brucellosis is a rare infection in France and its wide spectrum of clinical presentation can be a diagnostic challenge.Case report
We report here the case of a 76-year-old Tunisian-born woman referred for fatigue, weight loss, intermittent fever, and pain in the right upper quadrant, along with hepatic lesions on CT-scan, MRI and PET-FDG suggesting malignant lesions. However blood cultures were positive to Brucella melitensis leading to a diagnosis of hepatic brucelloma.Conclusion
Hepatic abscesses are rare in brucellosis. This infection has to be evoked in patients coming from endemic areas even with atypical manifestations. 相似文献14.
Mohamed A. Mekky Mohamed O. Abdel-Malek Heba A. Osman Essam M. Abdel-Aziz Abdel-Kader A. Hashim Helal F. Hetta Khairy H. Morsy 《Clinics and research in hepatology and gastroenterology》2019,43(1):82-87
Background
Till now, pooled data about the safety and efficacy of different direct-acting antiviral (DAAs) regimens in different renal situations are still under evaluation.Aim
To evaluate a real-life experience of the efficacy and safety of ombitasvir/paritaprevir/ritonavir plus ribavirin (OBV/PTV/r plus RIB) in patients with end-stage kidney disease (ESKD).Patients and methods
Between January 2017 and January 2018, an open-label multicenter prospective study was designed to enroll all consecutive patients with proven CHC genotype 4 infections and concomitant ESKD based on estimated glomerular filtration rate (eGFR) with (HD group) or without hemodialysis (non-HD group). Patients were given a co-formula of OBV/PTV/r (25/150/100?mg) once-daily plus RIB was given for 12?weeks. Sustained virologic response (SVR 12) was the primary endpoint.Results
A total of 110 patients were enrolled. An overall SVR 12 was reported in 104 (94.5%) patients, and treatment failure were reported in 6 patients [2 patients (1.8%) were relapsed, and 4 patients (3.6%) patients were non-responders]. SVR12 was 96% in HD and 91.4% in non-HD patients (P?=?0.286).There were no reported serious adverse events. Anemia was reported in 66.6% (n?=?50) in HD group and in 31.4% (n?=?11) in non-HD group.Conclusion
Although it is still challenging, achievement of SVR12 in patients with chronic HCV and concomitant end-stage kidney disease in the era of DAAs became possible with a 12?weeks course of a co-formula of ombitasvir/paritaprevir /ritonavir plus ribavirin.ClinicalTrials.gov ID
NCT03341988. 相似文献15.
Fangyuan Gao Qianqian Zhang Yao Liu Guozhong Gong Dewen Mao Zuojiong Gong Jun Li Xinla Luo Xiaoliang Li Guoliang Chen Yong Li Wenxia Zhao Gang Wan Hai Li Kewei Sun Xianbo Wang 《Digestive and liver disease》2019,51(3):425-433
Background
The current definitions and etiologies of acute-on-chronic liver failure (ACLF) are clearly very different between East and West.Aims
This study aimed to develop an effective prognostic nomogram for acute-on-chronic hepatitis B liver failure (ACHBLF) as defined by the Asia Pacific Association for the Study of the Liver (APASL).Methods
The nomogram was based on a retrospective study of 573 patients with ACHBLF, defined according to the APASL, at the Beijing Ditan Hospital. The results were validated using a bootstrapped approach to correct for bias in two external cohorts, including an APASL ACHBLF cohort (10 hospitals, N?=?329) and an EASL-CLIF ACHBLF cohort (Renji Hospital, N?=?300).Results
Multivariate analysis of the derivation cohort for survival analysis helped identify the independent factors as age, total bilirubin, albumin, international normalized ratio, and hepatic encephalopathy, which were included in the nomogram. The predictive value of nomogram was the strongest compared with CLIF-C ACLF, MELD and MELD-Na and similar to COSSH-ACLF in both the derivation and prospective validation cohorts with APASL ACHBLF, but the CLIF-C ACLF was better in the EASL-CLIF ACHBLF cohort.Conclusions
The proposed nomogram could accurately estimate individualized risk for the short-term mortality of patients with ACHBLF as defined by APASL. 相似文献16.
D. Ozceker F. Haslak F. Dilek S. Sipahi E. Yucel N. Guler Z. Tamay 《Allergologia et immunopathologia》2019,47(1):47-51
Background
Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction.Aim
The aim of this study was to evaluate the frequency of cutaneous sensitizations in patients with atopic dermatitis and to identify the most frequent causative allergens.Study design
The study group consisted of 112 children with atopic dermatitis, aged 1–18 years (median 88.5 months) and 39 healthy controls, aged 1–8 years (median 88.48 months).Methods
The diagnosis of atopic dermatitis was established by modified Hanifin and Rajka criteria; severity of the disease was assessed by scoring of atopic dermatitis. Serum blood eosinophil count, total IgE and skin prick tests for common aeroallergens and food allergens were performed. Patch tests with cosmetic series and European standard patch test series (Stallegenes© Ltd, Paris, France) were applied.Results
Of the children with atopic dermatitis, 17% (n = 19) were sensitized to either cosmetic or standard series or both of them; no children in the control group had a positive patch test (p = 0.001). Atopy and severity of atopic dermatitis was not a significant risk factor for cutaneous sensitization. The most common allergens were Nickel sulphate and Methychloroisothiazinolone (4.5% and 4.5%) in the European standard patch test and cocamidoproplybetaine (12.5%) in the cosmetic series patch test.Conclusion
Cutaneous sensitization can develop in children with atopic dermatitis, therefore allergic contact dermatitis should be kept in mind. 相似文献17.
Samantha Morais Luís Antunes Maria José Bento Nuno Lunet 《Digestive and liver disease》2019,51(4):584-588
Background
The growing number of gastric cancers together with improved survival resulted in an increasing population of survivors at risk of multiple primary cancers.Aims
To estimate the 10-year risk and survival of third primary cancers (TPCs) among gastric first primary cancers (FPCs).Methods
Gastric FPCs from the Portuguese North Region Cancer Registry, diagnosed in 2000-2006 (n?=?7409), were followed for a TPC (31/12/2012), and for all-cause death (31/12/2017). The cumulative incidence of TPCs was estimated. Patients with a TPC were matched (1:1, by sex, age group, years between FPC and second primary cancer [SPC] diagnosis, and SPC location) to FPC?+?SPC patients without a TPC.Results
Overall, 25 (0.3% of FPCs and 6.8% of SPCs) TPCs were diagnosed. The most common sites were tobacco-related, mainly including digestive organs. Among all FPCs, 10-year cumulative incidence (95% confidence interval [CI]) of a TPC was 0.4% (0.2–0.5%) and among SPCs 7.6% (4.4–10.8%). For TPCs, compared to matched patients, age-adjusted hazard ratio (95%CI) for death was 1.68 (0.77–3.67). The 10-year cumulative mortality of TPCs and matched patients was 92.6% and 67.9%, respectively.Conclusions
A clustering of tobacco-related cancers was observed in TPCs, with a 10-year cumulative incidence of 0.4% among FPCs. TPCs had worse survival than patients without a TPC. 相似文献18.
19.
Takeshi Ogura Atsushi Okuda Akira Miyano Miyuki Imanishi Nobu Nishioka Masanori Yamada Tadahiro Yamda Rieko Kamiyama Daisuke Masuda Kazuhide Higuchi 《Digestive and liver disease》2019,51(2):247-252
Background
Gastric cancer is sometimes complicated by obstructive jaundice. However, ERCP may be challenging in patients who have advanced gastric cancer, or recurrent gastric cancer after surgical resection that is complicated by obstructive jaundice. In such cases, percutaneous transhepatic biliary drainage (PTBD) is considered. Recently, EUS-guided biliary drainage (EUS-BD) has been developed. We conducted a retrospective study to compare the efficacy of EUS-BD and PTBD in patients with obstructive jaundice due to gastric cancer.Methods
Patients with gastric cancer complicated with obstructive jaundice who were contraindicated for standard ERCP were enrolled.Results
A total of 47 consecutive patients were enrolled during the study period. The technical success rates of PTBD and EUS-BD were 88.9% (16/18) and 96.7% (29/30), respectively (P?=?0.64). The stent patency period, including patient death was equivalent between the two groups (EUS-BD vs. PTBD: 188.4?days vs. 200.9 days, P?=?0.974). Time to stent dysfunction in the EUS-BD group (391.1 days) was not significantly different as compared to that in the PTBD group (398.1?days) (P?=?0.78). Adverse events were relatively severe in the PTBD group.Conclusions
Given the relative severity of adverse events in the PTBD group, EUS-BD might be the procedure of choice for gastric cancer patients with contraindications by inability to perform ERCP. 相似文献20.
Annie Lemelin Marc Barritault Valérie Hervieu Léa Payen Julien Péron Anne Couvelard Jérome Cros Jean-Yves Scoazec Sylvie Bin Laurent Villeneuve Catherine Lombard-Bohas Thomas Walter 《Digestive and liver disease》2019,51(4):595-599