Clinical and Translational Gastroenterology最新文献

Introduction: Obesity and overweight are linked to increased postoperative issues in patients with colorectal cancer (CRC). However, the impact of obesity on outcomes of simultaneous colon and liver resections for colorectal liver metastasis (CRLM) is not well studied. This study was to assess the impact of obesity and overweight on outcomes of simultaneous colon/rectum and liver resection in patients with CRLM.

Methods: This retrospective study analyzed data from the US Nationwide Inpatient Sample between 2005 and 2020. Regression analysis evaluated associations between obesity/overweight and in-hospital outcomes.

Results: Of the 3,269 patients included, 413 were overweight or obese. Overweight and obese patients were younger and had higher rates of comorbidities such as heart failure, diabetes, hypertension, nonalcoholic fatty liver disease, and chronic pulmonary disease compared with nonobese patients. Overweight and obesity were associated with an increased risk of unfavorable discharge (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.00-2.07) and a greater likelihood of developing any complication (aOR 1.27, 95% CI 1.05-1.5). In addition, overweight and obese patients had significantly higher odds of experiencing acute kidney injury (aOR 1.61, 95% CI 1.15-2.25), with the effect being more pronounced in patients younger than 60 years (aOR 1.80, 95% CI 1.13-2.87).

Discussion: Overweight and obesity are associated with increased risks of complications, particularly acute kidney injury, and unfavorable discharge in patients undergoing simultaneous colon and liver resection for CRLM.

Despite an overall decline in the incidence and mortality of colorectal cancer, diagnosed cases of colorectal cancer in young adults are rising significantly. As more and more young patients with colorectal cancer survive their primary disease, there is an increasing concern about reproductive health associated with primary treatment. There is considerable controversy in the available literature regarding the outcomes of pregnancies in patients with colorectal cancer, including maternal and fetal/neonatal outcomes. The most commonly reported adverse events in labor were cesarean section, pre-eclampsia, preterm birth, and neonatal complications associated with preterm birth. The purpose of this review was to summarize the unmet reproductive needs of patients with early-onset colorectal cancer, the gonadal toxicity and fertility effects of treatment on patients with early-onset colorectal cancer, and the maternal and fetal/neonatal effects of pregnancy, to optimize the overall prognosis of patients with early-onset colorectal cancer.

Introduction: The Toronto Inflammatory Bowel Disease (IBD) Global Endoscopic Reporting (TIGER) score was developed to provide 1 endoscopic scoring index for patients with both Crohn's disease (CD) and ulcerative colitis (UC). The goal of this study was to assess the predictive validity the TIGER score for daily-life disease burden (IBD Disk) and disease complications.

Methods: A prospective 12-month study was conducted in 1 tertiary IBD center. Baseline colonoscopy was performed. Moderate-to-severe mucosal involvement was defined as a TIGER score ≥100, Simple Endoscopic Score for CD >6, Mayo Endoscopic Score >1, and was used as a predictor for clinical outcomes. At each visit, IBD Disk questionnaires, disease complications, hospitalizations, surgeries, and medications were documented.

Results: A total of 107 adults, 52 with CD and 55 with UC, were included. Patients with a baseline TIGER score ≥100 had a significantly higher prevalence of an IBD Disk score ≥40 after the 12-month follow-up period despite receiving advanced therapy (33.9% vs 7.8%, P < 0.001). There were significantly more patients with a baseline TIGER score ≥100 who experienced at least 1 hospitalization (39.3% vs 2.0%, P < 0.001), underwent surgery (14.3% vs 0.0%, P < 0.005), had IBD-related complications (41.1% vs 9.8%, P < 0.001), and required steroids (67.9% vs 5.9%, P < 0.001) or advanced therapy (85.7% vs 7.8%, P < 0.001). Similar significant results were obtained with Simple Endoscopic Score for CD and Mayo Endoscopic Score as predictors of outcomes over the 12 months.

Discussion: The TIGER score is a simple endoscopic score for patients with CD and UC with an adequate predictive validity for worse clinical outcomes while having noninferiority to the current best-referenced endoscopic scores.

Autoimmune pancreatitis (AIP) is a distinct inflammatory pancreatic disorder characterized by its responsiveness to glucocorticoid therapy and association with autoimmune features. AIP primarily consists of type 1 and type 2, with relapse being a significant problem mainly associated with type 1 AIP, which has a high relapse rate of approximately 40%, whereas type 2 AIP has significantly lower relapse rates. This narrative review comprehensively examines the multifaceted factors influencing AIP relapse, particularly focusing on type 1 AIP. Dynamic changes in serum IgG4 levels-particularly insufficient decline, relative increase, or persistently elevated levels after steroid therapy-consistently correlate with relapse risk. Other serological markers including immunoglobulin E and autotaxin may serve as potential relapse predictors. Imaging features associated with relapse include diffuse pancreatic swelling, persistent post-treatment pancreatic enlargement, and elevated fluorodeoxyglucose positron emission tomography metabolic parameters. Extrapancreatic involvement, especially proximal biliary and renal manifestations, significantly increases relapse risk. Therapeutic considerations reveal that prolonged maintenance of glucocorticoid therapy reduces relapse rates, whereas immunosuppressants and rituximab show promise in managing refractory cases. This review synthesizes current evidence to guide clinicians in developing effective management strategies for this challenging pancreatic disorder.

Introduction: Rectal neuroendocrine tumors (rNETs) are subepithelial lesions with potential of malignancy. Despite the guidelines recommending that rNETs measuring 10-20 mm should be removed either endoscopic submucosal dissection (ESD) or transanal endoscopic microsurgery (TEM), the management with these entities is still a clinical dilemma. We performed a meta-analysis to compare ESD and TEM regarding method effectiveness and safety in the treatment of rNETs.

Methods: PubMed/MEDLINE/Embase/EBSCO/CINAHL was searched up for observational studies analyzing the efficacy and safety of both methods in the treatment of rNETs.

Results: A total of 59 observational studies with a total of n = 2,804 participants were included. In a subgroup analysis, we demonstrated that the R0 resection rate was significantly ( P = 0.002) lower for ESD (rate: 0.854) than for TEM (0.924). The recurrence rate differed significantly ( P = 0.008); the lowest (event rate [ER] = 0.015) was found for ESD and the highest for TEM (ER = 0.035). The overall bleeding rate was 0.046 and perforation rate was 0.023 and no significant differences ( P = 0.274 for bleeding, P = 0.808 for perforation) were found by intervention type. The rate of other complications (wound dehiscence, soilage, incontinence, rectovaginal fistula, pelvic pain, retroperitoneal emphysema, coagulation syndrome) was significantly ( P = 0.000) higher for TEM (ER = 0.107) than ESD (ER = 0.013). We also included 4 comparative studies with 490 patients. Using random-effects analysis, we found that the risk ratio for R0 resection was approximately 10% lower for ESD. Our analysis showed significantly greater size ( P = 0.01) and follow-up ( P = 0.03) in the group treated with TEM.

Discussion: The efficacy of TEM is higher than ESD with a higher risk of complications in this method. Lesions with a greater size are treated with TEM, and recurrence rate is greater for this procedure. Long follow-up is needed after the treatment of rNETs to detect the recurrence early.

Introduction: Esophageal adenocarcinoma (EAC) develops through histopathological stages, including Barrett's esophagus (BE). We analyzed the associations between plasma levels of one-carbon metabolism factors and risks of long-segment BE or EAC.

Methods: Plasma levels were measured from an Irish population-based case-control study (Factors INfluencing the Barrett Adenocarcinoma Relationship study; 204 long-segment BE cases, 211 EAC cases, and 251 controls). A "methyl replete score" was derived by assigning a score of 0 (median) to the levels of 3 dietary methyl donors (methionine, choline, and betaine) and summing across the metabolites. Multinomial logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between EAC or BE and sex-specific quartiles or score using the lowest level as the reference category and adjusted for potential confounders.

Results: Highest methionine, betaine, vitamin B6, and choline levels were all associated with 62%-82% reduced risks of EAC ( Ptrends < 0.001). Conversely, S-adenosylmethionine, S-adenosylmethionine/S-adenosylhomocysteine ratio, total homocysteine, and cystathionine were associated with a greater than 2-fold increased EAC risk. A higher methyl replete score was associated with reduced EAC risk (OR 0.33; 95% CI 0.16-0.66). The highest vs lowest plasma methionine levels were borderline statistically significantly associated with long-segment BE (OR 0.55; 95% CI 0.28-1.07), but all other associations were null.

Discussion: Several biomarkers of one-carbon metabolism are associated with EAC risk, particularly markers of dietary methyl group donors. Future studies to replicate and prospectively evaluate these markers are warranted.

Introduction: Total pancreatectomy and islet autotransplantation (TPIAT) can alleviate symptoms in chronic pancreatitis. We aimed to identify pre-TPIAT imaging markers predicting explanted pancreas health and islet yield.

Methods: We retrospectively analyzed 104 pediatric TPIAT patients, excluding those with presurgical diabetes or pancreatic surgeries. Pancreas parenchymal volume was manually segmented, and T1 signal intensity ratio pancreas to spleen (T1 SIRp/s) was calculated. An islet biologist assessed fat infiltration, fibrosis, and islet yield. Logarithmic transformation and regression analyses were used for variance stabilization and predictive modeling.

Results: Ninety-four patients (60% female, median age 12.5 years) were included. Univariate analyses revealed that an increase in pancreas volume was associated with less fibrosis (odds ratio [OR] = 0.88 per 5 mL, 95% CI: 0.77-0.99, P < 0.05), higher pellet volume, total islet equivalent and total islet count. For advanced fibrosis, an increase in T1 SIRp/s was linked to decreased odds (OR = 0.74 per 0.1 unit, 95% CI: 0.59-0.92, P < 0.05), whereas a higher Cambridge score was associated with increased odds (OR = 1.34 per 1 unit of Cambridge, 95% CI: 1.01-1.77, P < 0.05). A model incorporating segmented pancreas volume and T1 SIRp/s predicted advanced fibrosis with an area under receiver operating curve (AUC) of 0.75 (95% CI: 0.64-0.87). In addition, models that included larger pancreas volume and the absence of acute pancreatitis predicted total islet count and total islet equivalent.

Discussion: In children with chronic pancreatitis, noninvasive cross-sectional imaging focused on the parenchyma can guide the management, as a smaller parenchymal bulk and lower T1 SIRp/s predict advanced fibrosis, whereas larger pancreas volume and T1 SIRp/s predict larger pellet volumes.

Introduction: Chronic pancreatitis (CP) is a disease associated with chronic inflammation, fibrosis, and pain. There is a lack of tools available that facilitate early diagnosis, when intervention could prevent irreversible damage. Pilot data suggested prostaglandin E2 (PGE2) as a candidate biomarker for early CP. PGE2 activates signaling pathways that promote inflammation, pain, and fibrosis.

Methods: We assessed PGE2, metabolites, and downstream targets in pancreatic fluid collected endoscopically 0-10 (n = 110) and 10-20 (n = 111) minutes after intravenous secretin administration. PGE2 and metabolites were measured in plasma (n = 75) and urine (n = 71) from the same subjects. Subjects were enrolled in the PROCEED study and classified symptomatic controls, acute/recurrent acute pancreatitis (AP/RAP), or CP.

Results: A significant main effect was detected in 10-20 minutes pancreas fluid ( P = 0.027) and plasma ( P = 0.046); post hoc testing showed PGE2 was lower in the AP/RAP group compared with symptomatic controls. There was also trend toward lower PGE2 in urine ( P = 0.062). To elucidate the active downstream pathways, calcitonin gene-related peptide, substance P, and matrix metalloproteinases (MMPs) 1, 2, 3, 7, 9, and 13 were measured in pancreas fluid. A significant difference between the 3 groups was detected for both MMP7 and MMP9. MMP7 was elevated in individuals with CP vs AP/RAP ( P = 0.012) for samples collected early but both time points for MMP9 ( P = 0.027, P = 0.002).

Discussion: While PGE2 is detectable in pancreas fluid, these data suggest that it may not be sensitive enough to distinguish between AP/RAP and CP. However, MMPs may distinguish between stages of pancreatitis and require further testing as potential diagnostic biomarkers.

Introduction: Irritable bowel syndrome symptoms are thought to relate in part to the accumulation of luminal gases after ingestion of fermentable carbohydrates (i.e., fermentable oligosaccharides, disaccharides and monosaccharides, and polyols [FODMAPs]). To understand this relationship, participants monitored breath hydrogen (H 2 ) and methane (CH 4 ) levels using an at-home breath analysis device and recorded symptoms and meals in real-time using the associated app.

Methods: We studied 1,984 users from July 2021 to April 2025. Participants first completed a baseline week on their habitual diet, followed by a one-week low FODMAP diet (Reset), with continued tracking of meals, symptoms, and postprandial H 2 and CH 4 levels. Breath H 2 and CH 4 were measured in parts per million, and area under the curve was calculated to assess gas production during typical waking hours. Participants recorded dietary intake and gastrointestinal symptoms after meals (i.e., nonfasting).

Results: Breath H 2 , CH 4 , and gastrointestinal symptoms (bloating, abdominal pain, and flatulence) were significantly reduced after FODMAP restriction (all P < 0.0001). Both mild/absent and moderate/severe symptom groups showed significant improvements in symptoms with greater absolute reductions seen in the moderate/severe group. Exhaled gas levels, particularly H 2 , exhibited diurnal variation corresponding to mealtimes and symptom patterns.

Discussion: This study suggests that breath H 2 and CH 4 may be influenced by short-term dietary changes and could be a useful biomarker of response to FODMAP restriction. Future studies should investigate whether nonfasting breath H 2 and CH 4 levels, in response to habitual dietary intake, is predictive of response to the low-FODMAP diet.