Pub Date : 2025-09-28DOI: 10.1016/j.clinre.2025.102700
Clara Yzet , Camille Robert , Franck Brazier , Erica Meudjo , Capucine Moreau , Denis Chatelain , Mathurin Fumery
Background
The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved.
Methods
We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading).
Results
A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5–19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively p = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively p = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, p = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], p = 0.0118).
Conclusion
In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.
背景：STRIDE II指南承认内镜下愈合（EH）是溃疡性结肠炎（UC）的主要治疗目标之一。然而，组织学愈合（HH）可以降低UC长期并发症的风险。本研究的目的是评估UC复发的风险，这取决于缓解的程度。方法：我们进行了一项前瞻性研究，包括2021年1月至2024年1月期间所有临床缓解和EH （MES 0或1）的连续UC患者。主要终点是UC复发，定义为需要加强治疗和/或开始使用皮质类固醇和/或UC相关住院和/或结肠切除术。每6个月随访一次，随访2年。HH定义为Nancy指数≤1（盲法双读）。结果：共纳入75例患者。中位病程为12年（IQR[7.5-19.0]）， 66例（82%）患者出现左侧结肠炎（E2）或全结肠炎（E3）。患者在结肠镜检查前平均治疗3年（IQR[1.2 - 6.9]）， 49例（65%）患者MES为0。队列中59例（79%）患者患有HH。在中位随访21.0个月（IQR[12.0 - 26.5]）后，13例患者（17%）在中位延迟11个月（IQR[6.0 - 18.0]）后复发。MES 1和MES患者的复发风险无差异（分别为13.6% vs. 30.7% p = 0.275）。MES 1患者的复发风险明显高于无HH患者（分别为39.7%对20.1% p = 0.04）。同样，在MES 0患者中，无HH患者的复发风险明显更高（分别为70.0%和27.4%,p = 0.023）。随访期间无uc相关住院或结肠切除术报告。在多因素分析中，HH缺失是唯一与疾病复发相关的因素（HR 4.55 [1.69; 12.22], p = 0.0118）。结论：在这个前瞻性队列中，无论内镜下粘膜愈合程度如何，组织学愈合是唯一与UC患者长期预后改善相关的方法。
{"title":"Impact of histological healing on ulcerative colitis disease course among patients with endoscopic healing: results of a prospective study","authors":"Clara Yzet , Camille Robert , Franck Brazier , Erica Meudjo , Capucine Moreau , Denis Chatelain , Mathurin Fumery","doi":"10.1016/j.clinre.2025.102700","DOIUrl":"10.1016/j.clinre.2025.102700","url":null,"abstract":"<div><h3>Background</h3><div>The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved.</div></div><div><h3>Methods</h3><div>We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading).</div></div><div><h3>Results</h3><div>A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5–19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively <em>p</em> = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively <em>p</em> = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, <em>p</em> = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], <em>p</em> = 0.0118).</div></div><div><h3>Conclusion</h3><div>In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102700"},"PeriodicalIF":2.4,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-25DOI: 10.1016/j.clinre.2025.102693
Saqlain Haider
{"title":"Persistent portal hypertension in alcohol-associated hepatitis: A mirror of inflammation rather than mortality predictor","authors":"Saqlain Haider","doi":"10.1016/j.clinre.2025.102693","DOIUrl":"10.1016/j.clinre.2025.102693","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102693"},"PeriodicalIF":2.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.clinre.2025.102692
Fengchun Wang , Xiande Feng , Jianxiang Sun , Xiaoxin Fan , Jian Geng , Yu Leng , Hechao Tang
Background
Dynamic shifts in serum tumor markers during neoadjuvant therapy could refine prognostication in gastrointestinal (GI) cancers, but supporting evidence is limited.
Methods
We prospectively followed 200 patients with gastric (55 %) or colorectal (45 %) cancer who received neoadjuvant chemotherapy ± radiotherapy and curative-intent surgery (2016–2025). Carcinoembryonic antigen (CEA), CA19–9, CA72–4 and CA125 were assayed at baseline and pre-surgery. Three-year disease-free survival (DFS) and overall survival (OS) were primary endpoints. Multivariable Cox models assessed associations between marker dynamics and outcomes.
Results
Baseline positivity rates were 40 % for CEA and 30 % for CA19–9; 31 % of patients had ≥ 2 markers elevated. Therapy converted 45 % of CEA-positive and 53 % of CA19–9-positive cases to negative. Major pathological response (Tumor Regression Grade 0–1) occurred in 30 % overall and was higher in marker converters than non-converters (45 % vs 18 %, p < 0.001). Persistent positivity correlated with lower R0 resection (78 % vs 91 %, p = 0.04), more complications (26 % vs 12 %, p = 0.03) and poorer 3-year DFS (42 % vs 69 %). On multivariable analysis, persistence of ≥ 2 positive markers independently predicted shorter DFS (HR 1.9, 95 % CI 1.2–3.0) and OS (HR 2.1, 95 % CI 1.3–3.3). Sensitivity analyses using alternative cut-offs, multiple imputation and exclusion of borderline metastatic cases yielded consistent results.
Conclusion
Failure of serum tumor markers to normalize after neoadjuvant therapy signals inferior pathological response and survival. Serial marker assessment can enhance perioperative risk stratification and guide surgical decisions in GI cancers.
背景：在新辅助治疗期间血清肿瘤标志物的动态变化可以改善胃肠道（GI）癌症的预后，但支持证据有限。方法：前瞻性随访200例（55%）胃癌或结直肠癌（45%）患者（2016-2025年），接受新辅助化疗±放疗和治愈意图手术。在基线和术前检测癌胚抗原（CEA）、CA19-9、CA72-4和CA125。3年无病生存期（DFS）和总生存期（OS）是主要终点。多变量Cox模型评估了标志物动态和结果之间的关联。结果：CEA的基线阳性率为40%，CA19-9为30%；31%的患者有≥2项标志物升高。治疗将45%的cea阳性病例和53%的ca19 -9阳性病例转化为阴性。主要病理反应（肿瘤消退等级0-1）总体发生率为30%，标志物转换者高于非标记转换者（45% vs 18%, p < 0.001）。持续阳性与较低的R0切除（78%对91%，p = 0.04），更多的并发症（26%对12%，p = 0.03）和较差的3年DFS（42%对69%）相关。在多变量分析中，持续≥2个阳性标记独立预测较短的DFS （HR 1.9, 95% CI 1.2-3.0）和OS （HR 2.1, 95% CI 1.3-3.3）。敏感性分析采用替代截断、多重归算和排除边缘转移病例得出一致的结果。结论：新辅助治疗后血清肿瘤标志物未能恢复正常，表明病理反应和生存期较差。系列标志物评估可提高围手术期风险分层，指导消化道肿瘤的手术决策。
{"title":"Impact of dynamic changes in multiple serum tumor markers during neoadjuvant therapy on clinical outcome in gastrointestinal cancer","authors":"Fengchun Wang , Xiande Feng , Jianxiang Sun , Xiaoxin Fan , Jian Geng , Yu Leng , Hechao Tang","doi":"10.1016/j.clinre.2025.102692","DOIUrl":"10.1016/j.clinre.2025.102692","url":null,"abstract":"<div><h3>Background</h3><div>Dynamic shifts in serum tumor markers during neoadjuvant therapy could refine prognostication in gastrointestinal (GI) cancers, but supporting evidence is limited.</div></div><div><h3>Methods</h3><div>We prospectively followed 200 patients with gastric (55 %) or colorectal (45 %) cancer who received neoadjuvant chemotherapy ± radiotherapy and curative-intent surgery (2016–2025). Carcinoembryonic antigen (CEA), CA19–9, CA72–4 and CA125 were assayed at baseline and pre-surgery. Three-year disease-free survival (DFS) and overall survival (OS) were primary endpoints. Multivariable Cox models assessed associations between marker dynamics and outcomes.</div></div><div><h3>Results</h3><div>Baseline positivity rates were 40 % for CEA and 30 % for CA19–9; 31 % of patients had ≥ 2 markers elevated. Therapy converted 45 % of CEA-positive and 53 % of CA19–9-positive cases to negative. Major pathological response (Tumor Regression Grade 0–1) occurred in 30 % overall and was higher in marker converters than non-converters (45 % vs 18 %, <em>p</em> < 0.001). Persistent positivity correlated with lower R0 resection (78 % vs 91 %, <em>p</em> = 0.04), more complications (26 % vs 12 %, <em>p</em> = 0.03) and poorer 3-year DFS (42 % vs 69 %). On multivariable analysis, persistence of ≥ 2 positive markers independently predicted shorter DFS (HR 1.9, 95 % CI 1.2–3.0) and OS (HR 2.1, 95 % CI 1.3–3.3). Sensitivity analyses using alternative cut-offs, multiple imputation and exclusion of borderline metastatic cases yielded consistent results.</div></div><div><h3>Conclusion</h3><div>Failure of serum tumor markers to normalize after neoadjuvant therapy signals inferior pathological response and survival. Serial marker assessment can enhance perioperative risk stratification and guide surgical decisions in GI cancers.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102692"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.clinre.2025.102694
Anuradha S Tripathy , Meenal Sharma , Neeta Thorat , Prasad Babar , Nalini Kadgi , Leena Nakate
{"title":"Detection of occult Hepatitis B infection among the blood donors in Pune, India","authors":"Anuradha S Tripathy , Meenal Sharma , Neeta Thorat , Prasad Babar , Nalini Kadgi , Leena Nakate","doi":"10.1016/j.clinre.2025.102694","DOIUrl":"10.1016/j.clinre.2025.102694","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102694"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.clinre.2025.102691
Mohamed Elnaggar , Ibrahim Hassan , Ahmed Bahnasy , Hatem Eltaly , Houman Rezaizadeh
<div><h3>Background</h3><div>Esophageal carcinoma is the seventh most common cancer worldwide and poses a significant public health concern due to its poor overall survival rates. Although treatment advances, including multimodal approaches and enhanced surgical techniques, have emerged, their effect on national mortality trends remains unclear. Understanding the temporal changes in esophageal cancer mortality and potential disparities across demographic and geographic subgroups is crucial for guiding targeted interventions and resource allocation.</div></div><div><h3>Methods</h3><div>We obtained mortality data for esophageal cancer from the CDC WONDER database covering the years 1999 to 2020, using the ICD-10 code (C15) for malignant neoplasm of the esophagus. Annual mortality rates were age-adjusted to the 2000 U.S. standard population and expressed per 10,000 and 100,000 persons. Analyses were stratified by sex (male, female), race/ethnicity (Non-Hispanic Black or African American, Non-Hispanic White, Hispanic), U.S. Census region (Northeast, Midwest, South, West), and urbanization status (rural versus urban). Joinpoint regression identified periods with distinct trends and estimated annual percent changes (APC); the average annual percent change (AAPC) summarized the overall trend.</div></div><div><h3>Results</h3><div>From 1999 to 2020, there were 374,000 recorded deaths from esophageal cancer across a population of over 8 billion. The overall AAMR declined from 4.36 (95 % CI: 4.28–4.44) in 1999 to 3.69 (3.63–3.75) in 2020 (AAPC:0.8 %). Sex disparities were observed, as males had significantly higher mortality (6.43 per 100,000) compared to females (1.38 per 100,000) in 2020, though both showed declining trends (AAPC:0.84 % and -1.12 %, respectively). By race/ethnicity, Black or African American individuals experienced the most pronounced decline, from 6.61 to 2.73 (AAPC:3.82 %), with particularly steep declines after 2018 (APC:1.58 %). Hispanic populations showed moderate decreases from 2.54 to 1.99 (AAPC:1.32 %), while White populations showed minimal change from 4.3 to 4.28 (AAPC:0.05 %).</div><div>Regionally, the West experienced the greatest decline from 4.17 to 3.36 (AAPC:1.08 %), followed by the Northeast which fell from 4.61 to 3.57 (AAPC:1.07 %), the South from 4.23 to 3.56 (AAPC:0.89 %), and the Midwest displaying the smallest decrease from 4.46 to 4.37 (AAPC:0.31 %). Urban areas demonstrated a consistent decline (AAPC:1.09 %), while rural areas showed a modest increase from 4.16 to 4.52 (AAPC: 0.48 %).</div></div><div><h3>Conclusions</h3><div>Mortality due to esophageal cancer in the U.S. has declined modestly from 1999 to 2020, showing substantial variation across demographic and geographic subgroups. Black or African American populations experienced a significant decline in mortality rates compared to other racial groups, while rural areas exhibited concerning increases in mortality rates. Persistent disparities by sex, race/ethn
{"title":"Trends in esophageal cancer mortality in the United States (1999–2024): Disparities by sex, race/ethnicity, region, and urbanization","authors":"Mohamed Elnaggar , Ibrahim Hassan , Ahmed Bahnasy , Hatem Eltaly , Houman Rezaizadeh","doi":"10.1016/j.clinre.2025.102691","DOIUrl":"10.1016/j.clinre.2025.102691","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal carcinoma is the seventh most common cancer worldwide and poses a significant public health concern due to its poor overall survival rates. Although treatment advances, including multimodal approaches and enhanced surgical techniques, have emerged, their effect on national mortality trends remains unclear. Understanding the temporal changes in esophageal cancer mortality and potential disparities across demographic and geographic subgroups is crucial for guiding targeted interventions and resource allocation.</div></div><div><h3>Methods</h3><div>We obtained mortality data for esophageal cancer from the CDC WONDER database covering the years 1999 to 2020, using the ICD-10 code (C15) for malignant neoplasm of the esophagus. Annual mortality rates were age-adjusted to the 2000 U.S. standard population and expressed per 10,000 and 100,000 persons. Analyses were stratified by sex (male, female), race/ethnicity (Non-Hispanic Black or African American, Non-Hispanic White, Hispanic), U.S. Census region (Northeast, Midwest, South, West), and urbanization status (rural versus urban). Joinpoint regression identified periods with distinct trends and estimated annual percent changes (APC); the average annual percent change (AAPC) summarized the overall trend.</div></div><div><h3>Results</h3><div>From 1999 to 2020, there were 374,000 recorded deaths from esophageal cancer across a population of over 8 billion. The overall AAMR declined from 4.36 (95 % CI: 4.28–4.44) in 1999 to 3.69 (3.63–3.75) in 2020 (AAPC:0.8 %). Sex disparities were observed, as males had significantly higher mortality (6.43 per 100,000) compared to females (1.38 per 100,000) in 2020, though both showed declining trends (AAPC:0.84 % and -1.12 %, respectively). By race/ethnicity, Black or African American individuals experienced the most pronounced decline, from 6.61 to 2.73 (AAPC:3.82 %), with particularly steep declines after 2018 (APC:1.58 %). Hispanic populations showed moderate decreases from 2.54 to 1.99 (AAPC:1.32 %), while White populations showed minimal change from 4.3 to 4.28 (AAPC:0.05 %).</div><div>Regionally, the West experienced the greatest decline from 4.17 to 3.36 (AAPC:1.08 %), followed by the Northeast which fell from 4.61 to 3.57 (AAPC:1.07 %), the South from 4.23 to 3.56 (AAPC:0.89 %), and the Midwest displaying the smallest decrease from 4.46 to 4.37 (AAPC:0.31 %). Urban areas demonstrated a consistent decline (AAPC:1.09 %), while rural areas showed a modest increase from 4.16 to 4.52 (AAPC: 0.48 %).</div></div><div><h3>Conclusions</h3><div>Mortality due to esophageal cancer in the U.S. has declined modestly from 1999 to 2020, showing substantial variation across demographic and geographic subgroups. Black or African American populations experienced a significant decline in mortality rates compared to other racial groups, while rural areas exhibited concerning increases in mortality rates. Persistent disparities by sex, race/ethn","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102691"},"PeriodicalIF":2.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.clinre.2025.102690
Di Kang , Jing Li , Jingquan Xu, Yangyang Li, Weiliang Song, Zili Zhang
Objective
Multiple screening strategies are guideline-endorsed for colorectal cancer (CRC). We investigated the clinical value of plasma circulating tumor DNA (ctDNA) MYO1-G methylation and fecal occult blood test (FOBT) combination in CRC screening.
Methods
Participants were allocated to the healthy control, colorectal polyp (Col-pol), and CRC groups. Blood and stool samples were collected at least 1 day before colonoscopy, and plasma ctDNA MYO1-G methylation was measured. The quantitative FOBT was conducted using a fully-automatic OC-Sensor analyzer. CRC patients were assigned to the high-methylation (n = 34) and low-methylation (n = 33) groups as per the median value of methylation ratio of ctDNA MYO1-G. The diagnostic value of plasma ctDNA MYO1-G methylation plus FOBT and the correlation between sensitivity and clinical variables were analyzed.
Results
Col-pol or CRC patients exhibited raised plasma ctDNA MYO1-G methylation copy number and methylation ratio, with CRC patients showing a higher ratio. There was no significant difference in the total copy number of MYO1-G among the three groups. Plasma ctDNA MYO1-G methylation plus FOBT could distinguish Col-pol (AUC = 0.823) and CRC (AUC = 0.955) patients from controls, and discriminate CRC from Col-pol (AUC = 0.844), displaying higher performance than FOBT. The sensitivity of their combination for assessing CRC was independent of gender, age, tumor size, clinical TNM stage, differentiation degree, pathological pattern, and histology, whereas FOBT sensitivity varied by age (p = 0.04), with higher sensitivity in CRC patients > 50 years old.
Conclusion
Plasma ctDNA MYO1-G methylation plus FOBT exhibits high diagnostic value for Col-pol/CRC.
{"title":"Clinical application value of MYO1-G methylation in plasma circulating tumor DNA combined with fecal occult blood test for early screening of colorectal cancer","authors":"Di Kang , Jing Li , Jingquan Xu, Yangyang Li, Weiliang Song, Zili Zhang","doi":"10.1016/j.clinre.2025.102690","DOIUrl":"10.1016/j.clinre.2025.102690","url":null,"abstract":"<div><h3>Objective</h3><div>Multiple screening strategies are guideline-endorsed for colorectal cancer (CRC). We investigated the clinical value of plasma circulating tumor DNA (ctDNA) MYO1-G methylation and fecal occult blood test (FOBT) combination in CRC screening.</div></div><div><h3>Methods</h3><div>Participants were allocated to the healthy control, colorectal polyp (Col-pol), and CRC groups. Blood and stool samples were collected at least 1 day before colonoscopy, and plasma ctDNA MYO1-G methylation was measured. The quantitative FOBT was conducted using a fully-automatic OC-Sensor analyzer. CRC patients were assigned to the high-methylation (n = 34) and low-methylation (n = 33) groups as per the median value of methylation ratio of ctDNA MYO1-G. The diagnostic value of plasma ctDNA MYO1-G methylation plus FOBT and the correlation between sensitivity and clinical variables were analyzed.</div></div><div><h3>Results</h3><div>Col-pol or CRC patients exhibited raised plasma ctDNA MYO1-G methylation copy number and methylation ratio, with CRC patients showing a higher ratio. There was no significant difference in the total copy number of MYO1-G among the three groups. Plasma ctDNA MYO1-G methylation plus FOBT could distinguish Col-pol (AUC = 0.823) and CRC (AUC = 0.955) patients from controls, and discriminate CRC from Col-pol (AUC = 0.844), displaying higher performance than FOBT. The sensitivity of their combination for assessing CRC was independent of gender, age, tumor size, clinical TNM stage, differentiation degree, pathological pattern, and histology, whereas FOBT sensitivity varied by age (<em>p</em> = 0.04), with higher sensitivity in CRC patients > 50 years old.</div></div><div><h3>Conclusion</h3><div>Plasma ctDNA MYO1-G methylation plus FOBT exhibits high diagnostic value for Col-pol/CRC.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102690"},"PeriodicalIF":2.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-19DOI: 10.1016/j.clinre.2025.102689
Maria Pina Dore , Elettra Merola , Giovanni Mario Pes
Helicobacter pylori remains a major cause of gastritis. Rising antibiotic resistance worldwide has undermined traditional therapies, leading to the decline of standard clarithromycin-based triple therapy, necessitating new treatment strategies. In this review, we summarize advances in H. pylori pharmacotherapy, including the use of novel agents (e.g., the potassium-competitive acid blocker vonoprazan and rifabutin-containing regimens), optimized regimens (such as 10–14 day bismuth quadruple therapy), and adjunctive approaches (probiotics). We highlight region-specific challenges, such as developing countries with high H. pylori prevalence and limited resources, where eradication rates with standard therapies can be extremely low. We also discuss how personalized approaches, including antibiotic susceptibility testing, local resistance surveillance, and even artificial intelligence (AI)-driven decision tools, can guide regimen choice (triple vs. quadruple vs. salvage) to maximize success. Cost considerations are also addressed, noting that expensive treatments, may limit their use especially in low-resource settings. Finally, we outline future directions, such as integrating AI into clinical support systems and expanding access to diagnostics, to improve H. pylori management, patient adherence, maximize treatment efficacy, minimize antimicrobial misuse, and improve global eradication success rates.
{"title":"Advances and future perspectives in the pharmacological treatment of Helicobacter pylori infection: Taking advantage from artificial intelligence","authors":"Maria Pina Dore , Elettra Merola , Giovanni Mario Pes","doi":"10.1016/j.clinre.2025.102689","DOIUrl":"10.1016/j.clinre.2025.102689","url":null,"abstract":"<div><div><em>Helicobacter pylori</em> remains a major cause of gastritis. Rising antibiotic resistance worldwide has undermined traditional therapies, leading to the decline of standard clarithromycin-based triple therapy, necessitating new treatment strategies. In this review, we summarize advances in <em>H. pylori</em> pharmacotherapy, including the use of novel agents (e.g., the potassium-competitive acid blocker vonoprazan and rifabutin-containing regimens), optimized regimens (such as 10–14 day bismuth quadruple therapy), and adjunctive approaches (probiotics). We highlight region-specific challenges, such as developing countries with high <em>H. pylori</em> prevalence and limited resources, where eradication rates with standard therapies can be extremely low. We also discuss how personalized approaches, including antibiotic susceptibility testing, local resistance surveillance, and even artificial intelligence (AI)-driven decision tools, can guide regimen choice (triple vs. quadruple vs. salvage) to maximize success. Cost considerations are also addressed, noting that expensive treatments, may limit their use especially in low-resource settings. Finally, we outline future directions, such as integrating AI into clinical support systems and expanding access to diagnostics, to improve <em>H. pylori</em> management, patient adherence, maximize treatment efficacy, minimize antimicrobial misuse, and improve global eradication success rates.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102689"},"PeriodicalIF":2.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gut dysbiosis emerged as a potential metabolic dysfunction-associated steatotic liver disease (MASLD) trigger due to leaky gut and LPS leakage (endotoxemia). MASLD attracts attention from the scientific community due to the non-existence of a specific treatment, the intimate connection to obesity, and its multiple triggers. In this context, physical exercise is a relevant non-pharmacological strategy. However, different intensities and periodicities can produce divergent results, and their impact on the gut-liver axis remains unraveled. Therefore, this comprehensive review outlines the contribution of exercise (MICT or HIIT) to modulating the gut-liver axis in experimental obesity models, with a focus on the intestinal barrier and hepatic mitochondrial and endoplasmic reticulum (ER) homeostasis. The effects of both exercise protocols are likely related to restoring tight junctions and improving gut permeability. Ceased endotoxemia alleviates MASLD by targeting the endoplasmic reticulum (ER) and mitochondria, countering disturbances caused by glucolipotoxicity and inflammation, like ER stress and mitochondrial dyshomeostasis. Although HIIT is superior to MICT in enhancing gut structure and microbiota diversity and possibly mitigating MASLD due to reduced adiposity and improved insulin sensitivity, regular exercise should be encouraged to counter the obesity pandemic by modulating the gut-liver axis.
{"title":"Gut-liver axis: An emerging target for exercise in obesity management","authors":"Laura Alexia Ramos-da-Silva , Henrique Souza-Tavares , Gabriela Rodrigues Medeiros , Nathan Soares Dantas-Miranda , Gabrielle Lima-de-Figueiredo , Daiana Araujo Santana-Oliveira , Flavia Maria Silva-Veiga , Fabiane Ferreira Martins , Vanessa Souza-Mello","doi":"10.1016/j.clinre.2025.102687","DOIUrl":"10.1016/j.clinre.2025.102687","url":null,"abstract":"<div><div>Gut dysbiosis emerged as a potential metabolic dysfunction-associated steatotic liver disease (MASLD) trigger due to leaky gut and LPS leakage (endotoxemia). MASLD attracts attention from the scientific community due to the non-existence of a specific treatment, the intimate connection to obesity, and its multiple triggers. In this context, physical exercise is a relevant non-pharmacological strategy. However, different intensities and periodicities can produce divergent results, and their impact on the gut-liver axis remains unraveled. Therefore, this comprehensive review outlines the contribution of exercise (MICT or HIIT) to modulating the gut-liver axis in experimental obesity models, with a focus on the intestinal barrier and hepatic mitochondrial and endoplasmic reticulum (ER) homeostasis. The effects of both exercise protocols are likely related to restoring tight junctions and improving gut permeability. Ceased endotoxemia alleviates MASLD by targeting the endoplasmic reticulum (ER) and mitochondria, countering disturbances caused by glucolipotoxicity and inflammation, like ER stress and mitochondrial dyshomeostasis. Although HIIT is superior to MICT in enhancing gut structure and microbiota diversity and possibly mitigating MASLD due to reduced adiposity and improved insulin sensitivity, regular exercise should be encouraged to counter the obesity pandemic by modulating the gut-liver axis.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102687"},"PeriodicalIF":2.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-09DOI: 10.1016/j.clinre.2025.102685
Syed Muhammad Mehdi Zaidi , Qunoot Irfan , Rahmah Javed , Zulekha Khalid , Hamna Khan , Muhammad Hasan Ashraf , Mustafa Hassan Alvi , Faiq Wahid , Sana Zehra , Zainab Abbas
Introduction
Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is prevalent amongst children and adolescents. Despite higher incidence, effective treatment options for this population are controversial. This Meta-analysis aims to evaluate the effects of all non-invasive treatment modalities available for MASLD.
Methods
This study includes PubMed, Cochrane Library, and Embase searches (January 2010 to July 2025) for Randomised Controlled Trials (RCTs), evaluating different treatment modalities of MASLD in pediatrics and adolescent population. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Primary outcomes were Aspartate Aminotransferase (AST), Triglycerides (TGs) and Low-Density Lipoproteins (LDL). Secondary outcomes were Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), High-Density Lipoprotein (HDL) and adverse effects. Data were analyzed using Revman 5.3. Continuous values were pooled using the standard mean difference (SMD). Sensitivity analysis was performed to reduce heterogeneity. This study was registered with PROSPERO, CRD42024596682.
Results
We included 31 RCTs, having 1722 participants. Multiple treatment modalities were identified and categorized into dietary intervention, supplementation, drug intervention and exercise. We further categorized dietary intervention into low-sugar diet, low-fat diet and mediterranean diet and compared against different controls. The low-sugar diet showed significant improvement in TG levels against placebo/usual diet [-2.44,95 %CI:3.61,-1.27] and in AST levels against low-fat diet [-1.02, 95 %CI –1.88, -0.16]. LDL levels showed significant change when probiotics were administered against placebo [-0.33, 95 % CI:0.65,0.00].
Conclusion
Supplements and Dietary intervention have shown improvement in liver enzymes and lipid profile. However, more research is required to evaluate the dosage and adverse effects associated with these interventions.
{"title":"Treatment modalities for metabolic dysfunction-associated steatotic liver disease (MASLD) in children and adolescent: A systematic review and meta-analysis of randomized controlled trials","authors":"Syed Muhammad Mehdi Zaidi , Qunoot Irfan , Rahmah Javed , Zulekha Khalid , Hamna Khan , Muhammad Hasan Ashraf , Mustafa Hassan Alvi , Faiq Wahid , Sana Zehra , Zainab Abbas","doi":"10.1016/j.clinre.2025.102685","DOIUrl":"10.1016/j.clinre.2025.102685","url":null,"abstract":"<div><h3>Introduction</h3><div>Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is prevalent amongst children and adolescents. Despite higher incidence, effective treatment options for this population are controversial. This Meta-analysis aims to evaluate the effects of all non-invasive treatment modalities available for MASLD.</div></div><div><h3>Methods</h3><div>This study includes PubMed, Cochrane Library, and Embase searches (January 2010 to July 2025) for Randomised Controlled Trials (RCTs), evaluating different treatment modalities of MASLD in pediatrics and adolescent population. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Primary outcomes were Aspartate Aminotransferase (AST), Triglycerides (TGs) and Low-Density Lipoproteins (LDL). Secondary outcomes were Alanine Aminotransferase (ALT), Gamma-Glutamyl Transferase (GGT), High-Density Lipoprotein (HDL) and adverse effects. Data were analyzed using Revman 5.3. Continuous values were pooled using the standard mean difference (SMD). Sensitivity analysis was performed to reduce heterogeneity. This study was registered with PROSPERO, CRD42024596682.</div></div><div><h3>Results</h3><div>We included 31 RCTs, having 1722 participants. Multiple treatment modalities were identified and categorized into dietary intervention, supplementation, drug intervention and exercise. We further categorized dietary intervention into low-sugar diet, low-fat diet and mediterranean diet and compared against different controls. The low-sugar diet showed significant improvement in TG levels against placebo/usual diet [-2.44,95 %CI:3.61,-1.27] and in AST levels against low-fat diet [-1.02, 95 %CI –1.88, -0.16]. LDL levels showed significant change when probiotics were administered against placebo [-0.33, 95 % CI:0.65,0.00].</div></div><div><h3>Conclusion</h3><div>Supplements and Dietary intervention have shown improvement in liver enzymes and lipid profile. However, more research is required to evaluate the dosage and adverse effects associated with these interventions.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 9","pages":"Article 102685"},"PeriodicalIF":2.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gaucher disease (GD), the most common lysosomal storage disorders, is characterized by glucocerebroside accumulation within macrophages, leading to multisystem involvement including organomegaly, cytopenias, and bone disease. This study aimed to assess the presence and extent of hepatic, splenic, and bone marrow (BM) fibrosis in GD1 patients by using transient elastography (FibroScan®). Analysis a series of 26 adult GD1 patients, both treatment-naïve and enzyme replacement therapy (ERT) treated, was evaluated for liver and spleen stiffness. Eight patients with persistent cytopenia and hepatosplenomegaly underwent BM biopsy. Median liver and spleen stiffness were 4.8 kPa and 26 kPa, respectively. Mild liver fibrosis was identified in 77% of patients, moderate fibrosis in 15%, and cirrhosis in 7.7%, with comparable prevalence between naïve and treated groups. Splenic fibrosis was observed in 54% of patients, more frequently among those receiving ERT. A strong correlation was found between hepatic and splenic fibrosis, as well as between organ stiffness and fibrosis severity. Bone marrow fibrosis was detected in 75% of biopsied patients. These findings indicate that fibrotic progression may persist despite ERT and is not limited to the liver. Integrating non-invasive fibrosis assessment into routine GD1 monitoring may improve early detection and management of this disease complications.
{"title":"Multiorgan fibrosis in Gaucher disease type I: an unmet goal of enzyme replacement therapy","authors":"Zufit Hexner-Erlichman , Nimer Assy , Nayaf Habashi , Awni Yousif , Hanna Rosenbaum","doi":"10.1016/j.clinre.2025.102677","DOIUrl":"10.1016/j.clinre.2025.102677","url":null,"abstract":"<div><div>Gaucher disease (GD), the most common lysosomal storage disorders, is characterized by glucocerebroside accumulation within macrophages, leading to multisystem involvement including organomegaly, cytopenias, and bone disease. This study aimed to assess the presence and extent of hepatic, splenic, and bone marrow (BM) fibrosis in GD1 patients by using transient elastography (FibroScan®). Analysis a series of 26 adult GD1 patients, both treatment-naïve and enzyme replacement therapy (ERT) treated, was evaluated for liver and spleen stiffness. Eight patients with persistent cytopenia and hepatosplenomegaly underwent BM biopsy. Median liver and spleen stiffness were 4.8 kPa and 26 kPa, respectively. Mild liver fibrosis was identified in 77% of patients, moderate fibrosis in 15%, and cirrhosis in 7.7%, with comparable prevalence between naïve and treated groups. Splenic fibrosis was observed in 54% of patients, more frequently among those receiving ERT. A strong correlation was found between hepatic and splenic fibrosis, as well as between organ stiffness and fibrosis severity. Bone marrow fibrosis was detected in 75% of biopsied patients. These findings indicate that fibrotic progression may persist despite ERT and is not limited to the liver. Integrating non-invasive fibrosis assessment into routine GD1 monitoring may improve early detection and management of this disease complications.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 8","pages":"Article 102677"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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