Background:Combined double-balloon enteroscopy(DBE)plays an important role in the diagnosis and treatment of patients with suspected small bowel bleeding(SSBB).Aims:To investigate the performance of combined DBE in patients with SSBB and their clinical features.Methods:A total of 94 patients with SSBB underwent combined DBE from June 2018 to April 2023 at the Third People's Hospital of Bengbu and the First Affiliated Hospital of Anhui Medical University were enrolled,and the clinical features were analyzed.Results:Fifty-four SSBB patients completed the combined DBE,and the combination rate was 57.4%.Ten patients(10.6%)stopped combined DBE due to discovery of bleeding lesions.Five patients(5.3%)stopped combined DBE due to intestinal stenosis.Twenty-five patients(26.5%)stopped combined DBE due to difficulty in insertion.Combined DBE rate in SSBB patients was correlated with the combination time and the number of previous DBE for endoscopists(P<0.05),but not the gender,age,bleeding manifestations,tobacco smoking and alcohol drinking,nutritional risk,abdominal operation history,perianal lesions,autoimmune diseases,preoperative anemia,preoperative albumin level,and enteroscopy approach(P>0.05).ROC curve showed that when the cut-off value of first insertion depth was 385 cm,the sensitivity and specificity for successful combined DBE in SSBB patients were 72.2%and 77.5%,respectively,and the area under ROC curve was 0.800(95%CI:0.705-0.875,P<0.001).Conclusions:The combined DBE rate in SSBB patients is correlated with the combination time and the number of previous DBE for endoscopists.80%of the SSBB patients are expected to complete the combined DBE when the first insertion depth is greater than 385 cm.

Clinical pharmacists participated in the drug therapy and monitoring of a patient with Crohn's disease complicated with erythema multiforme.The patient,who had a previous diagnosis of Crohn's disease for many years and had been treated with infliximab to date,was admitted to the hospital with a scattered rash on the peripheral skin,normal stools,and fecal calprotectin＞1 800 μg-g-1,by collecting the patient's medical history,reviewing domestic and foreign literature,the clinical pharmacist assisted the physician in ruling out drug factors,and making a definitive diagnosis of Crohn's disease complicated with extraintestinal manifestations.Taking into account the patient's condition and guideline recommendations,the clinical pharmacist assisted doctors to adjust medication regimen,and determined that the next step in the patient's treatment program was ustekinumab combined with glucocorticoids therapy,and continuously monitoring the patient's condition.The patient's condition was effectively controlled immediately before discharge,with marked improvement in erythema multiforme,and the patient was followed up 3 months later with complete disappearance of erythema multiforme,normal bowel movements,and no specific discomfort.Since the extraintestinal manifestations of Crohn's disease are often similar to the adverse reactions caused by medications used in the treatment or other systemic diseases and disorders,it is necessary for the clinical pharmacist to assist the physician in screening.The case was studied and compiled with a view to providing references for the diagnosis and pharmacological treatment of such patients.

Background: The widespread use of biological agents in recent years can improve the nutritional status of partial patients with Crohn's disease (CD) and change the course of the disease. Aims: To investigate the correlation between the nutritional risk and clinical and endoscopic features in CD patients treated with biological agents. Methods: Sixty⁃eight CD patients treated with biological agents from June 2021 to June 2022 at the First Affiliated Hospital of Anhui Medical University were enrolled. Nutritional risk screening was conducted by nutritional risk screening 2002 (NRS2002), and its correlation with clinical and endoscopic features was analyzed. Results: In 68 CD patients treated with biological agents, incidence of nutritional risk was 66.2%. There was statistically significant difference in incidence of nutritional risk in patients with different disease behaviors, SES⁃CD score and postoperative Rutgeerts score (all P<0.05). The incidence of nutritional risk was not correlated with age, lesion location, perianal lesion, CDAI score, and the interval between CD diagnosis and the use of biological agents (all P>0.05). Conclusions: The incidence of nutritional risk is high in CD patients treated with biological agents, and is correlated with CD disease behavior, SES ⁃ CD score, and postoperative Rutgeerts score.

Objective To investigate the cumulative effective dose (CED) of ionizing radiation received by patients with Crohn's disease(CD) and to identify the risk factors associated with high levels of radiation in patients with Crohn's disease. Methods A total of 230 patients were enrolled. The classification of CD was according to the Montreal standards, and the CED of each patient was calculated retrospectively based on standards tables. High levels of radiation was defined as no less than 50 mSv CED. Patients who accepted no less than 50 mSv CED were assigned to high level of the radiation group, and those who accepted simultaneously less than 50 mSv CED were assigned to the control group. The risk factors for patients associating with high levels of radiation were analyzed by Logistic regression. Results CT enterography and abdominopelvic CT accounted for 52. 1％ and 39. 6％, respectively, and add up to 91. 7％ of total CED. The mean CED received per patient was 34. 07 mSv (95％ CI:30. 845～37. 304), and 51 patients (22. 2％ of total patients) with CD were exposed to no less than 50 mSv CED. Patients with long disease duration, surgical intervention, ileal location, stricturing or penetrating pattern received a higher dose of radiation. In a Logistic regression, stricturing or penetrating pattern(OR =3. 711, 95％ CI:2. 239 ～ 6. 151, P ＜0. 001) and the requirement for azathioprine (OR =4. 218, 95％ CI: 1. 221 ～14. 579,P=0. 023) were independent risk factors for the high levels of radiation in CD. Conclusion More than one in five of patients with CD are exposed to high levels of ionizing radiation, mainly caused by CT examination. Stricturing or penetrating pattern and the usage of azathioprine are independent risk factors for the high levels exposure of radiation in CD patients. During the clinical management and follow-up, it is important to either monitor the effective dose received per patient, minimizing unnecessary CT examination, or to transform to use no radiation imaging examination, such as MR enterography.

Objective To evaluate the value of serum soluble transferrin receptor ( sTFR) and sTFR-ferritin index (sTFR/LogSF) in diagnosing iron deficiency anemia ( IDA) with inflammatory bowel disease ( IBD) . Methods 161 patients with diagnosis of IBD was continuous collected, including 81 cases of Crohn's disease ( CD) and 80 cases of ulcerative colitis( UC) . Drawing venous blood to check complete blood count, iron metabolism, CRP, folic acid and vitamin B12 (VitB12) in the next morning with an empty stomach. According to the WHO anemia diag-nostic criterion, patients were divided into anemia group and non anemia group. The incidence and etiology of IBD were analysed. All patients with IBD were divided into iron deficiency anemia group and non iron deficiency group based on SF. Receiver-operating characteristic curve ( ROC curve) were applied to evaluate the value of sTFR and sTFR/LogSF in diagnosis of IDA with IBD. All the cases were followed till the endpoint of the study, lasted for 12 months at least. Results The incidence of IBD combined with anemia was 62. 1% (100/161), among which IDA and ACD hold up to 40. 0 % (40/100) and 14. 0% (14/100) respectively, while the mix of IDA and ACD ac-count for 26. 0% (26/100), and 10. 0% (10/100) was taken by lack of folic acid and VitB12. The level of sTFR and sTFR/LogSF in IDA group were obviously higher than those in non IDA group,and this difference was statisti-cally significant (U=655. 5,306. 0,P ＜0. 001). The AUC of sTFR/LogSF (0. 937) was higher than the AUC (0. 865) of sTFR. High sTfR levels ( ＞4. 7 mg/L) had a sensitivity of 77. 5% and a specificity of 86. 0%, whereas high sTfR/LogSF ( ＞2. 8) had a sensitivity of 87. 5% and a specificity of 90. 9% for the diagnosis of IDA. Both sTFR and sTFR/LogSF index were not correlated with CRP levels (r=0. 042,0. 958, P＞0. 05). Con-clusion The incidence of IBD combined anemia is high,among which IDA is common. By detecting serum sTFR/LogSF and sTfR,the diagnosis of IBD combined IDA may be more accurate.

Objective To evaluate the value of fecal calprotectin (FC) and stool lactoferrin (SL) for detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.Methods Publications in Pubmed,Embase,Science Direct,Springer Link,CBM,Cnki,Wan fang and VIP database before January 1 st 2016 were searched manually.Papers were screened according to inclusion and exclusion criteria.Quality assessment was conducted by QUADAS-2 scale.Meta-Disc 1.4 was used to analyze the heterogeneity of included articles.The pooled sensitivity,specificity,positive likelihood,negative likelihood were calculated respectively and the SROC curve was drawn.Stata 12.0 was used to assess the publication bias.Results A total of 19 papers in English language were included.The pooled sensitivities of FC,SL in detecting endoscopic activity and FC in monitoring postoperative recurrence of Crohn disease were 86％ (95％ CI:84％-88％),72％ (95 ％ CI:66％-79％),80％ (95％ CI:75％-84％),respectively.The specificities were 71％ (95％CI:67％-75％),84％ (95％ CI:74％-91％),65％ (95％ CI:59％-70％),respectively.The areas under the SROC curve were 0.865 6,0.834 6,0.811 0 respectively.The cut-off values of FC in detecting endoscopic activity of Crohn disease were set to ＜ 100 μg/g,100-＜200 μg/g or ≥ 200 μg/g with the area under the SROC curve being 0.898 7,0.788 8,0.888 8,respectively.The cut-off values of FC in monitoring postoperative recurrence of Crohn disease were set to 100-＜ 150 μg/g,150-＜200 μg/g or ≥ 200 μg/g with the areas under the SROC curve being 0.677 4,0.859 4 and 0.759 5,respectively.Conclusion FC and SL have higher diagnostic efficiency than C-reaction protein and are worthy of clinical promotion in detecting endoscopic activity and monitoring postoperative recurrence of Crohn disease.However,endoscopy cannot be replaced.

OBJECTIVE:To explore the clinical related factors of leucopenia induced by azathioprine in the treatment of inflam-matory bowel disease (IBD). METHODS:Clinical information of 114 IBD patients were collected from our hospital during Jan. 2013-Mar. 2015. Steady concentration of AZA metabolite 6-thioguanine(6-TGNs)in red blood cell was determined by HPLC. The correlation of patient’s gender,age,diseases,AZA daily dose and blood concentration of 6-TGNs with leucopenia induced by AZA were investigated. The optimal critical value of leucopenia could be predicted with ROC curves. RESULTS:Among 114 IBD patients,40 patients suffered from leucopenia(35.1%). There was no statistical significance in the proportion of leucopenia among patients with different age,gender,diseases and AZA daily dose(P>0.05). There was statistical significance in the proportion of leucopenia among patients with different concentrations of 6-TGNs(P<0.05). Mean blood concentration of 6-TGNs in leukopenia patients [(407.82±262.88)pmol/(8×108)RBC] was higher than patients with normal leukocyte level [(275.85±118.37)pmol/(8× 108)RBC],with statistical significance(P<0.05). ROC curve predicted that the optimal critical value of leucopenia was blood con-centration of 6-TGNs>291.04 pmol/(8 × 108)RBC. CONCLUSIONS:AZA induced leucopenia may be related to the concentration of 6-TGNs in red blood cell of IBD patients,and high concentration of 6-TGNs is risk factors of leucopenia. Clinicians can provide AZA individual treatment for IBD patient to reduce the occurrence of leucopenia according to routine blood test and the concentra-tion of 6-TGNs.

Objective To explore the risk factors associated with surgery and postoperative recurrence in patients with Crohn's disease (CD).Methods A total of 183 patients diagnosed as CD from January 2008 to December 2013 were enrolled.Forty-six patients after surgery were assigned to surgery group,and 137 non-surgical CD patients were assigned to control group.All the patients were followed up until the endpoint of the study or death,and the follow-up period was at least 12 months.Typing was according to the Montreal classification.The risk factors associated with surgery and postoperative recurrence were analyzed by Logistic regression.Results The surgery rate of CD patients was 25.1 ％ (46/183),the postoperative clinical recurrence rate of surgery group was 39.1％ (18/46),and the recurrence time was 20 months (7～42 months).Before surgery,the rate of definite diagnosis of CD was only 13.0％ (6/46).Stricture (odd ratio (OR)=5.836,95％ confidence interval (CI) 2.199 to 15.487,P＜0.01) and penetration (OR=25.706,95％oo CI 7.091 to 93.190,P＜0.01) were independent risk factors for the surgery.Furthermore,perianal disease(OR=23.550,95％CI 1.311 to 422.912,P=0.032) and lack of prophylaxes treatment after surgery (OR=58.701,95％CI 1.803 to 1 991.000,P=0.022) were independent risk factors for postoperative clinical recurrence.Conclusions Stricture and penetration are risk factors for surgery.Perianal disease and lack of prophylaxes treatment after surgery are risk factors for postoperative clinical recurrence.

Objective To evaluate the role of serum immunoglobulin G4 (IgG4) in differentiating autoimmune pancreatitis (AIP) from pancreatic cancer(PC).Methods The database,including Medline,EMBASE,Science Direct,Springer link,CBM,Wanfang,VIP and Cnki were searched by computer and the publication date was before April 1,2015.The studies on evaluating the accuracy of IgG4 in differentiating AIP from PC were screened and selected according to strict determined inclusion and exclusion criteria.Quality assessment was made by QUADAS scale.The publication bias were assessed by Stata12.0 software.The heterogeneity of included articles,calculate the pooled sensitivity,specificity,positive likelihood,negative likelihood were anylyzed by Meta-Disc1.4 software,respectively,and draw the summary ROC (SROC) curve.Results A total of 13 English articles were included and 1403 patients were involved.The pooled sensitivity was 74％ (95％ CI 70％ ～ 78％),the pooled specificity was 93％ (95％ CI 91％ ～ 95％),the positive likelihood ratio was 10.74 (95％ CI 7.16 ～ 16.11),the negative likelihood ratio was 0.25 (95％ CI 0.17 ～0.35) and the area under SROC curve was 0.9340.Conclusions IgG4 has high diagnostic efficacy but low misdiagnosis rate in differentiating AIP from PC,which can be used as one of early diagnostic markers for AIP.

Objective To evaluate the efficacy and safety of Houpu Paiqi mixture in treatment of functional dyspepsia (FD)with abdominal distension symptom.Methods From July 2014 to June 2015 , in nine centers,a total of 162 FD patients with abdominal distension symptom and met Rome Ⅲpostprandial distress syndrome (PDS)diagnostic criteria were enrolled.All patients were randomly divided into trial group and control group,81 patients in either group.The patients of trial group and control group took Houpu Paiqi mixture or placebo,respectively,25 mL per time,twice daily,and both the courses of treatment were two weeks.Before and after the treatment,the improvement of main symptoms,total clinical efficacy rate and efficacy of traditional medicine between two groups were compared.Chi square test,Fisher exact probability method and Wilcoxon test were performed for statistical analysis.Results According to the results of per-protocol (PP)analysis,the total efficacy rate of trial group and control group was 69.4% (50/72)and 59.2% (42/71),respectively,and there was no statistically significant difference in total efficacy rate between the two groups (χ2 =1 .650,P =0.199 ). And there was no statistically significant difference in the improvement of PDS main symptoms(postprandial fullnessand early satiety)between the two groups (56.3% ±27.9% vs 54.4% ±32.1%,t =0.606,P =0.727 ).For those with baseline symptom score over 14,median early satiety score of trial group after the treatment was 0,which was lower than that of control group,and the difference was statistically significant (Z =-2.370,P =0.018).The total efficacy rate of traditional medicine of trial group was 80.8% (59/73 )and that of control group was 72.0% (54/75 ),and the difference was not statistically significant (χ2 = 0.676,P =0.411 ).Conclusion Houpu Paiqi mixture has certain efficacy in FD with abdominal distension,and could be used for the treatment of PDS-predominant FD.