两种不同型号胶囊内镜在小肠检查过程中的对比研究

目的比较金山OMOM两种不同型号胶囊内镜在全小肠检查率(CER)中的差异及原因分析。方法回顾重庆医科大学附属第二医院2016年1月至2017年10月行胶囊内镜检查的患者,其中Ⅱ型胶囊内镜组82例(对照组),Ⅰ型胶囊内镜组85例(观察组)。比较两组胃转运时间(GTT)、小肠转运时间(SBTT)及CER的差异。结果Ⅰ型胶囊内镜组比Ⅱ型胶囊内镜组具有更高的CER(94.1%vs 84.1%,P=0.047),更短的GTT[(47.3±41.8) min vs (64.8±57.0) min,P=0.024],且工作时间更长,但两组患者SBTT差异无统计学意义(P0.05)。结论Ⅰ型胶囊内镜通过缩短GTT,延长胶囊内镜工作时间,从而提高全小肠检查率,具有更好的临床应用价值。     

实时干预对胶囊内镜全小肠检查完成率的影响

目的 探讨实时干预对胶囊内镜检查完成率的影响.方法 选取2011年3月-2014年1月深圳市罗湖区人民医院的104例患者,随机分为实验组和对照组,分别行胶囊内镜检查,实验组检查前肌注胃复安注射液10 mg,胶囊进入胃后实时监测,若胃通过时间（gastric transit time,GTT）超过90 min给予内镜干预推送胶囊通过幽门进入十二指肠;对照组检查前、检查过程中不作任何干预.结果 分析两组的GTT、小肠通过时间（small-bowel transit time,SBTT）及全小肠检查完成率的差异,发现GTT、SBTT及检查完成率两组比较差异均有统计学意义（P均＜0.05）,检查阳性率两组比较,差异无统计学意义（P＞0.05）.结论 实时干预可提高患者胶囊内镜全小肠检查完成率.     

胶囊内镜胃通过时间与全小肠检查完成率的关系

目的:探讨对胶囊内镜在胃内停留时间较长的患者进行干预的恰当时机.方法:分析了109例胶囊内镜检查的胃通过时间(gastric transit time,GTT)与全小肠检查完成率(complete examination rate,CER)的关系,GTT与小肠通过时间(small bowel transit time,SBTT)的相关性,完成与未完成全小肠检查者GTT的差异,小肠肠腔狭窄者完不成全小肠检查的风险.结果:胶囊GTT分别为≤30min,30-60min,60-90min,>90min的各组之间的CER无统计学差异(P=0.971);胶囊胃内停留时间过长者注射胃复安后,其SBTT明显短于非胃复安组(t=-2.027,P=0.046);完成全小肠检查者的GTT(45.6min±35.8min,n=85)与未完成者的GTT(42.0min±36.4min,n=24)之间无统计学差异(P=0.665);小肠肠腔狭窄者未完成全小肠检查的风险是无狭窄者的6.588倍(OR=6.588,95%CI=1.866-23.258,P=0.004).结论:过早使用胃镜将胶囊送入小肠可能并不一定有助于CER的提高,胶囊在胃内停留超过90min的要考虑用胃镜将胶囊送入小肠,整个送胶囊过程最好在30min之内完成.     

禁食12小时和聚乙二醇方案对显性小肠出血患者胶囊内镜检查肠道准备效果比较

目的 探讨禁食12小时与聚乙二醇方案对胶囊内镜肠道准备的有效性。方法 采用回顾性、单中心研究,纳入102例为检测可疑的活动性显性小肠出血来源行胶囊内镜检查的患者。A组63例患者采用2L聚乙二醇方案;B组39例患者在检查前禁食12小时。主要终点是病变检出率和诊断率,次要终点是临床结局、胶囊内镜完成率、运转时间和图像质量。结果A组发现阳性病变38例(60.3%),B组18例(46.2%)。两组患者的诊断率差异无统计学意义(47.6%vs. 51.3%;P=0.719)。A组胶囊内镜图像质量明显优于B组(57.2%vs. 38.5%;P=0.0012)。A组平均小肠运转时间短于B组(400 min vs. 519 min;P=0.01)。两组患者进一步治疗方法及预后差异无统计学意义(均P>0.05)。结论 与禁食12小时相比,2L PEG方案虽然提高了胶囊内镜图像质量,但并没有提高诊断率和改善临床结局。     

胶囊内镜在儿童小肠疾病中的临床应用价值

目的　评估胶囊内镜（capsule endoscopy,CE）在儿童患者小肠疾病诊断中的安全性和有效性。方法　回顾性分析2018年10月—2020年9月在西安市儿童医院接受胶囊内镜的113例患儿临床资料,分析胶囊内镜检查的完成率、胃及小肠通过时间、病变检出率、不良反应和并发症。结果　113例患儿中男78例（69.03%）、女35例（30.97%）,年龄（99.8±44.7）个月（9~195个月）,7岁以下31例（占27.43%）;体重最低9 kg,身高最低70 cm。患儿中经口吞入胶囊87例（76.99%）,为经口吞入组,最小年龄4岁3个月;经胃镜置入胶囊26例（23.01%）,为经胃镜置入组,最大年龄9岁2个月。患儿中以不明原因腹痛（47.79%）及不明原因消化道出血（31.89%）多见。胶囊内镜检查完成率97.35%（110/113）,小肠阳性病变检出率31.81%（35/110）。经胃镜置入组小肠通过时间显著长于经口吞入组［（461.04±129.27）min比（288.23±107.84）min,t=5.646,P<0.01］。不同性别、不同年龄组及不同镜检结果组胃及小肠通过时间差异均无统计学意义（P>0.05）。胶囊阳性结果与吞入方式（P=0.401,OR=2.562,95%CI：0.284~23.077）、性别（P=0.154,OR=2.352,95%CI：0.726~7.616）、年龄（P=0.949,OR=1.007,95%CI：0.816~1.242）、检查原因（P=0.246）、小肠通过时间（P=0.219,OR=1.003,95%CI：0.998~1.008）等均无相关性。所有患者在检查中无胶囊滞留等并发症发生。结论　胶囊内镜检查在儿童的开展具有无创、快速、简单等优点,能够提升儿童小肠疾病阳性诊断率,可在儿童患者中进一步推广。     

胶囊内镜消化道转运时间影响因素分析陈霖王春晖胡仁伟等

背景：PY囊内镜因具有良好的安全性、耐受性和有效性，目前已广泛应用于小肠疾病的诊断，能否在电池耗尽前完全通过小肠是决定胶囊内镜检查成功与否的关键因素之一。目的：探讨胶囊内镜消化道转运时间的影响因素。方法：对2009年1月-2012年12月于华西医院接受胶囊内镜检查的426例连续病例进行回顾性分析。以Cox比例风险回归模型分析胶囊内镜胃转运时间（GTF）和小肠转运时间（SBTT）的影响因素。结果：319例受检者完成全段小肠检查，检出病变317例，中位GTT和SBTT分别为33．3min和330．5min。在性别、年龄、小肠清洁程度和阳性诊断四个变量中，年龄与GTT呈正相关（OR=1．007，95％CI：1．001～1．013，P=0．032），小肠清洁程度与GTF（OR=0．874，95％CI：0．768-0．994，P=0．040）和SBTT（OR=0．769，95％CI：0．640-0．924，P=0．005）呈负相关。62例受检者胶囊内镜滞留于胃中，其中61例经口服多潘立酮片或胃镜推送后进入小肠。结论：较好的小肠清洁程度能缩短胶囊内镜的消化道转运时间。检查中应实时监测胶囊内镜通过情况，必要时可采取口服促动力药或胃镜推送以获得更短的转运时间。     

胶囊内镜消化道转运时间影响因素分析

背景:胶囊内镜因具有良好的安全性、耐受性和有效性,目前已广泛应用于小肠疾病的诊断,能否在电池耗尽前完全通过小肠是决定胶囊内镜检查成功与否的关键因素之一。目的:探讨胶囊内镜消化道转运时间的影响因素。方法:对2009年1月~2012年12月于华西医院接受胶囊内镜检查的426例连续病例进行回顾性分析。以Cox比例风险回归模型分析胶囊内镜胃转运时间(GTT)和小肠转运时间(SBTT)的影响因素。结果:319例受检者完成全段小肠检查,检出病变317例,中位GTT和SBTT分别为33.3 min和330.5 min。在性别、年龄、小肠清洁程度和阳性诊断四个变量中,年龄与GTT呈正相关(OR=1.007,95%CI:1.001~1.013,P=0.032),小肠清洁程度与GTT(OR=0.874,95%CI:0.768~0.994,P=0.040)和SBTT(OR=0.769,95%CI:0.640~0.924,P=0.005)呈负相关。62例受检者胶囊内镜滞留于胃中,其中61例经口服多潘立酮片或胃镜推送后进入小肠。结论:较好的小肠清洁程度能缩短胶囊内镜的消化道转运时间。检查中应实时监测胶囊内镜通过情况,必要时可采取口服促动力药或胃镜推送以获得更短的转运时间。     

术前肌注甲氧氯普胺在胶囊内镜检查中的作用分析

[目的]探讨胶囊内镜检查术中检查前患者肌注甲氧氯普胺的临床价值。[方法]170例疑似小肠疾病患者采用随机数字表法均分入观察组和对照组,检查当日2组肠道准备相同,观察组术前肌注甲氧氯普胺;比较2组胶囊内镜胃转运和小肠转运时间以及病变检出率的差异。[结果]观察组平均胃转运时间为(20.1±5.2)min,明显低于对照组的(36.2±7.6)min(P0.05);平均小肠转运时间为(258±4.9)min,明显低于对照组的(264±3.5)min(P0.05);小肠病变检出率为80%,明显高于对照组的60%(P0.05)。[结论]胶囊内镜检查前患者肌注甲氧氯普胺具有缩短检查时间及提高病变检出率的效果。     

“雪碧零卡®”在磁控胶囊内镜胃准备方案中的应用初探

目的　探究400 mL雪碧零卡®作为磁控胶囊内镜（magnetically controlled capsule endoscopy,MCE）检查胃准备方案的可行性。方法　本随机对照研究于2019-12-16至2020-01-15在海军军医大学长海医院消化内科开展。拟行胶囊内镜的患者及健康志愿者按1∶1的比例被随机分为雪碧（S）组和纯水（W）组。W组受试者在吞咽胶囊前10 min饮用纯水800 mL,而S组受试者则用400 mL“雪碧零卡®”饮料代替纯水。本研究主要研究终点为胃充盈度评分,次要终点包括饱胀感评分、胃通过时间（gastric transit time,GTT）、小肠通过时间（small bowel transit time,SBTT）、小肠检查完成率以及诊断效能。结果　共102例受试者纳入分析（S组52例,W组50例）。S组受试者中位液体摄入量明显少于W组（500 mL比950 mL,P<0.001）的情况下,两组在吞服胶囊0~5 min、>5~10 min、>10~15 min时胃充盈中位评分均能稳定在4.0分（P>0.05）。S组饱腹感较W组显著缓解（7.0分比7.5分,P=0.030）,GTT<30 min受试者占比较W组显著增加［69.57%（16/52）比27.59%（8/29）,P=0.030］,且S组的小肠检查完成率达到了100.00%,高于W组的89.66%（P=0.245）。结论　400 mL雪碧与800 mL水相比,不仅能够充分充盈胃腔,而且具有较优的舒适性,加速胃排空,间接提高了小肠检查的完成率,作为胃准备方案具有良好可行性。     

链霉蛋白酶与二甲硅油对胃镜检查微小病变检出率影响的比较

探讨链霉蛋白酶与二甲硅油对胃镜检查微小病变检出率影响，统计353例接受无痛胃镜检查的患者，分为试验组（予链霉蛋白酶联合碳酸氢钠）176例和对照组（予二甲硅油联合碳酸氢钠）177例。记录两组胃镜检查时视野清晰度、检查时长、冲洗次数、微小病灶检出率、早期癌检出率及不良反应发生率等临床指标。试验组和对照组比较视野清晰度［（1.84±0.51）分比（2.15±0.48）分，t=-5.900］、胃底黏液性状［（1.04±0.43）分比（1.46±0.76）分，t=-6.347］和冲洗次数［（0.76±0.66）次比（1.18±0.72）次，t=-5.628］等方面，差异有统计学意义（P<0.001）。试验组检查时长略高于对照组［（10.01±4.40）min比（8.98±4.22）min，t=2.239，P=0.026］。试验组微小病变检出率显著高于对照组］［97.73%（172/176）比91.53%（162/177），χ2=6.665，P=0.010］。在炎性增生、息肉、癌前病变和癌的检出率方面，试验组与对照组差异均无统计学意义（P>0.05）。两组患者均无术前喝药不适，试验组和对照组各有4例发生术中呛咳，术中呛咳发生率差异无统计学意义（P>0.999），术后均无不良反应。术前服用链霉蛋白酶可显著提高胃镜下视野清晰度并提高微小病变检出率，有助于发现胃内早期病变。     

Irritable bowel syndrome: Epidemiology,diagnosis and treatment: An update for health‐care practitioners

Irritable bowel syndrome (IBS), a chronic gastrointestinal disorder, affects from 3–20% of the US population, depending on sociocultural and comorbid factors. IBS is characterized by a symptom complex of abdominal pain and abnormal bowel habits that present as diarrhea or constipation, and general physical weakness in the absence of abnormal morphological, histological or inflammatory markers. The main diagnostic Rome III criteria as established by international professional organizations are based on exclusion criteria and the occurrence and rate of symptoms. Because the pathophysiology and causes of IBS are poorly understood, treatment approaches are mainly focused on symptom management to maintain everyday functioning and improve quality of life for persons with IBS. The mainstay of intervention is pharmacological treatment with antispasmodics and antidiarrheals for diarrhea, prokinetics and high‐fiber diets for constipation, and supportive therapy with low‐dose antidepressants to normalize gastrointestinal motility. Other interventions include lifestyle and dietary changes, psychotherapy, herbal therapies and acupuncture. The purpose of this review is to critically assess benefits and risks of current treatment approaches as well as promising complementary and alternative therapies.     

Computed tomography of bowel obstruction: tricks of the trade

Bowel obstruction (BO) is a frequent cause of hospitalization and surgical consultation for acute abdominal pain. It is usually suspected at physical examination, but clinical and laboratory data are often nonspecific. Thus, computed tomography plays a crucial role in a correct diagnosis of BO. Indeed, computed tomography can confirm a diagnosis of BO, and identify the location and cause of the obstruction. In this review, the computed tomography appearances of common and uncommon causes of BO and pseudo-obstruction are reviewed.     

State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

Irritable bowel syndrome （IBS） and inflammatory bowel disease （IBD） are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology （ WJG） presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.     

Recent advances in pharmacological treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a highly prevalent functional disorder that reduces patients’ quality of life. It is a chronic disorder characterized by abdominal pain or discomfort associated with disordered defecation in the absence of identifiable structural or biochemical abnormalities. IBS imposes a significant economic burden to the healthcare system. Alteration in neurohumoral mechanisms and psychological factors, bacterial overgrowth, genetic factors, gut motility, visceral hypersensitivity, and immune system factors are currently believed to influence the pathogenesis of IBS. It is possible that there is an interaction of one or more of these etiologic factors leading to heterogeneous symptoms of IBS. IBS treatment is predicated upon the patient’s most bothersome symptoms. Despite the wide range of medications and the high prevalence of the disease, to date no completely effective remedy is available. This article reviews the literature from January 2008 to July 2013 on the subject of IBS peripherally acting pharmacological treatment. Drugs are categorized according to their administration for IBS-C, IBS-D or abdominal pain predominant IBS.     

Comparison of bowel patterns in hispanics and non-Hispanic whites

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanic whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.-Mexico border. A forced-choice, self-report questionnaire was distributed to 1014 subjects and returned by 1000. Data from the 905 Hispanic and non-Hispanic white subjects were compared. Stool frequency was analyzed by multiple linear regression, and bowl dysfunction variables were analyzed by stepwise logistic regression, in ethnic and sex groups. Data were also analyzed controlling for age, socioeconomic status, dietary factors, and use of laxatives. There was a significant sex difference in mean number of stools per week reported (P<0.0001): Hispanic males greater than Hispanic females (8.6 vs 7.5) and non-Hispanic white males greater than non-Hispanic white females (9.3 vs 7.2). The frequency of irritable bowel syndrome-type symptoms was greater in females than males (23.4% vs 9.6%,P<0.001) and was less in Hispanics than non-Hispanic whites (16.9% vs 21.8%,P<0.05), but a significant ethnic difference was not found after controlling for covariates. Additionally, females reported more alternating bowel pattern (44.0% vs 28.5%,P<0.001) and constipation (25.5% vs 12.4%,P<0.01) than males, and non-Hispanic white females more abdominal pain than the other subgroups (P<0.05). Ethnic differences in dietary factors that may be relevant to bowel function were identified. This survey of a biethnic nonpatient population shows that, for both Hispanic as well as non-Hispanic whites, males have a greater stool frequency than females and there are sex differences in the prevalence of bowel dysfunction. Hispanics did not differ from non-Hispanic whites in stool frequency, while the finding of an ethnic difference in the prevalence of irritable bowel syndrome requires further study for clarification.     

益生菌对肠易激综合征和炎症性肠病的作用

由于胃肠道微生物参与炎症性肠病（inflammatory bowel disease,IBD）的病理过程,而且最近研究表明微生物可能在肠易激综合征（irritable bowel syndrome,IBS）中扮演重要作用.本文重点关注益生菌在这两种疾病中的作用机制和疗效.胃肠道微生物的组成受多种因素调节,包括年龄、饮食和疾病状态.益生菌可能通过影响宿主的微生物菌群和提高黏膜的免疫调节作用发挥疗效.益生菌的口服耐受性较好.许多短期研究表明益生菌在IBS中有效,尽管只是在部分的特殊菌株和某些特定症状中有效.在IBD中,许多临床试验表明大量的益生菌在结肠袋炎和溃疡性结肠炎中有效,而对克罗恩病无明显疗效.显然,益生菌在IBS和IBD的治疗中能起到巨大的作用,但是,这些只是针对特殊的菌株.将来迫切需要进行高质量的临床研究和实验观察益菌对IBD和IBS的疗效.     

Role of faecal calprotectin as non-invasive marker of intestinal inflammation

BACKGROUND/AIM: Faecal calprotectin, a neutrophil granulocyte cytosol protein, is considered a promising marker of intestinal inflammation. We assessed and compared the faecal calprotectin concentration in patients with organic and functional chronic intestinal disorders. PATIENTS AND METHODS: The study was carried out, using a commercially available ELISA test, measuring calprotectin in stool samples collected from 131 patients with inflammatory bowel diseases, 26 with intestinal neoplasms, 48 with irritable bowel syndrome and 34 healthy subjects. RESULTS: Median faecal calprotectin was significantly increased in Crohn's disease (231 microg/g, 95% confidence interval (CI) 110-353 microg/g), ulcerative colitis (167 microg/g, 95% CI 59-276 microg/g), and neoplasms (105 microg/g, 95% CI 0-272 microg/g), whereas normal values were found in patients with irritable bowel syndrome (22 microg/g, 95% CI 9-35 microg/g) and in healthy subjects (11 microg/g, 95% CI 3-18 microg/g). A positive correlation was observed with clinical activity scores in Crohn's disease and ulcerative colitis. In both groups, patients with clinically active disease showed higher calprotectin levels than those observed in patients with quiescent disease (405 microg/g, 95% CI 200-610 microg/g vs. 213 microg/g, 95% CI 85-341 microg/g in CD patients, p<0.05, and 327 microg/g, 95% CI 104-550 microg/g vs. 123 microg/g, 95% CI 40-206 microg/g in UC patients, p<0.001). CONCLUSIONS: Faecal calprotectin appears to be a promising and non-invasive biomarker of intestinal inflammation. If these findings are confirmed, it may provide a useful test for the diagnosis and follow up of inflammatory bowel diseases.