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Liu F, Wang ZK, Li MY, Zhang XL, Cai FC, Wang XD, Gao XF, Li W. Characterization of biliary and duodenal microbiota in patients with primary and recurrent choledocholithiasis. Health Inf Sci Syst 2024; 12:29. [PMID: 38584761 PMCID: PMC10994894 DOI: 10.1007/s13755-023-00267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/27/2023] [Indexed: 04/09/2024] Open
Abstract
Purpose To explore the biliary and duodenal microbiota features associated with the formation and recurrence of choledocholithiasis (CDL). Methods We prospectively recruited patients with primary (P-CDL, n = 29) and recurrent CDL (R-CDL, n = 27) for endoscopic retrograde cholangiopancreatography (ERCP). Duodenal mucosa (DM), bile and bile duct stones (BDS) samples were collected in P- and R-CDL patients. DM samples were also collected in 8 healthy controls (HC). The microbiota profile analysis was performed with 16S rRNA gene sequencing. Results Short-course antibiotic application before ERCP showed no significant effects in alpha and beta diversities of the biliary and duodenal microbiota in CDL. Alpha diversity showed no difference between DM and bile samples in CDL. The duodenal microbial richness and diversity was lower in both P- and R-CDL than HC. The biliary microbiota composition showed a high similarity between P- and R-CDL. Fusobacterium and Enterococcus were higher abundant in DM, bile, and BDS samples of R-CDL than P-CDL, as well as Escherichia and Klebsiella in bile samples of R-CDL. The enriched duodenal and biliary bacteria in CDL were closely associated with cholecystectomy, inflammation and liver dysfunction. The bile-associated microbiota of R-CDL expressed enhanced capacity of D-glucuronide and D-glucuronate degradation, implicating an elevated level of β-glucuronidase probably produced by enriched Escherichia and Klebsiella in bile. Conclusions The duodenal microbiota was in an imbalance in CDL. The duodenal microbiota was probably the main source of the biliary microbiota and was closely related to CDL formation and recurrence. Enterococcus, Fusobacterium, Escherichia and Klebsiella might contribute to CDL recurrence. Clinical trials The study was registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/index.html, ChiCTR2000033940). Supplementary Information The online version contains supplementary material available at 10.1007/s13755-023-00267-2.
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Affiliation(s)
- Fang Liu
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, The First Medical Center, No. 28 Fuxing Road, Beijing, 100853 China
| | - Zi-Kai Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, The First Medical Center, No. 28 Fuxing Road, Beijing, 100853 China
| | - Ming-Yang Li
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, The First Medical Center, No. 28 Fuxing Road, Beijing, 100853 China
| | - Xiu-li Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, The First Medical Center, No. 28 Fuxing Road, Beijing, 100853 China
| | - Feng-Chun Cai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, The First Medical Center, No. 28 Fuxing Road, Beijing, 100853 China
| | - Xiang-Dong Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, The First Medical Center, No. 28 Fuxing Road, Beijing, 100853 China
| | - Xue-Feng Gao
- Integrative Microecology Clinical Center, Shenzhen Key Laboratory of Gastrointestinal Microbiota and Disease, Shenzhen Clinical Research Center for Digestive Disease, Shenzhen Technology Research Center of Gut Microbiota Transplantation, The Clinical Innovation & Research Center, Shenzhen Hospital, Southern Medical University, Shenzhen, 518000 Guangdong China
| | - Wen Li
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, The First Medical Center, No. 28 Fuxing Road, Beijing, 100853 China
- Minimally Invasive Digestive Disease Center, Beijing and Shenzhen United Family Hospital, Beijing, China
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Chen HC, Wang ZJ, Song HL. A Grading System for Assessing the Status of the Sphincter of Oddi During Intraoperative Choledochoscopy: A Surgeon's Perspective. Surg Laparosc Endosc Percutan Tech 2024; 34:356-360. [PMID: 38752698 DOI: 10.1097/sle.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/18/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND The aim of this study was to establish a simple and practical grading system for evaluating the status of the sphincter of Oddi (SO) during intraoperative choledochoscopy. This system helps identify relevant variables that influence the status of the SO and provides recommendations for preventing stone recurrence. METHODS Ninety-three patients were selected retrospectively from a total of 316 patients diagnosed with choledocholithiasis between July 2020 and June 2023. All patients underwent common bile duct (CBD) exploration surgery and intraoperative choledochoscopy. The status of the SO was assessed during choledochoscopy. According to the severity of the condition, the patients were categorized into 4 groups. Data from each group, grades 1, 2, 3, 4, was analyzed statistically. RESULTS The number of patients in grade 1 was significantly lower than that of the other 3 groups. Except for grade 1, patients in grade 4 exhibited significant differences compared with the other 2 groups in terms of the diameter of the CBD, size of stones, presence of pneumobilia, and history of endoscopic retrograde cholangiopancreatography (ERCP) ( P <0.05). There were no significant differences between the groups in terms of sex, age, liver function, number of stones, history of gastrectomy, cholecystectomy, or CBD exploration. CONCLUSIONS The grading system helps us classify different sphincter functions and better understand the formation of choledocholithiasis by subdividing the status of the SO. Endoscopic sphincterotomy (EST) treatment can easily result in the loss of SO function, which increases the risk of stone recurrence.
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Affiliation(s)
- Hai Chuan Chen
- Department of Hepatobiliary Surgery, Wenzhou Central Hospital
- Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhe Jin Wang
- Department of Hepatobiliary Surgery, Wenzhou Central Hospital
| | - Hong Liang Song
- Department of Hepatobiliary Surgery, Wenzhou Central Hospital
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Fan Z, Qiu Y, Qi X, Xu J, Wan Y, Hao Y, Niu W, Huang J. Invasive acupuncture for gastroparesis after thoracic or abdominal surgery: a systematic review and meta-analysis. BMJ Open 2023; 13:e068559. [PMID: 37369406 PMCID: PMC10410841 DOI: 10.1136/bmjopen-2022-068559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This meta-analysis aimed to systematically evaluate the efficacy of acupuncture in treating postsurgical gastroparesis syndrome (PGS) after thoracic or abdominal surgery. DESIGN Systematic review and meta-analysis. DATA SOURCES Twelve databases (PubMed, Embase, Cochrane Library Cochrane Central Register of Controlled Trials (CENTRAL), Medline (Ovid) (from 1946), Web of Science, EBSCO, Scopus, Open Grey, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Database (VIP) and China Biology Medicine disc (CBM)) and three registration websites (WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Chinese Clinical Trial Registry (ChiCTR)) were searched from the inception to September 2022, and citations of the included literature were screened. ELIGIBILITY CRITERIA All randomised controlled trials addressing invasive acupuncture for PGS. DATA EXTRACTION AND SYNTHESIS Key information on the included studies was extracted by two reviewers independently. Risk ratio (RR) with 95% CI was used for categorical data, and mean difference with 95% CI for continuous data. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Outcomes were conducted with trial sequential analysis (TSA). RESULTS Fifteen studies with 759 patients met the inclusion criteria. Subgroup analyses revealed that compared with the drug group, the drug and acupuncture group had a greater positive effect on the total effective rate (TER) (nine trials, n=427; RR=1.20; 95% CI 1.08 to 1.32; P-heterogeneity=0.20, I2=28%, p=0.0004) and the recovery rate (RCR) (six trials, n = 294; RR = 1.61; 95% CI 1.30 to 1.98; P-heterogeneity=0.29, I2=19%, p<0.0001) of PGS after abdominal surgery. However, acupuncture showed no significant advantages in terms of the TER after thoracic surgery (one trial, p=0.13) or thoracic/abdominal surgery-related PGS (two trials, n = 115; RR=1.18; 95% CI 0.89 to 1.57; P-heterogeneity=0.08, I2=67%, p=0.24) and the RCR after thoracic/abdominal surgery (two trials, n=115; RR=1.40; 95% CI 0.97 to 2.01; P-heterogeneity=0.96, I2=0%, p=0.07). The quality of evidence for TER and RCR was moderate certainty. Only one study reported an acupuncture-related adverse event, in the form of mild local subcutaneous haemorrhage and pain that recovered spontaneously. TSA indicated that outcomes reached a necessary effect size except for clinical symptom score. CONCLUSION Based on subgroup analysis, compared with the drug treatment, acupuncture combined drug has significant advantages in the treatment of PGS associated with abdominal surgery, but not with thoracic surgery. PROSPERO REGISTRATION NUMBER CRD42022299189.
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Affiliation(s)
- Zhenjia Fan
- Department of minimally invasive acupuncture Oncology, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yuqin Qiu
- Department of Integrated Traditional Chinese and Western Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuewei Qi
- Department of minimally invasive acupuncture Oncology, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingnan Xu
- Department of minimally invasive acupuncture Oncology, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yuxiang Wan
- Department of minimally invasive acupuncture Oncology, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yingxu Hao
- Oncology Department of Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Jinchang Huang
- Department of minimally invasive acupuncture Oncology, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
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Liu L, Zhao Z, Hou X, Wu J. Effect of sphincter of Oddi dysfunction on the abundance of biliary microbiota (biliary microecology) in patients with common bile duct stones. Front Cell Infect Microbiol 2022; 12:1001441. [PMID: 36569207 PMCID: PMC9768453 DOI: 10.3389/fcimb.2022.1001441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Biliary calculi, a common benign disease of the gastrointestinal tract, are affected by multiple factors, including diet, lifestyle, living environment, and personal and genetic background. Its occurrence is believed to be related to a change in biliary microbiota. Approximately 10%-20% of symptomatic patients with cholecystolithiasis have choledocholithiasis, resulting in infection, abdominal pain, jaundice, and biliary pancreatitis. This study aimed to determine whether a dysfunction in the sphincter of Oddi, which controls the outflow of bile and separates the bile duct from the intestine, leads to a change in biliary microbiota and the occurrence of biliary calculi. Methods Forty patients with cholecystolithiasis and choledocholithiasis were prospectively recruited. Bile specimens were obtained, and biliary pressure was measured during and after surgery. The collected specimens were analyzed with 16S rRNA gene to characterize the biliary microbiota. The risk factors of common bile duct calculi were analyzed numerically combined with the pressure in the sphincter of Oddi. Results Different biliary microbiota were found in all cases. Patients with sphincter of Oddi dysfunction had significantly increased biliary microbiota as well as significantly higher level of systemic inflammation than patients with normal sphincter of Oddi. Conclusions The systemic inflammatory response of patients with sphincter of Oddi dysfunction is more severe, and their microbial community significantly differs from that of patients with normal sphincter of Oddi, which makes biliary tract infection more likely; furthermore, the biliary tract of patients with sphincter of Oddi dysfunction has more gallstone-related bacterial communities.
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Affiliation(s)
- Linxun Liu
- Department of General Surgery, Qinghai Provincial People’s Hospital, Xining, Qinghai, China,*Correspondence: Linxun Liu,
| | - Zhanxue Zhao
- Department of General Surgery, Qinghai Provincial People’s Hospital, Xining, Qinghai, China
| | - Xiaofan Hou
- Graduate College of Qinghai University, Xining, Qinghai, China
| | - Jindu Wu
- Graduate College of Qinghai University, Xining, Qinghai, China
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Bile Reflux Gastritis: Insights into Pathogenesis, Relevant Factors, Carcinomatous Risk, Diagnosis, and Management. Gastroenterol Res Pract 2022; 2022:2642551. [PMID: 36134174 PMCID: PMC9484982 DOI: 10.1155/2022/2642551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Bile reflux gastritis (BRG), a kind of gastrointestinal disorder in clinical practice, is characterized by regurgitation and inflammation. However, lack of guidelines leads to simple cognition and even ignorance of this disease for clinicians. Primarily, making the pathogenesis of BRG clear contributes to a correct and general understanding of this disease for physicians. Next, although recently there has been an increasing awareness among researchers in terms of the relevant factors for BRG, further studies involving large samples are still required to certify the relationship between them explicitly. Besides, researches have established that BRG is closely associated with the development of precancerous lesions and gastric cancer. Till now, there is still no golden standard for diagnosis of BRG. Nevertheless, advances in techniques, especially extensive applications of endoscopy and chemical analysis of reflux contents, have improved our ability to identify the occurrence of this disease as well as distinguishing physiological reflux from pathological reflux. Finally, it is fortunate for patients that more and more importance has been attached to the treatment of BRG. From lifestyle modification to drug therapy to surgery, all of them with the view of realizing symptomatic relief are employed for patients with BRG. In this review, we briefly evaluate this disorder based on the best available evidence, offering an overview of its complicated pathogenesis, diverse relevant factors, potential carcinomatous risk, modern diagnostic investigations, and effective therapeutic plans.
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Svistunov AA, Osadchuk MA, Mironova ED, Guliaev PV, Vasileva IN. The role of the main risk factors and endocrine cells of the antrum of the stomach producing motilin in the occurrence of cholelithiasis. TERAPEVT ARKH 2022; 94:194-199. [DOI: 10.26442/00403660.2022.02.201370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
Aim. To establish the role of the main risk factors and endocrine cells of the antrum of the stomach producing motilin (M-cells) in the occurrence of cholelithiasis.
Materials and methods. The first group included 122 patients with cholelithiasis. The second group consisted of 30 healthy individuals who underwent medical examination. The groups were matched for gender and age. The work analyzed anamnestic, biochemical and anthropometric data. All patients underwent esophagogastroduodenoscopy with targeted biopsy of the mucous membrane from the antrum. Biopsies were subjected to cytological and immunohistochemical studies in order to verify Helicobacter pylori and estimate the number of M-cells.
Results. Patients with cholelithiasis more often belonged to the group of people of mental labor, had low physical activity, were committed to inappropriate nutrition and more often indicated the presence of aggravated heredity for cholelithiasis. Patients with gallstone disease had higher body mass index, waist volume, total cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, lower high-density lipoprotein cholesterol, H. pylori infection was more often verified and M-cell hypoplasia in the mucous membrane was established. stomach in comparison with the representatives of the second group.
Conclusion. Our results suggest that certain external factors, nutritional characteristics of the metabolic syndrome components, hypoplasia of M-cells in the gastric mucosa are important factors in the formation of calculi in the gallbladder.
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7
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Zhang Q, Ye M, Su W, Chen Y, Lou Y, Yang J, Ma T, Chen W, Gao S, Que R, Zhang B, Li H, Bai X, Liang T. Sphincter of Oddi laxity alters bile duct microbiota and contributes to the recurrence of choledocholithiasis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1383. [PMID: 33313128 PMCID: PMC7723656 DOI: 10.21037/atm-20-3295] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Choledocholithiasis is closely associated with bacterial infection and inflammation in the bile duct. Our previous studies showed that sphincter of Oddi laxity (SOL) significantly altered the bile microbiota and might contribute to the recurrence of biliary stones. However, the direct association among SOL, the bile microbiota, and choledocholithiasis recurrence is unclear. Methods We prospectively recruited 202 patients with choledocholithiasis, and obtained bile samples from the common bile duct. We performed 16S ribosomal RNA gene analysis to characterize the bile microbiota and analyzed the risk factors for choledocholithiasis. Results Distinct bile microbial communities were identified in patients with and without SOL, with a significantly larger abundance of Rhizobiaceae in patients with SOL. Patients with SOL had a higher risk of biliary stone recurrence, with a considerably shorter recurrence time. The abundance of Clostridium was significantly higher in patients with stone recurrence. SOL [P=0.024, hazard ratio (HR) =10.800, 95% confidence interval (CI): 1.377–84.701] was an independent risk factor of choledocholithiasis recurrence. Conclusions Choledocholithiasis patients with and without SOL demonstrated significant differences in their microbial communities. SOL is a critical risk factor for the recurrence of choledocholithiasis after surgery. The presence of Clostridium may be potentially associated with the recurrence of SOL-induced choledocholithiasis.
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Affiliation(s)
- Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Mao Ye
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Wei Su
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Yiwen Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Yu Lou
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Jiaqi Yang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Tao Ma
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Wei Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Shunliang Gao
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Risheng Que
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Bo Zhang
- Department of General Surgery, Shenzhen Luohu People's Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Haijun Li
- Department of General Surgery, Shenzhen Luohu People's Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xueli Bai
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases of Zhejiang Province, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Hangzhou, China
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Shi K, Qu L, Lin X, Xie Y, Tu J, Liu X, Zhou Z, Cao G, Li S, Liu Y. Deep-Fried Atractylodis Rhizoma Protects against Spleen Deficiency-Induced Diarrhea through Regulating Intestinal Inflammatory Response and Gut Microbiota. Int J Mol Sci 2019; 21:ijms21010124. [PMID: 31878055 PMCID: PMC6981650 DOI: 10.3390/ijms21010124] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
According to the theories of traditional Chinese medicine, spleen deficiency often leads to diarrhea, and deep-fried Atractylodis Rhizoma (DAR) is commonly used for the treatment. However, the association between spleen deficiency and diarrhea remains unclear. The present study aimed to investigate the therapeutic effect of DAR for the treatment of diarrhea caused by spleen deficiency and analyze the related mechanisms. It was found that a high dose group of an ethanolic extract of deep-fried Atractylodis Rhizoma (EEDAR-H) significantly inhibited weight loss, diarrhea, and pathological changes in colon tissue induced by rhubarb. EEDAR-H was found to significantly reduce the level of intestinal inflammatory cytokines and increase the expression of gastrointestinal motility hormones. In addition, EEDAR-H significantly increased the expression of aquaporin 3 (AQP3) and aquaporin 8 (AQP8) and restored abnormal water metabolism; Shen-Ling-Bai-Zhu-San (SLBZS) induced the same effect as EEDAR-H. Additional tests on the mechanism found that EEDAR-H and SLBZS promoted the integrity of the intestinal barrier. Both significantly increased the expression of the tight junction protein ZO-1 and Occludin, inhibited the phosphorylation of p38MAPK and MLC, and significantly reduced the expression levels of PAR-2. Analysis of the gut microbiota indicated that overall changes in its structure were reversed after treatment with EEDAR-H or SLBZS, in addition to significant modulation of the abundance of different phyla. At the genus level, EEDAR-H or SLBZS significantly reduced the levels of potential pathogens and increased those of beneficial bacteria.
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Affiliation(s)
- Kun Shi
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
| | - Linghang Qu
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
| | - Xiong Lin
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
| | - Ying Xie
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
| | - Jiyuan Tu
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
- Center for Hubei TCM Processing Technology Engineering, Wuhan 430065, China
| | - Xianqiong Liu
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
- Center for Hubei TCM Processing Technology Engineering, Wuhan 430065, China
| | - Zhongshi Zhou
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
- Center for Hubei TCM Processing Technology Engineering, Wuhan 430065, China
| | - Guosheng Cao
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
- Center for Hubei TCM Processing Technology Engineering, Wuhan 430065, China
| | - Shuiqing Li
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
- Center for Hubei TCM Processing Technology Engineering, Wuhan 430065, China
| | - Yanju Liu
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China; (K.S.); (L.Q.); (X.L.); (Y.X.); (J.T.); (X.L.); (Z.Z.); (G.C.); (S.L.)
- Center for Hubei TCM Processing Technology Engineering, Wuhan 430065, China
- Correspondence: ; Tel.: +86-027-6889-0231
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9
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Kalkan Ç, Soykan I. The Relations Among Serum Ghrelin, Motilin and Gastric Emptying and Autonomic Function in Autoimmune Gastritis. Am J Med Sci 2018; 355:428-433. [PMID: 29753372 DOI: 10.1016/j.amjms.2017.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Gastric emptying (GE) of solids is delayed and autonomic dysfunction is detected in autoimmune gastritis (AIG). The goals of this study were to: (1) compare serum levels of ghrelin and motilin in subjects with delayed and normal GE and (2) investigate whether circulating antimyenteric antibodies (CAA), serum ghrelin levels and motilin levels have any effect on autonomic function. MATERIALS AND METHODS Noninvasive cardiovascular reflex tests were used in order to evaluate the autonomic function. GE was evaluated by a standard 2-hour scintigraphic test. Serum ghrelin and motilin levels were tested by enzyme-linked immunosorbent assay and CAA were tested by immunofluorescence. RESULTS The serum ghrelin and motilin levels in the patients with delayed GE (n = 22) were significantly decreased compared to the normal GE patients (n = 19), (67.55 ± 8.81 versus 126.79 ± 25.81pg/mL, P < 0.001 and 279.59 ± 111.12 versus 500.42 ± 155.95pg/mL, respectively, P < 0.001). Whereas, the serum ghrelin and motilin levels in the patients with deranged autonomic function (n = 26) were significantly decreased compared to the patients with normal autonomic function (n = 15), (80.73 ± 28.46 versus 127.79 ± 28.06pg/mL, P < 0.001 and 316.92 ± 160.47 versus 490.20 ± 141.02pg/mL, P < 0.001, respectively). None of the patients were positive for CAA. CONCLUSIONS Ghrelin and motilin levels in AIG subjects with delayed GE and deranged autonomic function were significantly decreased. The decrease in serum ghrelin and plasma motilin levels in AIG suggest their potential role in the delayed GE observed in these subjects.
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Affiliation(s)
- Çağdaş Kalkan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ibni Sina Hospital, Ankara, Turkey
| | - Irfan Soykan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Ibni Sina Hospital, Ankara, Turkey.
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Svistunov AA, Butorova LI, Osadchuk MA, Kireeva NV, Tokmulina GM, Ardatskaya MD. The biliary pain syndrome in the context of Rome IV criteria: the rational approach to the choice of spasmolytic therapy in the clinical practice. ACTA ACUST UNITED AC 2018. [DOI: 10.17116/dokgastro20187259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Symptomatic cholelithiasis and functional disorders of the biliary tract present with similar signs and symptoms. The functional disorders of the biliary tract include functional gallbladder disorder, dyskinesia, and the sphincter of Oddi disorders. Although the diagnosis and treatment of symptomatic cholelithiasis are relatively straightforward, the diagnosis and treatment of functional disorders can be much more challenging. Many aspects of the diagnosis and treatment of functional disorders are in need of further study. This article discusses uncomplicated gallstone disease and the functional disorders of the biliary tract to emphasize and update the essential components of diagnosis and management.
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Optimum cystic duct closure: a comparative study using metallic clips, ENSEAL, and ENDOLOOP in swine. Am J Surg 2013; 205:547-50; discussion 550-1. [PMID: 23592161 DOI: 10.1016/j.amjsurg.2013.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 01/07/2013] [Accepted: 01/15/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Metal clips are commonly used to secure the cystic duct during cholecystectomy, although use of an ENDOLOOP (Ethicon Endo-Surgery, Blue Ash, OH) is often touted as a more secure closure when postoperative endoscopic retrograde cholangiopancreatography (ERCP) is anticipated. The objective of this study was to test the strength of 3 different cystic duct closure methods in a model simulating postoperative biliary insufflation. METHODS The extrahepatic biliary system, including common bile duct, gallbladder, and cystic duct, was harvested en bloc from 22 swine postmortem. A cholecystectomy was performed and the cystic duct was secured using 1 of 3 randomly assigned methods: metallic clips (Ethicon Endo-Surgery), an ENDOLOOP (Ethicon Endo-Surgery), or an ENSEAL tissue sealing device (Ethicon Endo-Surgery). The common bile duct was cannulated with a pressure-monitoring system and insufflated with air. The burst pressures, location of rupture, and size of the common bile duct and cystic duct were recorded and compared. RESULTS There were 7 pigs each in the ENDOLOOP and ENSEAL groups and 8 in the metallic clip group, with no statistical significance between cystic and common bile duct size. Mean burst pressure was 432 mm Hg for metallic clips, 371 mm Hg for the ENDOLOOP, and 238 mm Hg for the ENSEAL device (P = .02). Post hoc analysis revealed clips to be statistically superior when compared with the ENSEAL (P= .01). There was no statistical difference between the ENDOLOOP and metal clips or between the ENDOLOOP and the ENSEAL. CONCLUSIONS All 3 closure methods successfully secured the cystic duct, with mean burst pressures exceeding 195 mm Hg. Metallic clips demonstrated the highest burst pressures and no cystic duct stump leaks. This study challenges the traditional dogma of additionally securing the cystic duct with an ENDOLOOP when postoperative biliary instrumentation is expected and also suggests that an adequately secure closure may be obtained with thermal sealing devices.
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Zhang ZH, Wu YG, Qin CK, Su ZX, Xu J, Xian GZ, Wu SD. Severe acute cholangitis after endoscopic sphincterotomy induced by barium examination: A case report. World J Gastroenterol 2012; 18:5658-60. [PMID: 23112564 PMCID: PMC3482658 DOI: 10.3748/wjg.v18.i39.5658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 06/07/2012] [Accepted: 06/15/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis. We herein report a case of severe cholangitis after endoscopic sphincterotomy induced by barium examination. An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultrasonography. EST was performed and the stone was completely cleaned. Barium examination was done 3 d after EST and severe cholangitis appeared 4 h later. The patient was recovered after treated with tienam for 4 d. Barium examination may induce severe cholangitis in patients after EST, although rare, barium examination should be chosen cautiously. Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi.
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Abstract
BACKGROUND The use of the Harmonic Scalpel (HS) for cystic duct ligation began with little data about its efficacy or safety. On the other hand, there is not any literature available about the use of PlasmaKinetic Sealer (PK) for closing the cystic duct in laparoscopic cholecystectomy (LC). Therefore, this study was designed to compare the efficacy and safety of HS and PK for achieving safe closure of the cystic ducts after LC. METHODS Ninety patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into three groups (n = 30) randomly. After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in all groups, and in the first group, distal of the cystic ducts also was sealed with single SC and the gallbladders were removed with SC. In the second and third groups, distal of the cystic ducts were sealed with HS and PK, respectively. The gallbladders were removed as sealed cystic ducts with HS and PK. Then, gallbladders were connected to a transducer set and increasing pressure with saline was applied. The bursting pressures of gallbladders were measured and differences between the groups were calculated by using Student's t test. The value of P < 0.05 was accepted as significant. RESULTS In this study, the mean cystic duct bursting pressures were 332.46 ± 4.62 mmHg with SC, 326.56 ± 4.53 mmHg with PK, and 343.06 ± 4.28 mmHg with HS. Differences of the mean cystic duct bursting pressures between the groups were indicated the superior results of HS. CONCLUSIONS The results of this study indicated that HS is more effective than PK and as safe and effective as SC for cystic duct closure.
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Kavlakoglu B, Pekcici R, Oral S. Verification of clipless closure of cystic duct by harmonic scalpel. J Laparoendosc Adv Surg Tech A 2011; 20:591-5. [PMID: 20822415 DOI: 10.1089/lap.2010.0222] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The excellent results of harmonic scalpel (HS) for closure of blood vessels encouraged surgeons to use these instruments for cystic ducts. The use of HS on tissues other than blood vessels was started with little data about its efficacy or safety. Therefore, this study was designed to verify the safety and efficacy of HS for achieving safe closure of the cystic ducts after laparoscopic cholecystectomy. MATERIALS AND METHODS Sixty patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into two groups (n = 30). After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in both groups. In the first group, distal of the cystic ducts was sealed with single SC and the gallbladders were removed with SC. In the second group, distal of the cystic ducts was sealed with HS and the gallbladders were removed as sealed cystic ducts with HS. Twenty-gauge catheters were inserted into the fundus of gallbladders in vitro and connected to the arterial line transducer set. A gradually increasing pressure was applied through a sphygmomanometer. The bursting pressures of the gallbladders were measured, and differences between HS and single SC groups were calculated with independent samples t-test. The value of P < 0.05 was accepted as significant. RESULTS The mean cystic duct bursting pressures in single SC and HS groups were 332.46 +/- 4.62 and 343.06 +/-4.28 mmHg, respectively. The mean values between the groups were found significant and indicated the superior results of HS. CONCLUSIONS HS sealer could be an alternative method for cystic duct closure, especially for avoiding the clip displacement and migration of the clip. Results of this study indicated that HS sealer was as reliable as single SC and it could be accepted as a standard closure technic.
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Affiliation(s)
- Burak Kavlakoglu
- Ministry of Health Ankara Oncology Training and Research Hospital , Ankara, Turkey
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Liu Y, Zhang HY. Mechanisms underlying the roles of nervous and humoral factors in the pathogenesis of gallstones. Shijie Huaren Xiaohua Zazhi 2010; 18:2673-2678. [DOI: 10.11569/wcjd.v18.i25.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallstone disease is a common disorder with an incidence rate of about 10%. Recent research has revealed that nervous and humoral factors are involved in the pathogenesis of gallstone disease. This article focuses on the mechanisms underlying the roles of parasympathetic nerve, sympathetic nerve, non-adrenergic non-cholinergic nerve, cholecystokinin, gastrin, bombesin, gastrin-releasing peptide, motilin, vasoactive intestinal polypeptide, somatostatin, pancreatic polypeptide, substance P, secretin, neurotensin, opioid peptide, nitric oxide, estrogen, thyroxine, and leptin in the pathogenesis of gallstones.
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