Clinical and Translational Gastroenterology最新文献

Abstract: Sessile serrated lesions (SSLs) are a class of colon polyps challenging to detect through current screening methods but highly associated with colon cancer. To improve detection, we sought a biomarker sensitive for SSLs. Recent endoscopic and histopathologic studies suggest that SSLs are associated with alterations in intestinal mucin expression, but the frequency with which this occurs is not known. We performed a meta-analysis of available pathologic studies comparing mucin expression on SSLs to normal colonic mucosa, tubular adenomas (TAs), villous adenomas (VAs), traditional serrated adenomas (TSAs), and hyperplastic polyps (HPs). We searched Medline, Pubmed, and Embase and found 440 publications in this topic, and 18 total studies met inclusion. We found that MUC5AC expression was more common in SSLs compared to normal colonic mucosa (OR=82.9, p<0.01), TAs (OR=11, p<0.01), and TSAs (OR=3.6, p=0.04). We found no difference in MUC5AC expression between SSLs versus HPs (OR=2.1, p=0.09) and no difference in MUC5AC expression between left colon and right colon HPs, with an OR=1.8, p=0.23. We found that MUC5AC expression was found commonly on VAs, SSLs, and TSAs while the frequency on colon cancers declined. MUC5AC is also upregulated in inflammatory bowel disease and in response to intestinal infections. MUC5AC expression highlights the potential of mucins as useful biomarkers, though not specific to SSLs. Further research into the clinical utility of MUC5AC as a pathologic or fecal biomarker could enhance SSL detection.

Introduction: Evidence-based recommendations for sexual practices regarding anal receptive intercourse (ARI) do not exist in patients with inflammatory bowel diseases (IBD) undergoing restorative proctocolectomy with ileal-pouch anal anastomosis (IPAA). This study surveys providers on perspectives and attitudes related to sexual practices post-IPAA.

Methods: We developed a 23-item survey and distributed it to providers caring for patients with IBD.

Results: 95% of providers think that it is important to discuss sexual orientation or practices before IPAA, but only 27% routinely discuss this. 50% did not feel comfortable and 74% did not feel confident discussing ARI recommendations with patients who underwent or will undergo IPAA.

Conclusion: Future interventions should aim to standardize recommendations regarding feasibility and timeline to safe ARI after IPAA.

Background: Helicobacter pylori (Hp) and gastric atrophy represent significant risk factors for gastric cancer. Nevertheless, to date no nomogram has been developed to predict gastric cancer based on the specific combination of risk factors, present in individual cases.

Methods: A retrospective-cohort study was conducted using health-screening data collected between 2003 and 2018. Subjects with positive results for anti-Hp antibody were enrolled. Individuals were classified into 4 groups: low-B (low titer without atrophy), high-B (high titer without atrophy), high-C (high titer with atrophy), and low-C (low titer with atrophy). Nomogram prediction models were developed for overall gastric cancers as well as intestinal and diffuse cancers, with each type considered a competing event, by employing both Cox proportional and sub-distribution hazard models. Prediction performance was evaluated using concordance index (c-index) and the area under the curve (AUC) through 10-fold cross-validation.

Results: During a median follow-up period of 5.7 years, 231 new gastric cancer cases developed among the total cohort of 28,311 subjects, including 159 intestinal type, 68 diffuse type, and 4 cases of unknown type. Multivariable analyses indicated that age, body mass index, family history, smoking, and classification into the high-C or low-C group were significant predictors of gastric cancer. The nomograms for intestinal type, diffuse type, and total gastric cancer demonstrated AUC values of 0.82, 0.62, and 0.75, respectively and c-indices of 0.85, 0.54, and 0.76, respectively.

Conclusions: The nomograms for gastric cancer prediction would be useful in identifying high risk individuals, particularly for intestinal type. This would facilitate the implementation of personalized eradication and intensive screening strategies to target those at higher risk for gastric cancer.

Introduction: Antibiotic overuse and subsequent antibiotic resistance lead to worse infection outcomes in cirrhosis. Secondary spontaneous bacterial peritonitis prophylaxis (SecSBBPr) is associated with higher SBP recurrence but impact on non-SBP infections is unclear.

Methods: We studied patients with cirrhosis and SBP who were given SecSBPPr or not between 2009-2019 in two complementary national cohorts [Veterans affairs corporate data warehouse (VA-CDW) and non-VA TriNetX]. Development of total non-SBP infections and specifically urinary tract infections (UTI), bacteremia, pneumonia, and C.difficile using validated codes over 2 years was compared between those on SecSBPPr versus not. Multi-variable regression for non-SBP infections was performed.

Results: VA-CDW: Of 4673 Veterans with index SBP, 2539 (54.3%) were started on SecSBPPr. 1406 (30.1%) developed non-SBP infections (13.5% UTI, 12.4% pneumonia, 8.5% bacteremia and 6.8% C.difficile). On multi-variable regression, SecSBPPr was significantly associated with any non-SBP infection (OR 1.26, 95% CI:1.10-1.44, p<0.0001) and UTI (OR 1.21, 95% CI:1.01-1.45, p=0.036). TriNetX: Of 6708 patients with index SBP, 3261 (48.6%) were started on SecSBPPr. 1932 (28.8%) patients developed non-SBP infections (13.4% UTI, 12.9% pneumonia, 8.6% bacteremia and 5.9% C.difficile). On multi-variable regression, SecSBPPr was significantly associated with any non-SBP infection (OR 1.33, 95% CI:1.12-1.59, p<0.0001), UTI (OR 1.35, 95% CI:1.07-1.71, p=0.010), pneumonia (OR 1.35, 95% CI:1.06-1.72, p=0.017), and bacteremia (OR 1.47, 95% CI:1.10-1.97, p=0.009).

Conclusions: In two diverse US-based national cohorts of patients with cirrhosis and SBP, use of secondary SBP prophylaxis was associated with a higher risk of non-SBP infections, especially urinary tract infections.

Introduction: This study aimed to investigate the impact of hepatic venous portal gradient (HVPG) on BC values and the prognostic value of BC value in cirrhotic patients.

Methods: A total of 173 cirrhotic patients with HVPG and Computed Tomography scan were screened retrospectively from a binary-center database. Seven BC values, including skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), deep SATI (dSATI), superficial SATI (sSATI), visceral adipose tissue index (VATI), and ratio of VATI and SATI (VSR) along with skeletal muscle radiodensity (SMRD), were analyzed. The correlation analyses and multiple linear regression were used to assess the impact of HVPG on BC values. The cumulative survival rate was assessed and risk factors of survival were identified by competing risk analysis using Fine-Gray model.

Results: Among 173 patients with a mean age 53.7±10.5 years, there were 111(64.2%) males and 62(35.8%) females. In male patients, SATI, dSATI and sSATI inversely correlated with HVPG, respectively (SATI: rho=-0.227; dSATI: rho=-0.229; sSATI: rho=-0.219; all P<0.05), especially in patients aged≤60 years or with compensated cirrhosis; Male patients with clinically significant portal hypertension (CSPH) had a lower SATI, dSATI, sSATI and SMRD than those without CSPH. After adjusted multiple linear models, male sex, Child-Pugh class B or C and elevated HVPG contributed to decreased SATI. Multiple competing survival analysis showed a lower SATI (male:<38 cm2/m2; female:<23 cm2/m2) and Child-Pugh B or C predict mortality.

Discussion: Decreased SATI, dSATI and sSATI were more closely associated with increased HVPG. A lower SATI and Child-Pugh B or C predicted mortality.

Introduction: Image-based diagnostic tools that aid endoscopists to biopsy putative esophageal malignant lesions are essential for ensuring the standardization and quality of Lugol's chromoendoscopy. But there's no such model available yet.

Methods: We developed a diagnostic model using endoscopic Lugol-unstained lesions (LULs) features and baseline data from 1099 individuals enrolled from a large-scale population-based ESCC screening cohort. 603 participants from a clinical outpatient cohort were included as the external validation set. High-grade intraepithelial neoplasia and above (HGINA) lesions identified at baseline or within 1 year after screening were defined as outcome. The final model was determined using logistic regression analysis by the Akaike Information Criterion.

Results: The optimal diagnostic model contained the size, irregularity, sharp border of LUL, age and body mass index of the participant, with the area under the curve of 0.83 (95% CI: 0.78-0.87) in the development set, 0.81 (95% CI: 0.77-0.86) in the internal validation set, and 0.87 (95% CI: 0.84-0.90) in the external set. This model stratified individuals with LULs into low-, moderate-, and high-risk groups based on tertiles of predicted probabilities. The high-risk group accounted for < 40% participants but enriched 80.8% and 82.7% of HGINA cases in the development and external validation sets, respectively, achieving detection ratios 16.2 and 11.0 times higher than the low-risk group.

Discussion: Our model can help maintain consistency and accuracy in detecting esophageal malignancy through Lugol's chromoendoscopy, particularly in primary healthcare units in high-risk rural areas.

Introduction: Visceroptosis is a potential cause of gastrointestinal symptoms in hypermobile Ehlers-Danlos syndrome (hEDS).

Methods: We systematically examined the prolapse of abdominal organs below their natural supine position (visceroptosis) during upright small bowel barium study in healthy and hEDS subjects with irritable bowel syndrome.

Results: Comparison of age- and sex-matched healthy (n=20) and hEDS (n=10) subjects did not show any significant difference in dynamic movement of the viscera. Subgroup analysis did not demonstrate any correlation between the degree of prolapse, clinical symptoms, and hypermobility clinical (Beighton) scores. The interobserver reliability for 3 out the 4 anatomical landmarks showed 'moderate' or 'good' correlation based on their interclass correlation coefficients.

Discussion: hEDS patients do not appear to have a significantly increased incidence of visceroptosis.

Abstract: Pancreatic steatosis is defined as the ectopic accumulation of fat in the pancreas. While historically considered a benign incidental imaging finding, it is now recognized as a significant, and potentially reversible risk factor for pancreatic ductal adenocarcinoma (PDAC) independently of obesity. Although its epidemiology is not well characterized, meta-analysis data suggest an approximately 30% prevalence, with individual studies reporting even higher rates among patients with obesity and/or metabolic syndrome. Concurrently, PDAC incidence is rising and is projected to soon become the second leading cause of cancer-related deaths. Given the critical importance of early PDAC detection and intervention for improving survival, it is particularly timely to explore the associations between pancreatic steatosis and PDAC. This review aims to provide a comprehensive overview of the pathogenesis and clinical associations between pancreatic steatosis and PDAC, as well as to discuss future perspectives within the context of current PDAC surveillance practices.

Introduction: Serum insulin-like growth factor 1 (IGF-1), a hepatocyte-derived cytokine, has been suggested to reflect hepatic function reserve. The aim of this systematic review and meta-analysis was to investigate the association between serum IGF-1 levels upon the admission and prognosis of patients with advanced liver diseases.

Methods: A thorough examination of the literature was conducted across various databases, namely PubMed, Embase, Web of Science, Wanfang, and CNKI, with the aim of identifying relevant cohort studies. The data were synthesized using the random-effects model, taking into account the potential impact of heterogeneity.

Results: A total of nine cohorts were included. Patients with a low serum level of IGF-1, as compared to those with a high IGF-1 at baseline, exhibited a significantly poorer transplant-free survival (risk ratio [RR]: 3.03, 95% confidence interval: 2.17 to 4.22, p < 0.001), with no significant heterogeneity observed (p for Cochrane Q test = 0.92, I2 = 0%). A sensitivity analysis, which was conducted by excluding one study at a time, yielded consistent results (RR: 2.94 to 3.24, p all < 0.05). Additionally, consistent results were observed in further subgroup analyses based on various factors, including cutoffs of IGF-1, country of the study, patient diagnosis, methods for measuring serum IGF-1, follow-up duration, analytic model, and quality scores (p for subgroup difference all > 0.05).

Conclusions: A diminished serum IGF-1 level upon admission could potentially serve as an indicator for an unfavorable prognosis among patients afflicted with advanced liver disease, such as severe hepatitis and cirrhosis.