Saudi Journal of Gastroenterology
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   Table of Contents - Current issue
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May-June 2020
Volume 26 | Issue 3
Page Nos. 111-167

Online since Wednesday, May 27, 2020

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EDITORIAL  

Minimal hepatic encephalopathy and sleep disorders in patients with cirrhosis: Which comes first? p. 111
Lorenzo Ridola, Oliviero Riggio, Stefania Gioia, Silvia Nardelli
DOI:10.4103/sjg.SJG_169_20  PMID:32415046
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SYSTEMATIC REVIEW/META-ANALYSIS Top

Endoscopic ultrasound versus computed tomography in determining the resectability of pancreatic cancer: A diagnostic test accuracy meta-analysis p. 113
Muhammad I. O. Rahman, Brian P. H. Chan, Parsa M Far, Lawrence Mbuagbaw, Lehana Thabane, Mohammad Yaghoobi
DOI:10.4103/sjg.SJG_39_20  PMID:32436866
Background/Aim: Endoscopic ultrasound (EUS) and contrast-enhanced computed tomography (CT) with pancreas protocol are used in assessing the resectability of neoplastic pancreatic lesions. Here, we performed a diagnostic test accuracy (DTA) meta-analysis, comparing the diagnostic accuracy of EUS and CT in evaluating the resectability of pancreatic cancer using surgical assessment as the reference standard. Patients and Methods: A comprehensive electronic search was conducted up to March 2020. Studies comparing EUS and CT in assessing the resectability of pancreatic cancer using surgical assessment as reference standard were included. QUADAS-2 tool was used to assess the quality of the included studies. After data extraction, an analysis was done using DerSimonian Laird method (random-effects model) to estimate the overall diagnostic odds ratio (DOR) and determine the best-fitting receiver operating characteristics (ROC) curve. Results: Two studies, with 77 subjects combined, were included in the analysis. Overall, the risk of bias was moderate. EUS and CT were comparable in determining the resectability of pancreatic cancer with AUC = 75% (95% confidence interval (CI) 66%- 84%) for EUS as compared to 78% (95% CI 69%- 87%) for CT (P > 0.05). Pooled sensitivity and specificity was 87% (95% CI 70%- 96%) and 63% (95% CI 48%- 77%), respectively for EUS and 87% (95% CI 70%- 96%) and 70% (95% CI 55%- 83%), respectively for CT. DOR was 11.51 (95% CI 3.55- 36.81) for EUS as compared to 15.91 (95% CI 4.83- 51.62) for CT (P > 0.05). Conclusions: Both EUS and CT provide reasonable sensitivity and specificity to detect the resectability of pancreatic cancer.
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ORIGINAL ARTICLES Top

EncephalApp Stroop App predicts poor sleep quality in patients with minimal hepatic encephalopathy due to hepatitis B-induced liver cirrhosis p. 120
Ming Luo, Xiao-Bing Yu, Sheng-Juan Hu, Fei-Hu Bai
DOI:10.4103/sjg.SJG_558_19  PMID:32270775
Background/Aim: A novel computerised Stroop test- EncephalApp Stroop App (EncephalApp) has good diagnostic validity for minimal hepatic encephalopathy (MHE) in cirrhotic patients. The Stroop test is correlated with sleep disturbances which are common, and severely affects health-related quality of life in cirrhotic patients with MHE. We evaluated the relationship between sleep quality and EncephalApp results in patients with MHE due to hepatitis B-induced liver cirrhosis. Patients and Methods: We enrolled 180 adult patients with hepatitis B-induced cirrhosis. All patients were tested using the psychometric hepatic encephalopathy score (PHES) and EncephalApp. We analysed the diagnostic validity of EncephalApp for MHE using PHES as the gold standard for reference. The sleep quality of included patients was evaluated using the Pittsburgh Sleep Quality Index (PSQI). The predictive factors for poor sleep quality were analysed using backwards conditional stepwise logistic regression analysis. Results: Ninety-eight patients (54.4%) were diagnosed with MHE by PHES. Receiver operating characteristic (ROC) curve analysis showed that the threshold value of EncephalApp for MHE diagnosis was 225.60 s. EncephalApp showed 85.2% sensitivity and 77.3% specificity for diagnosing MHE; the area under the ROC curve was 0.864. PSQI scores of cirrhotic patients with MHE were significantly lower than those without MHE (P < 0.05). Child Turcotte Pugh grades (Odds ratio [OR] = 2.11 [1.55–2.85], P < 0.01) and the total Off-time plus On-time of EncephalApp (OR = 4.14 [1.95–6.29], P < 0.01) were independent predictors of poor sleep quality in MHE patients. Conclusions: The total Off-time plus On-time of EncephalApp predicts poor sleep quality in patients with MHE due to hepatitis B-induced cirrhosis.
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Serum mucin 3A as a potential biomarker for extrahepatic cholangiocarcinoma p. 129
Jing Wang, Haibin Zhou, Yucheng Wang, Haitao Huang, Jing Yang, Weigang Gu, Xiaofeng Zhang, Jianfeng Yang
DOI:10.4103/sjg.SJG_447_19  PMID:32270773
Background/Aims: The aim of this study is to evaluate serum mucin 3A (MUC3A) as a candidate biomarker for extrahepatic cholangiocarcinoma (EHCC). Patients and Methods: 35 Patients with EHCC, 30 patients with pancreatic cancer, 35 patients with gallbladder carcinoma and 78 patients with benign biliary disease were enrolled during January 2015 to January 2016. Serum MUC3A, carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were measured in these patients. Pathology reports of patients with EHCC were collected. Results:(1) The serum levels of MUC3A (87.3 ± 10.8 ng/ml) in patients with EHCC were higher than in patients with pancreatic cancer (63.2 ± 7.7 ng/ml, P < 0.001), patients with gallbladder carcinoma (59.0 ± 10.3 ng/ml, P < 0.001) and patients with benign biliary disease (56.6 ± 13.1 ng/ml, P < 0.001). (2) ROC analysis showed that using MUC3A could clearly distinguish patients with EHCC from those without EHCC with a threshold of 73.2 ng/ml. (3) According to ROC analysis, the sensitivity, specificity, and accuracy of serum MUC3A for diagnosis of EHCC were 94.3%, 89.5% and 90.4%, respectively, which were all significantly higher than CA19-9 and CEA. (4) The serum levels of MUC3A at 1 month post-operatively in 35 patients with EHCC were decreased compared to pre-operative levels (51.8 ± 5.6 vs. 87.3 ± 10.8 ng/ml, P < 0.01). (5) Compared with 20 patients with low MUC3A levels (≤88.8 ng/ml), 15 patients with high MUC3A levels (>88.8 ng/ml) had higher percentage of lymph node metastasis (66.7% vs. 25%, P = 0.014), surrounding tissue infiltration (80% vs. 30%, P = 0.003), and UICC staging IIa-III (86.7% vs. 35%, P = 0.002). Conclusion: The diagnostic efficiency for EHCC of MUC3A is obviously superior to CA19-9 and CEA, and a high level of serum MUC3A indicates a poor prognosis, therefore, MUC3A can be used as a potential diagnostic and prognostic biomarker for EHCC.
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Comparison of the effect of 1-day and 2-day low residue diets on the quality of bowel preparation before colonoscopy p. 137
Li Jiao, Junmin Wang, Wenjuan Zhao, Xinying Zhu, Xia Meng, Liwei Zhao
DOI:10.4103/sjg.SJG_471_19  PMID:32270774
Background/Aim: Low residue diet (LRD) has a similar quality of bowel preparation with clear liquid diet before colonoscopy, but improved patient tolerance. However, the optimal LRD duration is still controversial. In this study, we have compared the effect of a 1-day LRD and 2-day LRD on the quality of bowel preparation and patient tolerance. Patients and Methods: Our prospective, randomized, single-blind trial, single-blind, trial compared two dietary regimens administered the day before colonoscopy. All patients were administered PEG-ES and simethicone for bowel preparation. The primary outcome measure was bowel preparation quality. The secondary outcome measures were insertion time, withdrawal time, polyp detection rate, patient tolerance, and willingness to use the same diet for bowel preparation again. Bowel preparation quality was evaluated using the Boston bowel preparation scale (BBPS). Patient tolerance was evaluated using a hunger-comfort scale. Results: There was no significant difference in bowel preparation quality between the 2 groups. The 1-day LRD group had a BBPS score of 6.48 ± 1.59 points, while the 2-day LRD group had a score of 6.42 ± 1.06 points (P > 0.05). The groups reported similar colonoscope insertion times, withdrawal times, polyp detection rates and patient tolerance scores (hunger-comfort scores). The numbers of patients who reported that compliance as easy or very easy were 126 (78.2%) in the 1-day group versus 88 (55.0%) in the 2 day group (P < 0.05) and the numbers who were willing to use the diet again in the future were 154 (95.7%) in the 1-day group versus 131 (81.9%) in the 2 day group (P < 0.05). Conclusion: LRD duration (1 day or 2 days) had no significant effect on bowel preparation quality. Patients in the 1-day LRD group had higher tolerance and satisfaction levels than patients in the 2-day LRD group. However, overall satisfaction was higher with the 1-day LRD group than with the 2-day LRD group.
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Inhibition of ALAS1 activity exerts anti-tumour effects on colorectal cancer in vitro p. 144
Yalei Zhao, Xiaoyun Zhang, Yabin Liu, Yiping Ma, Pong Kong, Tianliang Bai, Mei Han, Binghui Li
DOI:10.4103/sjg.SJG_477_19  PMID:32270771
Background/Aims: Colorectal cancer (CRC) is the third most common malignant tumour worldwide and the second leading cause of cancer-related deaths. Commonly, 5'-aminolevulinic acid synthase1 (ALAS1) is the rate-limiting enzyme for haem biosynthesis. Recent studies have shown that ALAS1 is involved in a number of cellular functions and has significant effects on non-small cell lung cancer (NSCLC). However, current concepts of disease pathogenesis fail to fully explain the role of ALAS1 expression and biological functions in CRC. Materials and Methods: A total of 67 paired tumour tissues and adjacent colorectal tissues were used to detect ALAS1 levels and further analyse the correlation between ALAS1 expression levels and clinical features. Using HCT116 cell lines, we studied the impact of ALAS1 on biological function by knocking down or inhibiting ALAS1. Results: We found an increase in the levels of ALAS1 in cancer tissues compared to adjacent colorectal tissues. The increase in ALAS1 expression was closely related to the invasion depth, N staging and tumour size of CRC patients. The proliferation and metastasis of CRC cells could be inhibited by suppressing ALAS1. Conclusions: The abnormal expression of ALAS1 is closely related to the proliferation and metastasis of CRC cells, suggesting that ALAS1 may be a novel therapeutic target for the treatment of CRC.
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Stachyose modulates gut microbiota and alleviates dextran sulfate sodium-induced acute colitis in mice p. 153
Liwen He, Feiran Zhang, Zhengyang Jian, Jiachen Sun, Jiamin Chen, Vuekhang Liapao, Qing He
DOI:10.4103/sjg.SJG_580_19  PMID:32270772
Background/Aim: Ulcerative colitis (UC) has been implicated to imbalanced enteric flora and reduced microbial diversity. Stachyose is a kind of natural prebiotic which favorably modulate the composition of the gut microbiota. The present study aims to investigate the effects of stachyose on inflammatory levels and gut microbiota of acute colitis mice. Materials and Methods: In this study, the mice were randomly divided into four groups: (1) control group; (2) stachyose group; (3) dextran sulfate sodium (DSS) group; (4) stachyose + DSS group. Hemotoxylin and Eosin (H and E) staining was performed for the distal colon to examine the inflammation and tissue damage. The inflammatory cytokines including IL-6, IL-10, IL-17a, and TNF-α in serum were determined by ELISA assay. The differences in the gut microbiota were analyzed by 16S rDNA gene sequencing. Results: Histological assay showed that the stachyose treatment significantly reduced the lesions of the colon in DSS-induced colitis. And the upregulated inflammatory cytokines induced by DSS were significantly inhibited by stachyose treatment. Additionally, the sequencing analysis showed that the stachyose changed the gut microbiota composition with a higher level of Akkermansia, as well as selectively increasing some probiotics, including Lactobacillus. Conclusions: Our results suggested that stachyose increased beneficial microbiota and bacterial diversity to alleviate acute colitis in mice, which might be a new promising option to UC patients.
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Circulating tumor cells in whole process management of gastrointestinal stromal tumor in a real-life setting p. 160
Qiang Zhang, Kangjing Xu, Ming Chen, Yongchang Miao, Nuofan Wang, Zekuan Xu, Hao Xu
DOI:10.4103/sjg.SJG_24_20  PMID:32386192
Background/Aim: Liquid biopsy is changing the diagnosis and treatment strategies of various neoplasms. However, the circulating tumor cells (CTCs) of gastrointestinal stromal tumor (GIST) patients with different disease process are not clear. To better understand the dynamic change of CTCs in GIST patients, we conducted a real-life setting study. Patients and Methods: One-hundred fifty GIST patients were included. The isolation by size of tumor cell (ISET) method was employed to detect the CTCs/circulating tumor microemboli (CTM). Imatinib (IM) plasma concentration was detected by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). Multivariate and univariate analysis were used to analyze the effects of clinical characteristics on the positive rate of CTC and the number of CTCs/CTM. Results: The positive rate of CTCs was 72%. The median number of CTCs and CTM was 4 and 0. Logistic multivariate regression analysis showed that tumor diameter was the only independent factor of the positive rate of CTCs (P < 0.05). The numbers of CTCs and CTM had intensive linear correlation (P < 0.001). Tumor diameter, Ki 67 expression and mitotic were related to the number of CTCs (P < 0.05). Patients with higher Ki 67 expression tend to have more CTM (P < 0.05). IM plasma concentration showed no influence to the CTCs/CTM (P > 0.05). Conclusions: In the current study, we assessed the CTCs and CTM of GIST patients in various disease progressions and identified clinicopathological factors influencing the detection of CTCs and CTM. These results are instructive for clinicians to understand CTCs/CTM in GIST patients.
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