Academic literature on the topic 'Gastroinestinal'

Introduction: Lesions in the gastroinestinal (GI) tract that are distal to the Treitz ligament are what cause the lower gastrointestinal bleeding (LGB) system. The purpose of this study was to investigate and compare the Charlson Comorbidity Index (CCI), mortality rates, length of hospital stays, need for intensive care, need for blood products, and surgical rates in patients with acute LGB. Material and Method: Retrospective research was done on patients who had lower GI bleeding and had been seen in our gastroenterology clinic between 2015 and 2021. We looked into the impact of CCI on patients' follow-up after LGB. Results: The mean age of the 210 patients who had lower GI bleeding was 67.70±13.67 years. For all of the patients, the median CCI value was 4.00. (2.00-5.00). While 16 study participants (group 1) passed away, 194 participants (group 2) were released from the hospital. The variance in the median CCI values between the two groups was statistically significant (p>0.001). The results of a multivariate logistic regression analysis revealed that CCI was a reliable predictor of mortality (p>0.001). Conclusion: It was found that CCI was an accurate predictor of mortality. CCI ought to be regarded as a crucial factor in the treatment of patients who are bleeding from their lower gastrointestinal tract.

Introduction. The goal of the study was to investigate the frequency of urogenital congenital abnormalities among atresias of the digestive system and analyze fetal maldevelopment. The study also deals with gastrointestinal and urogenital embryology. Material and methods. This retrospektive study analyzed the clinical status of 55 new-borns admitted to the Pediatric Surgery Clinic in Novi Sad due to atresia of the gastrointestinal tract during 1995-2003. All atresias were classified at primordial gut levels (foregut, midgut and hindgut). The incidence of associated abnormalities, especially urogenital, was analyzed. Diagnostic procedures included standard methods: clinical investigation, ultrasound, native and contrast medium radiography, etc. Results. Results showed that urogenital anomalies were present in 21 (38.18%) newborns with gastrointestinal atresia. Foregut atresia was diagnosed in 14 newborns and it was associated with urogenital congenital anomalies in 9 (64.28%) newborns. Midgut atresias were found in 15 patients and in 4 (22.22%) they were associated with urogenital anomalies. Hindgut atresias were established in 23 and in 8 (34.78%) cases they were associated with urogenital anomalies. Discussion and conclusions. It was confirmed that foregut atresias are commonly accompanied by associated abnormalities. That is why the fourth gestational week is important when both gastroinestinal and urogenital systems are developed. When midgut differentiates into its own derivates, the frequency of congenital anomalies decreases for a short period, and then increases again during foregut development (seventh and eighth gestational weeks). There were no information on environmental teratogenic factors in maternal history. These abnormalities may be explained by complex urorectal development and separation of two systems. .

Abstract Background and study aims Gastrointestinal endoscopy, being an aerosol-generating procedure, has the potential to transmit Severe Acute Respiratory Distress Syndrome Corona Virus-2 (SARS-CoV-2) during the current pandemic. Adequate knowledge is the key to prevention. A survey, perhaps the first, was conducted among Indian endoscopists to assess the impact of Coronavirus Disease (COVID)-19 on gastroinestinal endoscopy practice in the country. Methods From April 24 to 28, 2020, an electronic survey (using Google Form) was conducted with 23 questions (single or multiple answers) on: (1) endoscopy practice before the pandemic; (2) knowledge about COVID-19; and (3) its impact on endoscopy practice. Results Responses were received from 375 of 1205 (31.1 %) endoscopists. Most (35.7 %) were young (31–40 years), practicing in corporate multi-speciality hospitals (44.6 %) or independent practice set-up (17.7 %) in metropolitan cities (55.6 %) and urban areas (42.3 %). In most units (75.4 %), fewer than 10 % of procedures performed are endoscopies, as compared to before the pandemic. A reduction in volume of endoscopy related to restriction of the routine procedures by the latest guideline was reported by 86.9 % of respondents. Most are using N95 masks (74.7 %) and/or complete personal protective equipment (PPE, 49.2 %) during endoscopic procedures. Only 18.3 % of respondents had access to negative pressure rooms either within (5.4 %) or outside (12.9 %) the usual endoscopy suite. Conclusion Endoscopy units in India are performing fewer than 10 % of their usual volumes due to current restrictions. Resources to follow current international guidelines, including use of negative pressure rooms and PPE, are limited. Alternate measures are needed to keep up the services.

Radiotherapy-induced gastrointestinal toxicity (RIGT) involves damage to the gastrointestinal mucosa and is associated with symptoms including but not limited to, diarrhoea, pain, and rectal bleeding. Members of the matrix metalloproteinase (MMP) family have recently been identified as being upregulated in RIGT. Furthermore, the microvasculature has long been implicated in the development of toxicities following radiotherapy, however, the mechanisms behind this are yet to be explored. This thesis aimed to assess the microvascular response to irradiation, to further elucidate the role of MMPs in RIGT, and to assess the effect of MMP inhibition on microvascular endothelium following irradiation. This thesis consists of a general introduction, published literature review, three research chapters, one published and two submitted, and a general discussion. In chapter 1, the topic of this thesis is introduced, discussing the epidemiology and underlying pathobiology of RIGT. Chapter 2, a published critical review of the literature, consolidates literature on the role of MMPs, intestinal microvasculature, and vascular mediators in RIGT. This literature review surmised MMPs to be key regulators of endothelial mediators, and to play a key role in inducing damage to intestinal microvasculature following radiotherapy. The third chapter, published in Supportive Care in Cancer, utilized a Dark Agouti (DA) rat model of fractionated abdominal irradiation to assess changes to the intestinal microvasculature. A significant increase in apoptosis of microvascular cells 6 and 15 weeks from the first dose of irradiation was found, corresponding with histopathological damage and apoptosis in the jejunal and colonic crypts. This study suggested regional and timing-specific changes in the intestinal microvasculature to occur in response to fractionated radiotherapy. Chapter four assessed levels of MMPs in the jejunum and colon in the same DA rat model of RIGT. Whilst mRNA expression MMP-1, -2, and -14 significantly increased in the jejunum, only MMP-2 expression increased in the colon. MMP-2 immunostaining was also observed to be increased in both the jejunum and colon, a finding supported by western blotting, showing significantly increased MMP-2 protein levels in both the jejunum and colon at week 6. This supported a role for MMP-2 in the pathobiology of RIGT. Chapter five, the final research chapter, assessed vascular mediator expression in the DA rat model of RIGT, as well as the effects of irradiation and MMP inhibition on tumour-associated microvascular endothelial cells derived from DA rat mammary adenocarcinoma. This study confirmed an in vivo increase in the vascular mediators, VEGF, TGFβ, angiostatin, and endostatin. Cell culture results confirmed an increase in both MMP-2 and -9 following irradiation, significantly attenuated by MMP inhibition, however this attenuation did not alter the expression of vascular mediators or the toxicity profile of irradiation. In summary, this thesis contributed to the field of supportive care in cancer by elucidating a role for the intestinal microvasculature, MMPs, and vascular mediators, in RIGT. The findings of this thesis suggest these factors are likely part of a complex pathway involving many other mediators and intestinal components. Further research is now warranted to assess efficacy of treatments for RIGT targeting the intestinal microvasculature and MMPs.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2018

This thesis includes a series of clinical studies, focussing on the pivotal role of gastrointestinal (GI) function, particularly gastric emptying and GI hormones (e.g. glucagon-like peptide-1 (GLP-1)), in the regulation of postprandial glycaemia, energy expenditure and energy intake in both health and type 2 diabetes (T2D). The key themes relate to evaluation of: 1) gastric emptying of solid and liquid meals in healthy individuals and subjects with T2D, 2) the bidirectional relationship between gastric emptying and postprandial secretion of GLP-1, 3) the role of endogenous GLP-1 signalling in the regulation of postprandial glycaemia and energy expenditure in T2D, and 4) effects of intestinal bitter taste signalling on GI hormone secretion, gastric emptying, postprandial blood glucose and energy intake in health and T2D. Gastric emptying is a major determinant of the blood glucose response to dietary carbohydrate in both health and diabetes. The interaction of luminal nutrients and bioactive compounds with the intestines gives rise to the secretion of numerous GI hormones. Of particular importance to glycaemic control in T2D is the so-called incretin hormone, GLP-1, which has the capacity to stimulate insulin, suppress glucagon secretion and energy intake and slow gastric emptying. In T2D, gastric emptying is frequently abnormal, but may be either delayed, unchanged or accelerated. This discrepancy has reflected the substantial heterogeneity in subject characteristics (e.g. age, duration of diabetes, glycaemic status, pharmacotherapy and presence or absence of diabetic complications) of cohorts studied and the test meals employed (e.g. emptying of solid and liquid test meals is frequently disconcordant). The study reported in Chapter 4 evaluated gastric emptying of a semisolid high carbohydrate meal in a group of community-based individuals with relatively well-controlled T2D (HbA1c ≤ 7.9%), managed by diet or metformin monotherapy, in comparison with a cohort of age- and body mass index (BMI)-matched healthy subjects, and a group of healthy young subjects. The study described in Chapter 5, evaluated the gastric emptying of an oral glucose drink in two groups of community-based individuals with relatively well- (HbA1c ≤ 7.9%) and poorly- (HbA1c ≥ 9%) controlled T2D managed by diet or metformin alone, together with young and older subjects without diabetes. There is a complex bidirectional relationship between gastric emptying and the secretion of GLP-1 after a meal. In a given individual, the magnitude of GLP-1 secretion is related to the rate of nutrient delivery into the small intestine (i.e. gastric emptying); conversely, GLP-1 signalling slows gastric emptying. Gastric emptying exhibits a relatively modest intra-individual, but substantial inter-individual, variation. It remains unknown whether the latter reflects the differences in the ‘intestinal sensitivity’ to nutrients and hence secretion of GLP-1. In Chapter 6, the relationship between gastric emptying and the postprandial GLP-1 response was evaluated in subjects with T2D, the inter- and intra-individual variations in plasma GLP-1 response to enteral nutrient infusions were evaluated in health and T2D, and the relationship between gastric emptying of a glucose drink and the responsiveness of GLP-1 to intestinal glucose was further evaluated in subjects with and without T2D. Subsequent to its secretion, GLP-1 is rapidly degraded by the enzyme, dipeptidyl peptidase 4 (DPP-4). DPP-4 inhibitors are therefore a logical treatment option to augment intact GLP-1 levels for glycaemic control in T2D. In healthy humans, a single dose of DPP-4 inhibitor was shown to lower the blood glucose response to fat and increase energy expenditure and the thermic effect of feeding; the latter would favour a reduction in body weight with sustained use of DPP-4 inhibitors. The fact that DPP-4 inhibitors are weight neutral in subjects with T2D suggests that the effect of DPP-4 inhibition on energy expenditure may be compromised in this disorder. The study reported in Chapter 7, therefore, evaluated the effect of DPP-4 inhibition on the glycaemic and energy expenditure responses to an intraduodenal fat in subjects with T2D, including the role of endogenous GLP-1, assessed using the GLP-1 receptor antagonist, exendin (9-39). There is emerging evidence from preclinical studies suggesting that stimulation of GI bitter taste receptors (BTRs) has the potential to reduce postprandial glycaemia and suppress energy intake by modulating the secretion of GI hormones and slowing gastric emptying. The study reported in Chapter 8 evaluates the effects of a non-nutritive bitter taste compound, denatonium benzoate (DB), encapsulated for oral administration, on gastric emptying, postprandial glycaemia and energy intake in subjects with T2D. In Chapter 9, the effects of DB and a bitter tasting bile acid, taurocholic acid, administered via rectal perfusion, on GLP-1 and peptide YY secretion were evaluated in the presence or absence of a BTR antagonist, probenecid, in healthy humans.
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2021