History Of Gastrointestinal Surgery Research Articles

Antacids and reflux esophagitis as a risk factor for gastric neoplasm of fundic-gland type: A retrospective, matched case-control study.

Since the first report of gastric adenocarcinoma of the fundic-gland type in 2010, the clinicopathological characteristics of gastric neoplasm of the fundic-gland type (GNFG) have become clearer; however, their risk factors remain unclear. This exploratory study aimed to identify the risk factors for GNFG. We conducted a single-center, retrospective, matched case-control study using medical information recorded at our health management center from January 2014 to July 2023. During this period, 39240 people underwent upper gastrointestinal endoscopy. GNFG were extracted as cases and matched to controls, according to age and sex, in a 1:8 ratio, excluding those with a history of gastrointestinal surgery and those with a history or comorbidity of cancer. Univariate analysis was used to compare patient background and endoscopic findings. Multivariable analysis was performed, adjusting for factors with P values <0.1 and antacid use. A total of 20 GNFG cases and 160 matched healthy controls were included. In the univariate analysis, only reflux esophagitis was significantly more common in GNFG (40.0% vs 18.1%; P=0.036). Factors antacids and duodenitis had P values <0.1. Logistic regression analysis was performed, adjusting for antacids, reflux esophagitis, and duodenitis. Antacids and reflux esophagitis were the independent risk factors for GNFG (odds ratio=3.68 [95% confidence interval: 1.04-11.91] and 3.25 [95% confidence interval: 1.11-9.35]). Although the sample of patients with GNFG was small, antacids and reflux esophagitis were identified as a risk factor. The pathogenesis of antacids and reflux esophagitis may be involved in the development of GNFG.

Clinical and microbiological characteristics of Ruminococcus gnavus bacteremia and intra-abdominal infection

ObjectivesRuminococcus gnavus is a rare human pathogen, and clinical data on R. gnavus infection are insufficient. This retrospective study aimed to investigate the clinical characteristics of R. gnavus infections. MethodsThis study included 13 cases of bacteremia and three cases of non-bacteremia infections caused by R. gnavus. We evaluated the patient data, infection source, clinical outcomes, and antimicrobial susceptibility of R. gnavus isolates for these cases. ResultsThe median age of patients was 75 years (range 47–95), and eight patients were female. Twelve cases were presumed to have an intra-abdominal infection source, and the remaining four cases had an unknown infection source. The most common underlying conditions were immunosuppression (seven cases), solid tumors (seven cases), and history of gastrointestinal surgery (five cases). Thirteen patients exhibited gastrointestinal problems (dysfunction, bleeding, intra-abdominal infection, or inflammation). Multiple pathogens were observed in six cases, and fatal outcomes were recorded in three cases. Antimicrobial susceptibility data were available for eight isolates, all of which exhibited low minimum inhibitory concentrations to penicillin (≤0.03 μg/mL), ampicillin–sulbactam (≤0.5 μg/mL), piperacillin–tazobactam (≤4 μg/mL), and metronidazole (≤0.5–1 μg/mL). ConclusionRuminococcus gnavus is frequently associated with an intra-abdominal infection source, and treatment strategies should consider the possibility of multiple pathogens.

Safety and efficacy of direct percutaneous endoscopic jejunostomy placement in patients with previous upper gastrointestinal resection: A retrospective cohort study.

Percutaneous jejunal enteral access can be obtained with percutaneous endoscopic gastric jejunostomy (PEGJ) and direct percutaneous endoscopic jejunostomy (DPEJ) tubes. PEGJ may not be feasible in patients with previous gastric resection (PGR) and DPEJ may be the only option. Our aim is to determine if DPEJ tubes can be placed successfully in patients with history of gastrointestinal (GI) surgery and if success rates are comparable to DPEJ or PEGJ in those without prior GI surgery. We reviewed all tube placements performed from 2010 to present. Procedures were performed using a pediatric colonoscope. Previous upper GI surgery was defined as PGR or esophagectomy with gastric pull-up. Adverse events (AEs) were graded perAmerican Society for Gastrointestinal Endoscopy criteria. Mild events included unplanned medical consultation or hospitalization <3 days, and moderate events included repeat endoscopy without surgical intervention. Successful placement rates were high regardless of GI surgical history. Patients receiving a DPEJ with a history of GI surgery were significantly less likely to experience an AE compared with those receiving DPEJ with no history and compared with PEGJ patients with or without a history. DPEJ placement in patients with previous upper GI surgery has very high success rate. It is associated with lower AE rates than patients receiving DPEJ without previous gastric surgery, or PEGJ regardless of previous gastric surgery. Patients with a history of upper GI surgery requiring enteral access may benefit from DPEJ over PEGJ placement considering its very high success rate and lower incidence of AEs.

Children Dyspepsia Symptoms Questionnaire Discriminates Dyspeptic versus Non-Dyspeptic and Organic versus Functional Dyspepsia in Children and Adolescents with Chronic Abdominal Pain

Background: Chronic Abdominal Pain (CAP) is common in children/adolescents, and Dyspepsia is a symptom complex. Their investigation represents a significant burden and a great deal regarding the initial work-up. Consequently, scoring based on clinical symptoms and patients' characteristics comparing organic and functional Dyspepsia would be valuable in assessing CAP. Objective: To develop and validate a dyspepsia symptoms questionnaire to identify patients with Dyspepsia and discriminate between functional and organic subtypes. Methods: A single-centre, observational, prospective cohort study in a convenience sample of consecutive cases of children/adolescents for CAP. Inclusion criteria: age of 5- 17 years; CAP according to Apley and von Baeyer &amp; Walker criteria; uninvestigated Dyspepsia. Exclusion criteria: genetic, neurological and mental disorders, history of gastrointestinal surgery, active gastrointestinal bleeding, and inflammatory bowel disease. The Questionnaire was developed in four steps: Step 1. Generation of terms. Step 2. Construct the Preliminary Questionnaire. Step 3. A pilot survey confirmed that the Questionnaire was comprehensible. Step 4. The final Children Dyspepsia Symptoms Questionnaire (CDSQ) was based on a Cronbach's alpha coefficient of 0.74. Detailed Clinical protocols for CAP, Alarm signs, and CDSQ were applied at the inclusion visit. The pain was determined using a Pain Faces Scale, and Pain Intensity was obtained. Results: The study was performed on 338 patients, with no difference in baseline characteristics between Dyspepsia and Non-dyspepsia. The comparisons of CDSQ items between Dyspepsia and Non-dyspepsia reach higher values for Dyspepsia in epigastric pain, retrosternal pyrosis, concomitant epigastric pain and retrosternal pyrosis, belching, early satiety, nausea, and postprandial fullness. The comparisons of CDSQ items between Organic and Functional groups reach higher values for Organic Dyspepsia in retrosternal pyrosis, concomitant epigastric pain and retrosternal pyrosis, nausea and belching. Alarm signs were higher for Organic Dyspepsia, except for unintentional weight loss. There was a positive and statistically significant correlation between the CDSQ score and its eight items' components for the Dyspepsia and the Non-Dyspepsia group. No effect of age of patients, sex, and duration of symptoms was found for CDSQ. Conclusion: The CDSQ is a brief questionnaire, cost-effective and well suited for uninvestigated Dyspepsia. Patients reported significantly more severe symptoms in Dyspepsia than Non-Dyspepsia. Thus, the primary application of this discriminative instrument is case-finding in epidemiological surveys and clinical trials. Assumed that the CDSQ differentiating organic from functional Dyspepsia would help manage unnecessary endoscopy procedures, compared with a strategy that would entail prompt endoscopy for all patients.

Intrapyloric Botulinum Toxin A Injection for Gastroparesis and Functional Upper Gastrointestinal Symptoms in Children: Mayo Clinic Experience, Review of the Literature, and Meta-analysis.

We aimed to assess the efficacy of intrapyloric botulinum toxin A injection (IPBTI) in children with and without gastroparesis and to perform a meta-analysis and review of the literature. We retrospectively searched our electronic health records to identify children (aged <18 years) who underwent an esophagogastroduodenoscopy with IPBTI between 2007 and 2018 for persistent upper gastrointestinal tract symptoms. We included children with and without gastroparesis and excluded children with a history of gastrointestinal surgery, gastrointestinal obstruction, or mucosal disease that could explain their symptoms. A meta-analysis including our study findings was performed. We identified 20 children (mean [standard deviation] age, 9.7 [5.8] years; 14 [70%] girls) with upper gastrointestinal symptoms who underwent IPBTI at our institution during the study period. Of the 20 children, 17 (85%) underwent gastric emptying scintigraphy, only nine (53%) of whom had gastroparesis. Response to IPBTI was reported in ten children (50%). Response to IPBTI did not differ by the presence of gastroparesis in included children (p = 0.64). Repeated IPBTI was performed in four children who had a response to the first injection; all four reported no benefit from the second IPBTI. There were no reported complications of IPBTI in our cohort. The meta-analysis indicated that 68% (95% confidence interval 59-78) of patients had a response to IPBTI, regardless of the presence of gastroparesis; 66% (95% confidence interval 53-78) of patients who had gastroparesis had a response to IPBTI. Intrapyloric botulinum toxin A injection is safe in children and can offer transient relief for patients with refractory upper gastrointestinal symptoms with and without gastroparesis.

S0479 Clinical Predictors of Nutritional Failure in Patients With Gastrointestinal Dysmotility and/or Functional Gastrointestinal Disorders

INTRODUCTION: Gastrointestinal dysmotility and functional gastrointestinal disorders (FGID) may be associated with intolerance of oral nutrition and/or risk of malnutrition. When severe, this malnutrition can require initiation of supplemental (enteral or parenteral) nutrition. We performed a retrospective case-control study to identify factors associated with initiation of nutrition support in FGID/dysmotility patients. METHODS: We conducted a chart review of patients (>18 years old) hospitalized at our institution between 2016 and 2019 with at least one prespecified FGID/dysmotility discharge diagnosis and at least one visit to our ambulatory gastroenterology practice. Cases were defined as patients initiated on enteral or parenteral nutrition within the designated study period. Patients with inflammatory bowel disease, cirrhosis, active malignancy, cystic fibrosis, dementia, or history of gastrointestinal surgery were excluded. Controls were defined as patients with dysmotility and/or FGIDs who were hospitalized without receiving nutrition support. Cases and controls were compared with Fisher's exact or Chi squared testing as appropriate for categorical variables and Wilcoxon rank-sum for continuous variables. Conditional logistic regression was used to determine factors associated with institution of nutrition support, accounting for matching on age and gender. RESULTS: 768 patients were screened, with 19 cases and 71 controls meeting criteria for analysis. Gastroparesis was the most common diagnosis requiring initiation of supplemental nutrition (7/19, 37%). Relative to controls, cases were associated with younger age, lower BMI, comorbid Ehlers-Danlos syndrome, comorbid postural orthostatic tachycardia syndrome (POTS), and multiple dysmotility/FGID diagnoses (Table 1). In an adjusted regression analysis, BMI was associated with nutrition support. There was a trend towards multiple dysmotility/FGID diagnoses being associated with nutrition support. CONCLUSION: In this retrospective case-control study, patients initiated on supplemental nutrition were significantly younger, of lower BMI, and more likely to have EDS, POTS, and multiple dysmotility/FGID diagnoses as compared with hospitalized controls not initiated on supplemental nutrition. Lower BMI remained a significant predictor of nutrition support on matched regression analysis. The overall prevalence of supplemental nutrition among patients with dysmotility/FGID is low, but the presence of risk factors may warrant closer monitoring.Table 1.: Unmatched comparison between dysmotility/FGID patients with and without required initiation of nutritional support

376-P: Analysis of the Fasting and Postprandial Plasma Metabolome Reveals Metabolic Signatures of Postbariatric Hypoglycemia

One severe complication of gastrointestinal and bariatric surgery is post-bariatric hypoglycemia (PBH). Affected patients may develop severe hypoglycemia, typically 1-3 hours after meals. While exaggerated postprandial incretin hormone and insulin secretion has been implicated, additional contributors to hypoglycemia remain uncertain. We performed untargeted semiquantitative metabolomic analysis of plasma samples collected in the fasting state and at 30 and 120 minutes after a liquid mixed meal (Ensure) in 13 individuals with PBH post-RYGB, 10 asymptomatic post-RYGB, and 8 overweight/obese individuals without history of gastrointestinal surgery. Multiple analytes were reduced in the fasting state in PBH, including 10 amino acids (Leu, Ile, Val, Ala, Phe, Tyr, Met, Trp, Thr, Asn, nominal p&amp;lt;0.05 vs. asymptomatic, FC -1.2 to -1.4), multiple lipid species (C22:6 LPC, C22:6 LPE, C20:4 LPE, C56:7 TAG, C54:5 TAG, C50:5 TAG, p&amp;lt;0.05 vs. asymptomatic,FC -1.3 to -1.5). We also observed robust reduction (2-10 fold, p&amp;lt;0.05) in multiple tryptophan pathway metabolites, including kynurenic acid, xanthurenate, and serotonin. Markers of insulin resistance and T2D risk, such as 2-aminoadipate and alpha-hydroxybutyrate, and multiple B complex vitamins (B3, B5, B6) were also decreased in PBH in the fasting state. By contrast, tricarboxylic acid (TCA) cycle intermediates such as aconitate, isocitrate, succinate and malate and the ketone beta-hydroxybutyrate were all increased in PBH (p&amp;lt;0.05). In summary, we identify several metabolic signatures of PBH including reduction in multiple circulating AA, lipid species, and tryptophan intermediates as well as increased TCA cycle intermediates. Together these could potentially contribute to alterations in glucose metabolic flux in both the fasting and postprandial state in individuals with PBH. Disclosure R. Ferraz-Bannitz: None. C.M. Mulla: None. J. Dreyfuss: None. H. Pan: None. M. Patti: Consultant; Self; Fractyl Laboratories, Inc. Research Support; Self; Dexcom, Inc., Xeris Pharmaceuticals, Inc. Other Relationship; Self; Academy of Nutrition and Dietetics, American Diabetes Association, American Society of Metabolic and Bariatric Surgery, Endocrine Society, Insulet Corporation, King Abdullah International Medical Research Center, SUNY Downstate. Funding National Institutes of Health (R01DK121995, P30DK046200)

Sarcina ventriculi: A Rare Case of Life-Threatening Perforated Gastric Ulcer and Review of Literature

Sarcina ventriculi is a gram-positive anaerobic bacterium reported rarely in patients with a history of gastrointestinal surgery and delayed gastric emptying. Sarcina has been implicated in the development of gastric ulcers, emphysematous gastritis, and gastric perforation. So far, less than 30 cases of Sarcina isolated from gastric specimens have been reported, including 3 cases associated with life-threatening illness: emphysematous gastritis and gastric perforation. Herein, we report a case of a 58-yearold woman with history of gastric surgery who presented for evaluation of persistent gastric pain and incurable ulcer. She underwent total gastrectomy, and the resected stomach demonstrated a perforated ulcer with the presence of Sarcina microorganisms. We also report a second case of a 56-year-old woman with history of NSAID use who presented with gastric outlet obstruction. The gastric biopsy identifi ed concurrent Helicobacter pylori and Sarcina. Given Sarcina‘s association with emphysematous gastritis and gastric perforation, its identifi cation on gastric biopsies should be clearly stated in pathology reports and, depending on the clinical scenario, prompt clinicians to add adjunctive antimicrobials to anti-ulcer therapeutic regimens.

Bezoar in upper gastrointestinal endoscopy: A single center experience.

We aimed to investigate the association of bezoar with endoscopic findings, risk factors for bezoar occurrence, and the success of endoscopic treatment in a tertiary center. This retrospective study was conducted between January 2012 and December 2015. Overall, 8200 endoscopy records were examined and 66 patients with bezoar were included in the study. We enrolled 29 (44%) female and 37 (56%) male patients in this study. The mean age of the patients was 63±9.4 years. The most frequent risk factors were history of gastrointestinal surgery (23%), diabetes mellitus (17%), trichophagia (9%), and anxiety disorder (6%). Gastric ulcer, duodenal ulcer, erosive gastritis, and reflux esophagitis were present in 27%, 11%, 20%, and 23% of the patients, respectively. While bezoars were most commonly observed in the stomach (70%), the majority of them were phytobezoars (91%). The mean number of interventions for each patient was 1.5 (range, 1-6). Endoscopy was successful in removing bezoars in 86.5% of the patients. Among those referred to surgery, seven patients underwent gastrostomy (10.5%); one (1.5%) patient underwent gastroenterostomy because of concomitant pyloric stenosis; and one (1.5%) patient underwent fistula repair surgery due to the development of duodenal fistula caused by bezoar. The findings of this study indicated that bezoars are more common among subjects with history of gastrointestinal surgery, diabetes mellitus, or psychiatric disorders; bezoars are closely related to peptic ulcer and reflux esophagitis; and they can be successfully treated with endoscopy.

Retrospective evaluation of candidemic patients among general surgery department in a tertiary care university hospital

Candida species are among the most important causes of hospital acquired blood borne infections, and with high rates of mortality and morbidity, these infections are still a major problem today. History of gastrointestinal surgery, administration of total parenteral nutrition and/or wide spectrum antibiotics and immune suppression following organ transplantations are considered serious risk factors for these infections. This study aimed to evaluate the patients from our general surgery department with diagnosed candidemia; by means of strain, treatment and prognosis. Patients with positive blood cultures for Candida species who were treated in the wards and Ege University Faculty of Medicine general surgery department of surgical intensive care units of our between 2012 and 2017 were retrospectively analyzed by means of strain, treatment and prognosis. A total of 50 patients were enrolled in the study. Mean age was 58.96 years and 54% of the patients were female. There were nine patients with organ transplantation (four liver and five kidney transplantations), six with intestinal perforation and three with anastomotic leakage. Isolated strains were Candida albicans (36%; 18/50), Candida tropicalis (14%; 7/50), Candida glabrata (12%; 6/50), Candida parapsilosis (8%; 4/50), Candida kefyr (6%; 3/50), Candida krusei (4%; 2/50), Candida pulcherrima (2%; 1/50), Cryptococcus neoformans (2%, 1/50), Geotrichum capitatum (2%, 1/50), Candida spp. (unidentified, 14%; 7/50) with decreasing frequency. The highest antifungal sensitivity rates (> 90%) were measured for amphotericin B, voriconazole and echinocandins among all isolates. One-month mortality rate was 43.4% (20/46). Documented eradication was achieved among 24 of the 33 patients who had control blood culture samples (72.7%), and mean eradication time was 7.6 days. Echocardiography was performed in 14% (7/50) and ophthalmic examination in 8% (4/50). Although C. albicans appears to be the dominant strain in patients with candidemia, frequencies of other strains are increasing. Early diagnosis and treatment of patients with candidemia is of vital importance due to high mortality and morbidity rates.

Health-related quality of life in children after laparoscopic gastrostomy placement

IntroductionA gastrostomy placement (GP) is an established treatment to provide enteral feeding in pediatric patients with feeding difficulties aiming to improve nutritional status and health-related quality of life (HRQoL). The aim of this study was to evaluate HRQoL in children with severe feeding difficulties who have undergone GP.Materials and methodsA cross-sectional study was performed including 128 patients who had undergone laparoscopic GP (2004–2011). HRQoL was evaluated using the validated Pediatric Quality of Life 4.0 Inventory. Multiple regression analysis was performed to identify predictors of HRQoL.ResultsAfter a mean follow-up of 4.0 years (interquartile range 2.9–6.2) after GP, mean HRQoL was 53.0 out of 100 (standard deviation 21.1). HRQoL was significantly lower in children with neurologic impairment, with a mean difference of −21.4 points between neurologically impaired and neurologically normal children (p < 0.001). HRQoL was also lower in children with cardiac disease (−19.0 points; p = 0.01) and in children with a history of previous gastrointestinal surgery (−15.2 points; p = 0.03). Feeding through a gastrojejunostomy tube (−33.0 points; p = 0.01) and higher age at the time of operation (−1.2 points per year; p = 0.03) were also associated with lower HRQoL. GP-related complications requiring reintervention were associated with lower HRQoL, although this association was not statistically significant (p = 0.06).ConclusionsChildren with severe feeding difficulty, who have undergone GP, have significantly lower HRQoL compared to a healthy pediatric population. Neurologic impairment, cardiac disease, a history of gastrointestinal surgery, older age, and the need for jejunal feeding through the gastrostomy were predictive of even lower HRQoL.

Vitamin D deficiency in cancer patients and predictors for screening (D-ONC study)

Vitamin D is a prohormone that is vital for calcium/phosphate balance, bone structure, and physiological functioning. Vitamin D deficiency (VDD) is an important clinical problem worldwide. However, there are no standardized protocols for screening of patients with a diagnosis of cancer. The purpose of this study is to define the prevalence of VDD in cancer patients and establish the predictors of VDD to address a specific group of patient for screening. The study was designed as a retrospective case-control study. The patients cared in the outpatient clinic between December 2016 and May 2018 with a diagnosis of cancer were evaluated. The clinical properties and the 25(OH) D levels were evaluated. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the association between VDD and clinical parameters. In 2 cancer centers, 706 patients with a diagnosis of cancer were evaluated. Median 25(OH) D level was 12.2 ng/mL (2.1-96.4). VDD was present in 509 (72.0%) of patients. The multivariate analysis of factors associated with VDD showed that female gender (OR: 1.5 [95% CI: 1.05-2.4], P = 0.026), low sun light exposure (OR: 1.4 [95% CI: 1.009-2.1], P = 0.045), being under palliative (OR: 1.5, [95% CI: 1.008-2.4] P = 0.04) or adjuvant setting (OR: 2.6 [95% CI: 1.3-5.1], P = 0.006), and history of gastrointestinal surgery (OR: 1.8, [95% CI: 1.03-3.2] P = 0.03) were associated with VDD. The female patients with headscarf had lower 25(OH) D levels than without group (10.5 ng/mL vs 23.4 ng/mL, P < 0.001) and they had more VDD (77.2% vs 29.4%, P < 0.001). Our study concluded that prevalence of VDD is high in cancer patients and female gender, low sun light exposure, being under palliative or adjuvant setting, and history of gastrointestinal surgery are associated with VDD. These parameters should be used for selecting patients for screening.

Analysis on risk factors of methicillin-resistant staphylococcus aureus enterocolitis after gastrointestinal surgery

To investigate the risk factors of methicillin-resistant Staphylococcus aureus(MRSA) enterocolitis after gastrointestinal surgery. Clinical and pathological data of 17 cases with MRSA enteritis after gastrointestinal surgery from March 2015 to March 2017 at Department of General Surgery of Affiliated Drum Tower Hospital were retrospectively analyzed. (1) age of 18 to 80 years;(2) with history of gastrointestinal surgery; (3) diarrhea symptoms within 7 days after gastrointestinal surgery; (4) use of antibiotics before diarrhea; (5) fecal smear showing a large number of gram positive cocci; (6) fecal culture suggested the presence of MRSA; (7) application of antibiotic therapy against MRSA was effective. (1)clostridium difficile toxin positive; (2) toxic shock syndrome caused by food poisoning. According to gender, age, and inpatient ward, 1:2 pairing was performed, and 34 patients with non-MRSA enteritis from the hospitalized cases in the same ward were selected as the control group for retrospective case-control study. There were no significant differences in the gender, age, and constitution index between two groups (all P>0.05), indicating that the two groups were comparable. The χ² test was used to perform univariate analysis on 11 factors, including the nature of the primary disease, colorectal surgery, emergency surgery, use of multiple antibiotics, preoperative bowel preparation, perioperative hormone, intraoperative intraperitoneal chemotherapy, perioperative nasogastric tube, diabetes history, intensive care unit stay, and previous infectious disease hospitalization, and then multivariate logistic regression analysis was performed. MRSA enteritis occurred 3 to 5 days after surgery in all the 17 cases, and 4 cases developed septic shock rapidly. Univariate analysis showed that the operation site (colorectal surgery) (χ²=4.747, P=0.029) and use of two antibiotics before MRSA enteritis (χ²=3.959, P=0.047) were associated with MRSA enteritis after gastrointestinal surgery. Multivariate logistic regression analysis revealed that colorectal surgery was the only independent risk factor for MRSA enteritis after gastrointestinal surgery(OR=5.526, 95%CI: 1.350-22.602,P=0.017), while the use of two antibiotics was not (OR=0.204, 95%CI:0.051-0.819, P=0.025). MRSA enteritis has a rapid onset, and a high incidence of septic shock, which requires immediate attention. Colorectal surgery is an independent risk factor for MRSA enteritis.

Internal Hernia as Cause of Small Bowel Obstruction without History of Gastrointestinal Surgery

Internal Hernia as Cause of Small Bowel Obstruction without History of Gastrointestinal Surgery

Gut Microbiota as a Potential Target for Treatment of Polycystic Ovary Syndrome

Objective: Emerging evidence has linked the gut microbiota with human metabolic diseases. This study is aimed at investigating the role of gut microbiota and the potential effect of gut microbiota modulation in polycystic ovary syndrome (PCOS). Methods: We performed an observational study in a cohort of reproductive women with and without PCOS. Subjects with previous history of gastrointestinal surgery or diseases (such as inflammatory bowel disease), taking antibiotics within 3 months prior to the study were excluded. Diagnosis of PCOS was done according to Rotterdam criteria. A total of 78 women were finally included, information regarding their clinical history, symptoms, anthropometric measurements and laboratory data were collected. Fecal bacteria profiling was conducted using 16S rRNA sequencing method. Individuals with PCOS were then randomized to metformin or probiotics (containing Lactobacillus and Bifidobacterium) treatment for 3 months. Results: We identified that women with PCOS had lower fecal bacteria gene counts, lower bacterial diversity and higher β diversity, indicating lower gene richness and a more heterogeneous gut microbiota community structure. In addition, serum lipid profiles (including total cholesterol, HDL-cholesterol), androgen levels and indexes of insulin resistance (HOMA-IR, Matsuda insulin sensitivity index) were closely correlated with Prevotellaceae, Ruminococcaceae and Lachnospiraceae, which are dominant bacteria in energy metabolism. Furthermore, treating PCOS patients with metformin or probiotics both improved their menstruation cycles, decreased androgen levels and alleviated insulin resistance. Meanwhile, there were significant correlations between changes in metabolic parameters and shifted bacterial populations. Conclusion: Our findings identify the gut microbiota dysbiosis in PCOS and suggest that it may be possible to intervene in PCOS by targeting the gut microbiota. Disclosure B. Zhang: None. S. Shen: None. Y. Bi: None. D. Zhu: None.

Retrospect and prospect: brief history and current status of gastrointestinal surgery in Guangdong Province, China

The First Affiliated Hospital of Sun Yat-sen University has made many lasting contributions to gastrointestinal surgery in Guangdong Province and even in China. The Department of Gastrointestinal Surgery was established at the First Affiliated Hospital of Sun Yat-sen Medical College in 1965, which opened the prelude to the development of gastrointestinal surgery in Guangdong. This article summarizes the evolution of gastrointestinal surgery and highlights the milestones specific to the field of gastrointestinal surgery in Guangdong Province, China. Main features and trends of gastrointestinal surgery in Guangdong Province are analyzed as well.

The clinical features of 93 bacterial liver abscess cases

Objective To investigate the clinical features of patients with bacterial liver abscess. Methods The clinical data of patients with liver abscess during January 2014 to December 2016 were retrospectively analyzed. Results There were 93 cases enrolled, 26.88% were accompanied by diabetes mellitus (DM), 60.22% were accompanied liver, gall bladder, pancreas diseases or had history of liver, bile duct or gastrointestinal surgery. The most common symptoms were fever (94.62%) and gastrointestinal symptoms (50.54%), while 15.05% for shock; 91.40% were single abscess, and 73.12% were in the right lobe. The white blood cell count (WBC), neutrophil (N), hypersensitive C-reactive protein (hsCRP), procalcitonin (PCT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were elevated in 60.22%, 65.59%, 97.85%, 82.93% (34/41), 47.31%, and 46.24% of patients, respectively. 12/62 (19.35%) were positive by blood culture and 32/54 (59.26%) were positive by pyogenic fluids or bile culture, the top two pathogenic bacteria were Klebsiella pneumonia (52.27%) and Escherichia coli (27.27%). Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were between 0-25 points, 72.04% cases were (0-10) points, 26.88% case were (11-20) points and one patient was more than 20 points. Among the 93 cases, 82.79% were underwent antibacterial by carbapenem, penicillin enzyme compound preparation or combined with levofloxacin, and 45.16% were underwent liver puncture of drainage treatment. A percentage (96.77%) of patients was cured or recovered. Conclusions Biliary retrograde infection is the main cause of hepatic abscess. In the early experiential antibacterial therapy, the first-line choices of antibiotics are those effective to extended spectrum β-lactamase (ESBL) positive enterobacteriaceae bacteria. Liver puncture of drainage treatment may be effective and safety. APACHE Ⅱ score may be useful to assess the prognosis of live abscess. Key words: Liver abscess, pyogenic/DI/TH

Establishment of prediction model of acute gastrointestinal injury classification of critically ill patients based on digital gastrointestinal sounds monitoring

To develop the prediction model of acute gastrointestinal injury (AGI) classification of critically ill patients. The binary channel gastrointestinal sounds (GIS) monitor system was used to gather and analyze the GIS of 60 consecutive critically ill patients who were admitted in Critical Care Medicine of PLA General Hospital from April 2015 to November 2015 (patients with chronic gastrointestinal disease or history of gastrointestinal surgery were excluded). Meanwhile, the AGI grades were evaluated according to the ESICM guidelines of AGI grading system. Correlations between GIS and AGI classification were examined with Spearman rank correlation. Then principal component analysis was performed on the significantly correlated parameters after standardization. The top 3 post-normalized main components were selected for back-propagation (BP) neural network training to establish primary AGI grade model of critically ill patients based on the neural network model. A total of 1 132 GIS and 333 AGI were collected from 60 patients. The number (P = 0.0005), percentage of time (P = 0.0004), mean power (P = 0.0088), maximum power (P = 0.0101) and maximum time (P = 0.0025) of GIS wave from the channel located at the stomach were negatively correlated with the AGI grades, while the parameters of GIS wave from the channel located at the intestine had no significant correlation with the AGI grades(all P > 0.05). Three main components were selected after principal component analysis of these five correlated parameters. An AGI grade network model including 9 hide layers, with a fitting degree of 0.981 64 was built by BP artificial neural network based on the analysis of these three main components of GIS. The accuracy rate of the model to predict the AGI grade was 70.83%. The preliminary model based on GIS in classifying AGI grade is established successfully, which can help predict the classification of AGI grade of critically ill patients.

Is it bowel-associated dermatosis-arthritis syndrome induced by small intestinal bacteria overgrowth?

IntroductionBowel-associated dermatosis-arthritis syndrome is rare systemic diseases characterized by a prodrome of fever, chills, and influenza-like symptoms with subsequent skin eruptions, myalgias, and polyarthralgias. It is reported to be occurred in Intestinal bypass surgery and inflammatory bowel disease.Case descriptionHerein, we described a 29-years-old man with Bowel-associated dermatosis-arthritis syndrome. He had no history of gastrointestinal surgery and inflammatory bowel disease. Distribution of the gut bacterial flora showed small intestinal bacterial overgrowth.Discussion and EvaluationIt is rarely form as Non-intestinal bypass road and non-inflammatory bowel disease was induced by small intestinal bacteria overgrowth.ConclusionsWe concluded that Immuno-inflammatory response to overgrowth of intestinal bacterial antigen induce the clinical symptoms of bowel-associated dermatosis-arthritis syndrome.

Proximal Lesions and Colon Cancers in Iron Deficiency Anemia

Introduction: Distal colorectal cancers (cancers distal to the splenic flexure) are more common than proximal cancers (cancers proximal to the splenic flexure) until about age 70, when proximal cancers begin to outnumber distal cancers. But there is a slight preponderance of proximal colon cancers in African American. We hypothesized that the more patient with identifiable lesions in proximal colon will have colon cancers, during work up for iron deficiency anemia (IDA) in African American. Methods: Patients referred for endoscopic evaluation for IDA (defined by hemoglobin ≤ 12 g/dl in females and ≤13 g/dl in males, and ferritin ≤ 45 ng/mL or transferrin saturation ≤ 15%) were included in the study. Patients with excessive menstrual bleeding, pregnant patients, history of blood donation, other causes for anemia, prisoners, or those with a history of gastrointestinal surgery were excluded. Eligible patients were assigned to two groups: Patients with endoscopic findings on proximal colon and patients with endoscopic findings on distal colon. Malignancy, ulcer/erosion, multiple AVM's, colitis, and adenoma > 1 cm were considered to be a positive GI lesion. Logistic regression analysis was performed using proximal colon cancer as a predictor variable in patients of both groups. Results: From January 2005 to December 2007, 495 consecutive patients were referred for IDA work up and 238 patients met inclusion criteria. There were 41 IDA patients who were positive GI lesion in colon. Demographic and clinical characteristics were similar in both groups. (Table 1)Table 1: Demographic and clinical characteristicsEndoscopic finding on proximal colon in IDA patient were significantly more likely to have been a cancer than finding on distal colon. (86.59 % vs 50.00 %, p=0.01). Conclusion: African American patient with IDA, identifiable proximal colon lesions were significantly more likely to have been a cancer than distal lesions.