AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) pa...AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.RESULTS: In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P < 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P < 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c ≥ 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) < 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI < 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI < 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.展开更多
Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco ...Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco smoking,alco-hol consumption,and unhealthy diet.CRC screening methods vary considerably between countries and depend on incidence,economic resources and healthcare structure.Important aspects of screening include adherence,which can vary signi-ficantly across ethnic and socioeconomic groups.Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colono-scopy or radiologic imaging techniques.Technological capabilities for CRC scree-ning are rapidly evolving and include stool DNA test,liquid biopsy,virtual colo-nography,and the use of artificial intelligence.A CRC prevention strategy should be comprehensive and include active patient education along with targeted imple-mentation of screening.展开更多
Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended form...Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended formulas in humans on digestive health by assessing defecation frequency,defecation symptoms,stool quality,self-reported digestive feelings,defecation satisfaction,and gut bacteria.A parallel,randomized,double-blind,controlled trial was conducted in 168 eligible adults randomized to 3 groups for 14 days:Intervention groups A and B received 2 different doses of oatβ-glucan-based prebiotic blended formulas and a Control group received oatβ-glucan mixed with hydroxypropylmethyl-cellulose and microcrystalline cellulose.Participants completed a defecation diary and Bristol stool chart daily and digestive system questionnaires weekly.Fecal samples were collected on day 0 and day 14 to evaluate gut bacteria using 16S rDNA analysis.Both formulas improved defecation frequency,stool quality,defecation symptoms,defecation satisfaction,and on digestive health of human,compared with baseline(P<0.05).Both formulas led to increased quantities of Bifidobacterium and Akkermansia bacteria,compared to control,on day 14.This study therefore demonstrated the beneficial effects of oatβ-glucan-based prebiotic blended formulas on gut health in generally healthy Chinese adults.These formulas are a feasible nutritional strategy for digestive health.展开更多
BACKGROUND Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection,but it is encountered with drug resistance.The stool antigen test is a cost-effective and easy-to-perform test...BACKGROUND Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection,but it is encountered with drug resistance.The stool antigen test is a cost-effective and easy-to-perform test to confirm the eradication of H.pylori,4-8 weeks post-therapy,with 86%sensitivity and 92%specificity.AIM To assess the H.pylori eradication rate of standard triple therapy and factors affecting the eradication rate.METHODS We conducted a prospective,multicenter follow-up study in Addis Ababa,Ethiopia,at selected healthcare facilities among dyspeptic patients with positive stool H.pylori antigen tests from June 1,2023 to October 30,2023 to assess the H.pylori eradication rate.After completing the standard triple therapy,the eradication was confirmed using a stool antigen test 4 weeks later.The data were analyzed using bivariate and multivariate logistic regression methods.RESULTS The H.pylori eradication rate was 85.4%.Patients with a previous diagnosis of H.pylori infection,smokers,and local alcohol consumption were associated with a lower H.pylori eradication rate,with adjusted odds ratio(AORs)of 0.159[95%confidence interval(CI):0.050-0.511],0.206(95%CI:0.052-0.822),and 0.228(95%CI:0.052-0.997),respectively.Patients with complete symptom resolution were 5.383 times more likely to achieve eradication than patients without symptom improvement,AOR=5.383,95%CI:1.74-21.089.CONCLUSION H.pylori eradication rate was lower than expected.Post-treatment testing is crucial to confirm eradication and guide further management,such as susceptibility testing.展开更多
This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual.The report highlights chal...This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual.The report highlights challenges in diagnosing ap-pendiceal intussusception,emphasizing the importance of endoscopic expertise in preventing impulsive decisions such as inappropriate polypectomies.The rarity of the concurrent intussuscepted appendix and mucinous cecal cancer is under-scored,prompting consideration of malignancy in appendiceal intussusception cases.Additionally,the report addresses the increasing incidence of early-onset colorectal cancer and the need for a revaluation of diagnostic paradigms in the context of evolving epidemiological trends.The awareness of potential misinter-pretations and the imperative for further investigation into this rare condition are emphasized.展开更多
The population with metabolic dysfunction-associated fatty liver disease(MAFLD)is increasingly common worldwide.Identification of people at risk of progression to advanced stages is necessary to timely offer intervent...The population with metabolic dysfunction-associated fatty liver disease(MAFLD)is increasingly common worldwide.Identification of people at risk of progression to advanced stages is necessary to timely offer interventions and appropriate care.Liver biopsy is currently considered the gold standard for the diagnosis and staging of MAFLD,but it has associated risks and limitations.This has spurred the exploration of non-invasive diagnostics for MAFLD,especially for steatohepatitis and fibrosis.These non-invasive approaches mostly include biomarkers and algorithms derived from anthropometric measurements,serum tests,imaging or stool metagenome profiling.However,they still need rigorous and widespread clinical validation for the diagnostic performance.展开更多
BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histolog...BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.展开更多
Introduction: Infectious diseases constitute a major concern of public health in developing countries. Facilities and well trained staff have been shown to be one of the major obstacles in the rapid and quality diagno...Introduction: Infectious diseases constitute a major concern of public health in developing countries. Facilities and well trained staff have been shown to be one of the major obstacles in the rapid and quality diagnosis of these diseases. As such, we carried out an analysis to compare the Widal test and stool culture to identify febrile patients with Salmonella infection. Method: A cross sectional study was conducted to diagnose salmonella infection with out-patients who demonstrated signs of salmonella infection. Serum was harvested from blood collected from 368 (Vina = 234, Mayo Banyo 65, and Djerem = 69) patients accompanied by stool, Widal test was conducted on the spot and stool was taken to a reference laboratory for culture using standard microbiological methods, sociological set up was calculated in percentages, prevalence was calculated using excel while statistical difference was calculated using SPSS. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to compare the Widal test against stool culture. Results: A total of 368 (50.8% females and 49.2% males) participants took part in the survey. Salmonella prevalence (66.24%) in stool culture in the Vina division was significantly different (p 0.05). The sensitivity,specificity, PPV, and NPV of slide agglutination test against stool culture varied from different areas (Vina: 51.6%, 73.62%, 79.21% and 43.61%;Mayo Banyo: 60.53%, 77.78%, 79.31% and 58.33%;Djerem: 53.18%, 83.73% 73.91% and 67.39%) respectively. Slide agglutination test has a fair agreement with the stool culture (kappa, Vina = 0.202;Mayo Banyo = 0.37 and Djerem = 0.38). Conclusion: Generally, in the three areas of study, the Widal test had a fair correlation with the stool culture;This means the Widal test should not be used alone but in combination with stool culture in the detection of salmonella infections.展开更多
The incidence of hematochezia in infants aged three months or younger has shown an upward trend in recent years. This condition is characterized by visible bloody stools, which may appear bright red, dark red, jam-lik...The incidence of hematochezia in infants aged three months or younger has shown an upward trend in recent years. This condition is characterized by visible bloody stools, which may appear bright red, dark red, jam-like, or mucus-purulent bloody stools, and is often accompanied by positive fecal occult blood tests, with or without additional systemic clinical symptoms. The etiology is multifactorial, potentially influenced by the maternal health status during pregnancy, neonatal diseases or treatments received in the NICU, and the methods used for establishing enteral and parenteral nutrition. Notably, allergic factors have gained prominence in recent years. This paper reviews recent studies to elucidate the incidence, primary causes, and current treatment approaches for early infant hematochezia, providing a reference for clinical practice.展开更多
BACKGROUND Irritable bowel syndrome(IBS),defined according to the Rome IV diagnostic criteria,is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain related to altered bowel habits...BACKGROUND Irritable bowel syndrome(IBS),defined according to the Rome IV diagnostic criteria,is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain related to altered bowel habits.First-line recommended treatments are limited to combining drugs targeting predominant symptoms,particularly pain(antispasmodics),constipation(laxatives),and diarrhea(loperamide),yielding only a limited therapeutic gain.GASTRAP^(■)DIRECT is a class IIa medical formulation composed of a combination of chitin-glucan and simethicone indicated for the symptomatic treatment of gas-related gastrointestinal disorders by combining different mechanisms of action.AIM To evaluate the efficacy,tolerability,and safety of 4-week GASTRAP^(■)DIRECT treatment in patients with IBS.METHODS In this prospective,multicenter,open-label trial,120 patients with IBS received three sticks of GASTRAP^(■)DIRECT(1.5 g/d of chitin-glucan and 0.75 mg/d of simethicone)per day for 4 weeks.The primary endpoint was the responder rate,defined as the number of patients whose abdominal pain score decreased by≥30%from baseline to week(W)4.The analysis was performed using the per-protocol set.Cardinal symptoms,impact of global symptoms on daily life,change in stool consistency,and improvement in defecatory disorders were evaluated.RESULTS Overall,100 patients were evaluated.At W4,67%(95%CI:57-75)showed improvement in abdominal pain(score:5.8±2.4 vs 2.9±2.0,P<0.0001).Similar improvements were observed for bloating[8.0±1.7 vs 4.7±2.9,P<0.0001;60%(95%CI:50-70)responders],abdominal distension[7.2±2.1 vs 4.4±3.1,P<0.0001;53%(95%CI:43-63)responders],and impact of global symptoms on daily life[7.1±2.0 vs 4.6±2.9,P<0.0001;54%(95%CI:44-64)responders].Stool consistency improved in most patients(90%and 57%for patients with liquid and hard stools,respectively).Overall,42%of patients with defecatory disorders reported very much/considerable improvements by W2.No severe adverse event occurred,and tolerability was rated“good”or“very good”by 93%of patients.CONCLUSION GASTRAP^(■)DIRECT is safe and well tolerated,alleviating IBS symptoms rapidly in 2 weeks.This open-label study suggests that the combination of chitin-glucan and simethicone could be beneficial in patients with IBS.展开更多
Objective To explore clinical efficacy and safety of acupuncture in treatment of functional constipation.Methods One hundred and twenty cases were randomly divided into an observation group and a control group,60 case...Objective To explore clinical efficacy and safety of acupuncture in treatment of functional constipation.Methods One hundred and twenty cases were randomly divided into an observation group and a control group,60 cases in each group.The patients in the observation group were treated with acupuncture at Tiānshū（天枢 ST 25）,Shàngjùxū（上巨虚 ST 37）,Zúsānlǐ（足三里 ST 36）,Dàchángshū（大肠俞 BL 25）,etc.,and the control group was treated with oral administration of Macrogol 4000 and Mosapride.Defecation frequency,stool property,constipation symptom score,accompanying symptom score,gastrointestinal transit time and adverse reaction were observed before treatment,at the end of treatment and 4 weeks after treatment in the two groups.Results Compared with those before treatment,defecation frequency was increased significantly at the end of treatment in the two groups,while stool property,constipation symptom score,accompanying syndrome score and gastrointestinal transit time all were decreased significantly（all P0.01）,with no significant difference in these indexes between the two groups at the end of treatment （all P0.05）.Compared with the end of treatment,the above-mentioned indexes did not significantly recur in the observation group 4 weeks after the treatment （all P0.05）,but the therapeutic effects were unstable with decreased to some extent in the control group （all P0.05）.No serious adverse reaction was found in the two groups.Conclusion In the patients with functional constipation,acupuncture can significantly increase defecation frequency,change stool property,alleviate constipation and accompanying symptoms,and shorten gastrointestinal transit time with better safety and tolerance,and the therapeutic effect is more stable than that of Macrogol 4000 and Mosapride.展开更多
AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H.pylori),using^(13)Curea breath test as the reference standard,and explore bacterial antibiotic resistance.METHODS We conduc...AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H.pylori),using^(13)Curea breath test as the reference standard,and explore bacterial antibiotic resistance.METHODS We conducted a prospective two-center diagnostic test accuracy study.We enrolled consecutive people≥18 years without previous diagnosis of H.pylori infection,referred for dyspepsia between February and October 2017.At enrollment,all participants underwent 13 C-urea breath test.Participants aged over 50 years were scheduled to undergo upper endoscopy with histology.Participants collected stool samples 1-3 d after enrollment for a new fecal investigation(THD fecal test).The detection of bacterial 23 S rRNA subunit gene indicated H.pylori infection.We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin.Independent investigators analyzed index test and reference test standard results blinded to the other test findings.We estimated sensitivity,specificity,positive(PPV)and negative(NPV)predictive value,diagnostic accuracy,positive and negative likelihood ratio(LR),together with 95%confidence intervals(CI).RESULTS We enrolled 294 consecutive participants(age:Median 37.0 years,IQR:29.0-46.0 years;men:39.8%).Ninetyfive(32.3%)participants had a positive^(13)C-urea breath test.Twenty-three(7.8%)participants underwent upper endoscopy with histology,with a full concordance between^(13)C-urea breath test and histology in detecting H.pylori infection.Four(1.4%)out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing.In the 290 participants who completed the study,the THD fecal test sensitivity was 90.2%(CI:84.2%-96.3%),specificity 98.5%(CI:96.8%-100%),PPV 96.5%(CI:92.6%-100%),NPV 95.6%(CI:92.8%-98.4%),accuracy 95.9%(CI:93.6%-98.2%),positive LR 59.5(CI:19.3-183.4),negative LR 0.10(CI:0.05-0.18).Out of 83 infected participants identified with the THD fecal test,34(41.0%)had bacterial genotypic changes consistent with antibiotic-resistant H.pylori infection.Of these,27(32.5%)had bacterial strains resistant to clarithromycin,3(3.6%)to levofloxacin,and 4(4.8%)to both antibiotics.CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H.pylori infection while additionally enabling the assessment of bacterial antibiotic resistances.展开更多
目的观察改变细菌裂解温度对提取粪便细菌基因组DNA量和纯度的影响。方法收集10例肝硬化患者粪便,每例患者粪便等分成两份,再随机分成两组。采用QIAamp DNA Stool Mini Kit试剂盒(国际通用粪便细菌基因组DNA提取试剂盒)进行抽提,一组(A...目的观察改变细菌裂解温度对提取粪便细菌基因组DNA量和纯度的影响。方法收集10例肝硬化患者粪便,每例患者粪便等分成两份,再随机分成两组。采用QIAamp DNA Stool Mini Kit试剂盒(国际通用粪便细菌基因组DNA提取试剂盒)进行抽提,一组(A组)按照试剂盒说明书温度要求进行粪便细菌基因组DNA提取,一组(B组)对试剂盒细菌裂解温度改良后再进行提取。结果与按照试剂盒说明书温度进行提取组相比,改变细菌裂解温度后粪便基因组DNA提取量明显增高(P<0.05),而粪便基因组DNA提取纯度(OD260/280、OD260/230)无明显变化(P>0.05)。结论改变细菌裂解温度能明显提高粪便细菌基因组DNA提取量,而不改变粪便细菌基因组DNA的提取纯度。该方法可以解决因粪便采样量少导致粪便基因组DNA提取量不足的问题。展开更多
AIM: To investigate the effect of a fermented milk containing Bifidobacterium lactis DN-173010 and yogurt strains (BIO) on adult women with constipation in Beijing.METHODS: A total of 135 adult females with constipati...AIM: To investigate the effect of a fermented milk containing Bifidobacterium lactis DN-173010 and yogurt strains (BIO) on adult women with constipation in Beijing.METHODS: A total of 135 adult females with constipation were randomly allocated to consume for 2 wk either 100 g of the test fermented milk or 100 g of an acidified milk containing non-living bacteria (control).Stool frequency,defecation condition scores,stool consistency and food intake were recorded at baseline and after 1 and 2 wk in an intention-to-treat population of 126 subjects.In parallel,safety evaluation parameters were performed.RESULTS: At baseline,no differences were found between groups.Following consumption of test product,stool frequency was significantly increased after 1 wk (3.5 ± 1.5 vs 2.4 ± 0.6,P < 0.01) and 2 wk (4.1 ± 1.7 vs 2.4 ± 0.6,P < 0.01),vs baseline.Similarly,after 1 and 2 wk,of test product consumption,defecation condition (1.1 ± 0.9 vs 1.9 ± 1.2,P < 0.01 and 0.8 ± 1.0 vs 1.9 ± 1.2,P < 0.01,respectively) and stool consistency (1.0 ± 0.8 vs 1.5 ± 1.1,P < 0.01 and 0.6 ± 0.8 vs 1.5 ± 1.1,P < 0.01,respectively) were significantly improved.Compared with the control group,stool frequency was also significantly increased (3.5 ± 1.5 vs 2.5 ± 0.9,P < 0.01 and 4.1 ± 1.7 vs 2.6 ± 1.0,P < 0.01,respectively),and defecation condition (1.1 ± 0.9 vs 1.6 ± 1.1,P < 0.01 and 0.8 ± 1.0 vs 1.6 ± 1.1,P < 0.01,respectively) and stool consistency (1.0 ± 0.8 vs 1.4 ± 1.0,P < 0.05 and 0.6 ± 0.8 vs 1.3 ± 1.0,P < 0.01,respectively) significantly decreased after 1 and 2 wk of product consumption.During the same period,food intake did not change between the two groups,and safety parameters of the subjects were within normal ranges.CONCLUSION: This study suggests a beneficial effect of a fermented milk containing B.lactis DN-173010 on stool frequency,defecation condition and stool consistency in adult women with constipation constipated women after 1 and 2 wk of consumption.展开更多
AIM: To investigate the feasibility of detecting aberrantly hypermethylated Wnt-antagonist gene promoters (SFRP2 and WIF-1) in fecal DNA as non-invasive biomarkers for early colorectal cancer (CRC).
基金Supported by Health Sciences Research Grants(Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus No.H25-016)from the Ministry of HealthLabour and Welfare of Japanand supported in part by Grants-in-Aid for Research from the National Center for Global Health and Medicine No.26A-201
文摘AIM: To determine the bowel symptoms associated with diabetes and diabetes-related factors after excluding gastrointestinal (GI) organic diseases.METHODS: Participants were 4738 (603 diabetic and 4135 non-diabetic) patients who underwent colonoscopy and completed a questionnaire. On the day of pre-colonoscopy, 9 symptoms (borborygmus, abdominal distension, increased flatus, constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) were prospectively evaluated on a 7-point Likert scale. The test-retest reliability of the bowel symptom scores from the baseline and second questionnaires was analyzed using kappa statistics. Associations between bowel symptom scores and diabetes or diabetes-related factors were analyzed by a rank-ordered logistic model adjusted for related confounders, and odds ratios (ORs) were estimated.RESULTS: In multivariate analysis, constipation [adjusted odds ratio (AOR) = 1.57, CI: 1.33-1.85, P < 0.01] and hard stools (AOR = 1.56, CI: 1.33-1.84, P < 0.01) were associated with diabetes, and fecal urgency (AOR = 1.16, CI: 0.99-1.37, P = 0.07) and incomplete evacuation (AOR = 1.16, CI: 1.00-1.36, P = 0.06) were marginally associated with diabetes. These symptoms remained associated even after excluding organic GI diseases on colonoscopy. Test-retest reliability of symptom score with a mean duration of 3.2 mo was good (mean kappa, 0.69). Associations of symptoms with diabetes-related factors were found; constipation with HbA1c ≥ 8.0% (AOR = 2.11, CI: 1.19-3.73), body mass index (BMI) < 25 (AOR = 2.11, CI: 1.22-3.66), and insulin use (AOR = 1.90, CI: 1.08-3.36); hard stools with diabetes duration (AOR = 1.03, CI: 1.00-1.07); fecal urgency with BMI < 25 (AOR = 1.73, CI: 1.00-2.98); and incomplete evacuation with BMI < 25 (AOR = 2.60, CI: 1.52-4.43), serum creatinine level (AOR = 1.27, CI: 1.10-1.47), and insulin use (AOR = 1.92, CI: 1.09-3.38).CONCLUSION: Diabetes is associated with constipation, hard stools, fecal urgency, and incomplete evacuation, and poor glycemic control, duration, leanness, and nephropathy affect the risk of these symptoms.
文摘Colorectal cancer(CRC)is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.The leading risk factors for CRC include male gender,age over 50,family history,obesity,tobacco smoking,alco-hol consumption,and unhealthy diet.CRC screening methods vary considerably between countries and depend on incidence,economic resources and healthcare structure.Important aspects of screening include adherence,which can vary signi-ficantly across ethnic and socioeconomic groups.Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colono-scopy or radiologic imaging techniques.Technological capabilities for CRC scree-ning are rapidly evolving and include stool DNA test,liquid biopsy,virtual colo-nography,and the use of artificial intelligence.A CRC prevention strategy should be comprehensive and include active patient education along with targeted imple-mentation of screening.
基金funded by the Chinese Nutrition Society and PepsiCo Inc.
文摘Digestive health is important for overall well-being,but gut health problems are common in the Chinese population.The objective of this study was to investigate the effects of oatβ-glucan-based prebiotic blended formulas in humans on digestive health by assessing defecation frequency,defecation symptoms,stool quality,self-reported digestive feelings,defecation satisfaction,and gut bacteria.A parallel,randomized,double-blind,controlled trial was conducted in 168 eligible adults randomized to 3 groups for 14 days:Intervention groups A and B received 2 different doses of oatβ-glucan-based prebiotic blended formulas and a Control group received oatβ-glucan mixed with hydroxypropylmethyl-cellulose and microcrystalline cellulose.Participants completed a defecation diary and Bristol stool chart daily and digestive system questionnaires weekly.Fecal samples were collected on day 0 and day 14 to evaluate gut bacteria using 16S rDNA analysis.Both formulas improved defecation frequency,stool quality,defecation symptoms,defecation satisfaction,and on digestive health of human,compared with baseline(P<0.05).Both formulas led to increased quantities of Bifidobacterium and Akkermansia bacteria,compared to control,on day 14.This study therefore demonstrated the beneficial effects of oatβ-glucan-based prebiotic blended formulas on gut health in generally healthy Chinese adults.These formulas are a feasible nutritional strategy for digestive health.
文摘BACKGROUND Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection,but it is encountered with drug resistance.The stool antigen test is a cost-effective and easy-to-perform test to confirm the eradication of H.pylori,4-8 weeks post-therapy,with 86%sensitivity and 92%specificity.AIM To assess the H.pylori eradication rate of standard triple therapy and factors affecting the eradication rate.METHODS We conducted a prospective,multicenter follow-up study in Addis Ababa,Ethiopia,at selected healthcare facilities among dyspeptic patients with positive stool H.pylori antigen tests from June 1,2023 to October 30,2023 to assess the H.pylori eradication rate.After completing the standard triple therapy,the eradication was confirmed using a stool antigen test 4 weeks later.The data were analyzed using bivariate and multivariate logistic regression methods.RESULTS The H.pylori eradication rate was 85.4%.Patients with a previous diagnosis of H.pylori infection,smokers,and local alcohol consumption were associated with a lower H.pylori eradication rate,with adjusted odds ratio(AORs)of 0.159[95%confidence interval(CI):0.050-0.511],0.206(95%CI:0.052-0.822),and 0.228(95%CI:0.052-0.997),respectively.Patients with complete symptom resolution were 5.383 times more likely to achieve eradication than patients without symptom improvement,AOR=5.383,95%CI:1.74-21.089.CONCLUSION H.pylori eradication rate was lower than expected.Post-treatment testing is crucial to confirm eradication and guide further management,such as susceptibility testing.
文摘This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual.The report highlights challenges in diagnosing ap-pendiceal intussusception,emphasizing the importance of endoscopic expertise in preventing impulsive decisions such as inappropriate polypectomies.The rarity of the concurrent intussuscepted appendix and mucinous cecal cancer is under-scored,prompting consideration of malignancy in appendiceal intussusception cases.Additionally,the report addresses the increasing incidence of early-onset colorectal cancer and the need for a revaluation of diagnostic paradigms in the context of evolving epidemiological trends.The awareness of potential misinter-pretations and the imperative for further investigation into this rare condition are emphasized.
基金Supported by The National Natural Science Foundation of China,No.82104525.
文摘The population with metabolic dysfunction-associated fatty liver disease(MAFLD)is increasingly common worldwide.Identification of people at risk of progression to advanced stages is necessary to timely offer interventions and appropriate care.Liver biopsy is currently considered the gold standard for the diagnosis and staging of MAFLD,but it has associated risks and limitations.This has spurred the exploration of non-invasive diagnostics for MAFLD,especially for steatohepatitis and fibrosis.These non-invasive approaches mostly include biomarkers and algorithms derived from anthropometric measurements,serum tests,imaging or stool metagenome profiling.However,they still need rigorous and widespread clinical validation for the diagnostic performance.
文摘BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.
文摘Introduction: Infectious diseases constitute a major concern of public health in developing countries. Facilities and well trained staff have been shown to be one of the major obstacles in the rapid and quality diagnosis of these diseases. As such, we carried out an analysis to compare the Widal test and stool culture to identify febrile patients with Salmonella infection. Method: A cross sectional study was conducted to diagnose salmonella infection with out-patients who demonstrated signs of salmonella infection. Serum was harvested from blood collected from 368 (Vina = 234, Mayo Banyo 65, and Djerem = 69) patients accompanied by stool, Widal test was conducted on the spot and stool was taken to a reference laboratory for culture using standard microbiological methods, sociological set up was calculated in percentages, prevalence was calculated using excel while statistical difference was calculated using SPSS. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to compare the Widal test against stool culture. Results: A total of 368 (50.8% females and 49.2% males) participants took part in the survey. Salmonella prevalence (66.24%) in stool culture in the Vina division was significantly different (p 0.05). The sensitivity,specificity, PPV, and NPV of slide agglutination test against stool culture varied from different areas (Vina: 51.6%, 73.62%, 79.21% and 43.61%;Mayo Banyo: 60.53%, 77.78%, 79.31% and 58.33%;Djerem: 53.18%, 83.73% 73.91% and 67.39%) respectively. Slide agglutination test has a fair agreement with the stool culture (kappa, Vina = 0.202;Mayo Banyo = 0.37 and Djerem = 0.38). Conclusion: Generally, in the three areas of study, the Widal test had a fair correlation with the stool culture;This means the Widal test should not be used alone but in combination with stool culture in the detection of salmonella infections.
文摘The incidence of hematochezia in infants aged three months or younger has shown an upward trend in recent years. This condition is characterized by visible bloody stools, which may appear bright red, dark red, jam-like, or mucus-purulent bloody stools, and is often accompanied by positive fecal occult blood tests, with or without additional systemic clinical symptoms. The etiology is multifactorial, potentially influenced by the maternal health status during pregnancy, neonatal diseases or treatments received in the NICU, and the methods used for establishing enteral and parenteral nutrition. Notably, allergic factors have gained prominence in recent years. This paper reviews recent studies to elucidate the incidence, primary causes, and current treatment approaches for early infant hematochezia, providing a reference for clinical practice.
文摘BACKGROUND Irritable bowel syndrome(IBS),defined according to the Rome IV diagnostic criteria,is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain related to altered bowel habits.First-line recommended treatments are limited to combining drugs targeting predominant symptoms,particularly pain(antispasmodics),constipation(laxatives),and diarrhea(loperamide),yielding only a limited therapeutic gain.GASTRAP^(■)DIRECT is a class IIa medical formulation composed of a combination of chitin-glucan and simethicone indicated for the symptomatic treatment of gas-related gastrointestinal disorders by combining different mechanisms of action.AIM To evaluate the efficacy,tolerability,and safety of 4-week GASTRAP^(■)DIRECT treatment in patients with IBS.METHODS In this prospective,multicenter,open-label trial,120 patients with IBS received three sticks of GASTRAP^(■)DIRECT(1.5 g/d of chitin-glucan and 0.75 mg/d of simethicone)per day for 4 weeks.The primary endpoint was the responder rate,defined as the number of patients whose abdominal pain score decreased by≥30%from baseline to week(W)4.The analysis was performed using the per-protocol set.Cardinal symptoms,impact of global symptoms on daily life,change in stool consistency,and improvement in defecatory disorders were evaluated.RESULTS Overall,100 patients were evaluated.At W4,67%(95%CI:57-75)showed improvement in abdominal pain(score:5.8±2.4 vs 2.9±2.0,P<0.0001).Similar improvements were observed for bloating[8.0±1.7 vs 4.7±2.9,P<0.0001;60%(95%CI:50-70)responders],abdominal distension[7.2±2.1 vs 4.4±3.1,P<0.0001;53%(95%CI:43-63)responders],and impact of global symptoms on daily life[7.1±2.0 vs 4.6±2.9,P<0.0001;54%(95%CI:44-64)responders].Stool consistency improved in most patients(90%and 57%for patients with liquid and hard stools,respectively).Overall,42%of patients with defecatory disorders reported very much/considerable improvements by W2.No severe adverse event occurred,and tolerability was rated“good”or“very good”by 93%of patients.CONCLUSION GASTRAP^(■)DIRECT is safe and well tolerated,alleviating IBS symptoms rapidly in 2 weeks.This open-label study suggests that the combination of chitin-glucan and simethicone could be beneficial in patients with IBS.
文摘Objective To explore clinical efficacy and safety of acupuncture in treatment of functional constipation.Methods One hundred and twenty cases were randomly divided into an observation group and a control group,60 cases in each group.The patients in the observation group were treated with acupuncture at Tiānshū（天枢 ST 25）,Shàngjùxū（上巨虚 ST 37）,Zúsānlǐ（足三里 ST 36）,Dàchángshū（大肠俞 BL 25）,etc.,and the control group was treated with oral administration of Macrogol 4000 and Mosapride.Defecation frequency,stool property,constipation symptom score,accompanying symptom score,gastrointestinal transit time and adverse reaction were observed before treatment,at the end of treatment and 4 weeks after treatment in the two groups.Results Compared with those before treatment,defecation frequency was increased significantly at the end of treatment in the two groups,while stool property,constipation symptom score,accompanying syndrome score and gastrointestinal transit time all were decreased significantly（all P0.01）,with no significant difference in these indexes between the two groups at the end of treatment （all P0.05）.Compared with the end of treatment,the above-mentioned indexes did not significantly recur in the observation group 4 weeks after the treatment （all P0.05）,but the therapeutic effects were unstable with decreased to some extent in the control group （all P0.05）.No serious adverse reaction was found in the two groups.Conclusion In the patients with functional constipation,acupuncture can significantly increase defecation frequency,change stool property,alleviate constipation and accompanying symptoms,and shorten gastrointestinal transit time with better safety and tolerance,and the therapeutic effect is more stable than that of Macrogol 4000 and Mosapride.
文摘AIM To assess the diagnostic accuracy of a new fecal test for detecting Helicobacter pylori(H.pylori),using^(13)Curea breath test as the reference standard,and explore bacterial antibiotic resistance.METHODS We conducted a prospective two-center diagnostic test accuracy study.We enrolled consecutive people≥18 years without previous diagnosis of H.pylori infection,referred for dyspepsia between February and October 2017.At enrollment,all participants underwent 13 C-urea breath test.Participants aged over 50 years were scheduled to undergo upper endoscopy with histology.Participants collected stool samples 1-3 d after enrollment for a new fecal investigation(THD fecal test).The detection of bacterial 23 S rRNA subunit gene indicated H.pylori infection.We also used the index diagnostic test to examine mutations conferring resistance to clarithromycin and levofloxacin.Independent investigators analyzed index test and reference test standard results blinded to the other test findings.We estimated sensitivity,specificity,positive(PPV)and negative(NPV)predictive value,diagnostic accuracy,positive and negative likelihood ratio(LR),together with 95%confidence intervals(CI).RESULTS We enrolled 294 consecutive participants(age:Median 37.0 years,IQR:29.0-46.0 years;men:39.8%).Ninetyfive(32.3%)participants had a positive^(13)C-urea breath test.Twenty-three(7.8%)participants underwent upper endoscopy with histology,with a full concordance between^(13)C-urea breath test and histology in detecting H.pylori infection.Four(1.4%)out of the 294 participants withdrew from the study after the enrollment visit and did not undergo THD fecal testing.In the 290 participants who completed the study,the THD fecal test sensitivity was 90.2%(CI:84.2%-96.3%),specificity 98.5%(CI:96.8%-100%),PPV 96.5%(CI:92.6%-100%),NPV 95.6%(CI:92.8%-98.4%),accuracy 95.9%(CI:93.6%-98.2%),positive LR 59.5(CI:19.3-183.4),negative LR 0.10(CI:0.05-0.18).Out of 83 infected participants identified with the THD fecal test,34(41.0%)had bacterial genotypic changes consistent with antibiotic-resistant H.pylori infection.Of these,27(32.5%)had bacterial strains resistant to clarithromycin,3(3.6%)to levofloxacin,and 4(4.8%)to both antibiotics.CONCLUSION The THD fecal test has high performance for the non-invasive diagnosis of H.pylori infection while additionally enabling the assessment of bacterial antibiotic resistances.
文摘目的观察改变细菌裂解温度对提取粪便细菌基因组DNA量和纯度的影响。方法收集10例肝硬化患者粪便,每例患者粪便等分成两份,再随机分成两组。采用QIAamp DNA Stool Mini Kit试剂盒(国际通用粪便细菌基因组DNA提取试剂盒)进行抽提,一组(A组)按照试剂盒说明书温度要求进行粪便细菌基因组DNA提取,一组(B组)对试剂盒细菌裂解温度改良后再进行提取。结果与按照试剂盒说明书温度进行提取组相比,改变细菌裂解温度后粪便基因组DNA提取量明显增高(P<0.05),而粪便基因组DNA提取纯度(OD260/280、OD260/230)无明显变化(P>0.05)。结论改变细菌裂解温度能明显提高粪便细菌基因组DNA提取量,而不改变粪便细菌基因组DNA的提取纯度。该方法可以解决因粪便采样量少导致粪便基因组DNA提取量不足的问题。
基金Danone (Shanghai) Consulting Co.Ltd115 national science and technology program
文摘AIM: To investigate the effect of a fermented milk containing Bifidobacterium lactis DN-173010 and yogurt strains (BIO) on adult women with constipation in Beijing.METHODS: A total of 135 adult females with constipation were randomly allocated to consume for 2 wk either 100 g of the test fermented milk or 100 g of an acidified milk containing non-living bacteria (control).Stool frequency,defecation condition scores,stool consistency and food intake were recorded at baseline and after 1 and 2 wk in an intention-to-treat population of 126 subjects.In parallel,safety evaluation parameters were performed.RESULTS: At baseline,no differences were found between groups.Following consumption of test product,stool frequency was significantly increased after 1 wk (3.5 ± 1.5 vs 2.4 ± 0.6,P < 0.01) and 2 wk (4.1 ± 1.7 vs 2.4 ± 0.6,P < 0.01),vs baseline.Similarly,after 1 and 2 wk,of test product consumption,defecation condition (1.1 ± 0.9 vs 1.9 ± 1.2,P < 0.01 and 0.8 ± 1.0 vs 1.9 ± 1.2,P < 0.01,respectively) and stool consistency (1.0 ± 0.8 vs 1.5 ± 1.1,P < 0.01 and 0.6 ± 0.8 vs 1.5 ± 1.1,P < 0.01,respectively) were significantly improved.Compared with the control group,stool frequency was also significantly increased (3.5 ± 1.5 vs 2.5 ± 0.9,P < 0.01 and 4.1 ± 1.7 vs 2.6 ± 1.0,P < 0.01,respectively),and defecation condition (1.1 ± 0.9 vs 1.6 ± 1.1,P < 0.01 and 0.8 ± 1.0 vs 1.6 ± 1.1,P < 0.01,respectively) and stool consistency (1.0 ± 0.8 vs 1.4 ± 1.0,P < 0.05 and 0.6 ± 0.8 vs 1.3 ± 1.0,P < 0.01,respectively) significantly decreased after 1 and 2 wk of product consumption.During the same period,food intake did not change between the two groups,and safety parameters of the subjects were within normal ranges.CONCLUSION: This study suggests a beneficial effect of a fermented milk containing B.lactis DN-173010 on stool frequency,defecation condition and stool consistency in adult women with constipation constipated women after 1 and 2 wk of consumption.
基金Supported by The National Natural Science Foundation of China,No.81101868The Natural Science Foundation of Hubei Province of China,No.2011CDB505
文摘AIM: To investigate the feasibility of detecting aberrantly hypermethylated Wnt-antagonist gene promoters (SFRP2 and WIF-1) in fecal DNA as non-invasive biomarkers for early colorectal cancer (CRC).
