AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscop...AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.展开更多
AIM:To investigate the yield,etiologies and impact of capsule endoscopy(CE) in Thai patients with obscure gastrointestinal bleeding(OGIB).METHODS:The present study is a retrospective cohort study.All patients with OGI...AIM:To investigate the yield,etiologies and impact of capsule endoscopy(CE) in Thai patients with obscure gastrointestinal bleeding(OGIB).METHODS:The present study is a retrospective cohort study.All patients with OGIB who underwent CE in Siriraj Hospital,Bangkok,Thailand during 2005-2009 were included in the study.All the patients' medical records and results of the CE videos were reviewed.CE findings were classified as significant,suspicious/equivocal and negative.Sites of the lesions were located to duodenum,jejunum,jejunoileum,ileum and diffuse lesions by the localization device of the CE.Impact of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion.Patients' outcomes(rebleeding,persistent bleeding,anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients.RESULTS:Overall,there were 103 patients with OGIB included in the study.Mean age of the patients was 64 ± 16 years(range 9-88 years) and 57 patients(55%) were male.Types of OGIB were overt in 80(78%) and occult in 23 patients(22%).The median time interval of CE after onset of OGIB was 10 d(range 1-180 d).The median time of follow-up was 19 mo(range 1-54 mo).Capsules reached caecum in 77 patients(74%) and capsule retention was found in 1 patient(1%).The diagnostic yield of CE revealed significant lesions in 37 patients(36%),suspicious/equivocal lesions in 15 patients(15%) and 51 patients(49%) had negative CE result.Among the significant lesions,the bleeding etiologies were small bowel ulcers in 44%,angiodysplasia in 27%,small bowel tumor in 13%,miscellaneous in 8% and active bleeding without identifiable causes in 8%.Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs(48%,P = 0.034),while patients with small bowel tumors were more commonly female(86%,P = 0.043) compared to the other etiologies.The rate of rebleeding,persistent bleeding or anemia in patients with positive,equivocal and negative CE results were 5%,0% and 18%,respectively(P = 0.078).All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders(4),colonic diverticulosis(2),colonic Dieulafoy's(1),hemorrhoid(1) and hemosuccus pancreaticus(1).Results of CE had a positive impact on the patients' management in 35% of the patients whose results were positive,but none on the patients whose results were equivocal or negative CE(P < 0.001).CONCLUSION:In Thai OGIB patients,CE had low yield and small bowel ulcer was most common.Positive CE impacted managements and outcomes.Negative CE caused low rebleeding.展开更多
Chronic pancreatitis(CP) is a chronic inflammatory disease of the pancreas. The main symptom of patients with CP is chronic and severe abdominal pain. However, the pathophysiology of pain in CP remains obscure.Traditi...Chronic pancreatitis(CP) is a chronic inflammatory disease of the pancreas. The main symptom of patients with CP is chronic and severe abdominal pain. However, the pathophysiology of pain in CP remains obscure.Traditionally, researchers believed that the pain was caused by anatomical changes in pancreatic structure. However, treatment outcomes based on such beliefs are considered unsatisfactory. The emerging explanations of pain in CP are trending toward neurobiological theories. This article aims to review current evidence regarding the neuropathophysiology of pain in CP and its potential implications for the development of new treatments for pain in CP.展开更多
文摘AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.
基金Supported by The Gastroenterological Association of Thailand
文摘AIM:To investigate the yield,etiologies and impact of capsule endoscopy(CE) in Thai patients with obscure gastrointestinal bleeding(OGIB).METHODS:The present study is a retrospective cohort study.All patients with OGIB who underwent CE in Siriraj Hospital,Bangkok,Thailand during 2005-2009 were included in the study.All the patients' medical records and results of the CE videos were reviewed.CE findings were classified as significant,suspicious/equivocal and negative.Sites of the lesions were located to duodenum,jejunum,jejunoileum,ileum and diffuse lesions by the localization device of the CE.Impact of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion.Patients' outcomes(rebleeding,persistent bleeding,anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients.RESULTS:Overall,there were 103 patients with OGIB included in the study.Mean age of the patients was 64 ± 16 years(range 9-88 years) and 57 patients(55%) were male.Types of OGIB were overt in 80(78%) and occult in 23 patients(22%).The median time interval of CE after onset of OGIB was 10 d(range 1-180 d).The median time of follow-up was 19 mo(range 1-54 mo).Capsules reached caecum in 77 patients(74%) and capsule retention was found in 1 patient(1%).The diagnostic yield of CE revealed significant lesions in 37 patients(36%),suspicious/equivocal lesions in 15 patients(15%) and 51 patients(49%) had negative CE result.Among the significant lesions,the bleeding etiologies were small bowel ulcers in 44%,angiodysplasia in 27%,small bowel tumor in 13%,miscellaneous in 8% and active bleeding without identifiable causes in 8%.Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs(48%,P = 0.034),while patients with small bowel tumors were more commonly female(86%,P = 0.043) compared to the other etiologies.The rate of rebleeding,persistent bleeding or anemia in patients with positive,equivocal and negative CE results were 5%,0% and 18%,respectively(P = 0.078).All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders(4),colonic diverticulosis(2),colonic Dieulafoy's(1),hemorrhoid(1) and hemosuccus pancreaticus(1).Results of CE had a positive impact on the patients' management in 35% of the patients whose results were positive,but none on the patients whose results were equivocal or negative CE(P < 0.001).CONCLUSION:In Thai OGIB patients,CE had low yield and small bowel ulcer was most common.Positive CE impacted managements and outcomes.Negative CE caused low rebleeding.
文摘Chronic pancreatitis(CP) is a chronic inflammatory disease of the pancreas. The main symptom of patients with CP is chronic and severe abdominal pain. However, the pathophysiology of pain in CP remains obscure.Traditionally, researchers believed that the pain was caused by anatomical changes in pancreatic structure. However, treatment outcomes based on such beliefs are considered unsatisfactory. The emerging explanations of pain in CP are trending toward neurobiological theories. This article aims to review current evidence regarding the neuropathophysiology of pain in CP and its potential implications for the development of new treatments for pain in CP.
