Digestive Diseases最新文献

Introduction: Acute esophageal necrosis (AEN) is a rare and lethal condition that may progress to sepsis and perforations. Most related literature comes from case reports; however, a few small reviews have been published. We conducted a large systematic review of AEN using PubMed, Medline, and Embase to organize data into one consolidated manuscript, find potential prognosticators of illness, and determine possible treatment guidelines for AEN.

Methods: Advanced searches were performed of all English case reports from 1990 to 2021 using medical subject heading terms. Data on patient age, sex, comorbidities, initial presentation, management, progression of illness, and hospital survival were collected.

Results: Our study included 226 articles, encompassing 319 cases. A total of 32.3% of patients had diabetes, 26.6% had hypertension, and 19.7% had alcohol use disorder. Overall, 66.5% presented with an upper gastrointestinal bleed and 21.9% developed sepsis or esophageal perforation. In total, 60.9% of patients were reported to have survived their illness, but 16.6% of cases did not have their discharge status documented. Interestingly, patients presenting with pain or ketoacidosis demonstrated improved survival.

Conclusion: AEN becomes more prevalent as patients age and develop cardiovascular disease, which increases the risk of developing a hypoperfusive state and mucosal injury to the distal esophagus. Early fluid resuscitation, acid-reducing agents, and bowel rest may serve as potential lifesaving interventions, and antibiotics should be considered if there is concern for infection. Patients require close follow-up in anticipation of impending stricture.

Introduction: Acute esophageal necrosis (AEN) is a rare and lethal condition that may progress to sepsis and perforations. Most related literature comes from case reports; however, a few small reviews have been published. We conducted a large systematic review of AEN using PubMed, Medline, and Embase to organize data into one consolidated manuscript, find potential prognosticators of illness, and determine possible treatment guidelines for AEN.

Methods: Advanced searches were performed of all English case reports from 1990 to 2021 using medical subject heading terms. Data on patient age, sex, comorbidities, initial presentation, management, progression of illness, and hospital survival were collected.

Results: Our study included 226 articles, encompassing 319 cases. A total of 32.3% of patients had diabetes, 26.6% had hypertension, and 19.7% had alcohol use disorder. Overall, 66.5% presented with an upper gastrointestinal bleed and 21.9% developed sepsis or esophageal perforation. In total, 60.9% of patients were reported to have survived their illness, but 16.6% of cases did not have their discharge status documented. Interestingly, patien

Introduction: Tissue-clearing technology has shown potential for comprehensive structural and functional analysis through three-dimensional (3D) imaging of biological tissue. However, its effectiveness in human specimens remains insufficiently explored. In this study, we validated the illuminate cleared organs to identify target molecules (LUCID) protocol for human gastrointestinal specimens and demonstrated its utility in enhancing tissue transparency and 3D imaging.

Methods: The gastrointestinal mucosa specimens resected via endoscopic submucosal dissection including the esophagus, stomach, duodenum, and colon were fluorescently stained and optically cleared using LUCID. Cleared specimens were imaged in 3D form by confocal laser scanning microscope, and the observable depth at any five points was measured and compared to non-cleared specimens, respectively. After clearing and imaging, the specimens were restored to the formalin-fixed paraffin-embedded form again, and conventional two-dimensional pathological evaluation using hematoxylin-eosin, Ki67, p53, and E-cadherin staining was performed to compare them with their preclearing state.

Results: The observable depth was significantly extended after clearing for specimens from each organ (esophagus 228.3 ± 14.9 µm vs. 1,036.7 ± 62.9 µm, p < 0.05; stomach 115.2 ± 5.5 µm vs. 428.7 ± 15.9 µm, p < 0.05; duodenum 256.2 ± 9.5 µm vs. 787.0 ± 18.6 µm, p < 0.05, colon 113.9 ± 5.4 µm vs. 436.6 ± 18.5 µm, p < 0.05). The pathological evaluation after clearing revealed a preserved fine structure and staining and showed no apparent deformation, degeneration, or tissue damage compared with before clearing.

Conclusions: The effectiveness of tissue clearing using LUCID on human gastrointestinal specimens was demonstrated, and the LUCID protocol had minimal impact on specimen morphology and staining. LUCID is expected to be a method that enables comprehensive structural analysis of human gastrointestinal mucosa and lesions that may avoid missing microscopic findings that may occur in split-face pathological assessment.

Introduction: This study investigated the off-therapy relapse in hepatitis B e antigen (HBeAg)-negative non-cirrhotic patients who discontinued tenofovir alafenamide (TAF) or entecavir (ETV).

Methods: Non-cirrhotic HBeAg-negative patients who discontinued TAF or ETV were enrolled. The propensity score matching method at a ratio of 1:1 and Cox proportional hazard model were performed to analyze factors associated with virological relapse and clinical relapse.

Results: A total of 62 patients were analyzed. The cumulative rates of virological relapse at 12 months after discontinuing TAF and ETV were 80.4% and 60.0%, respectively. The respective rates of clinical relapse at 12 months were 48.7% and 21.1%. Multivariable Cox regression analysis showed that discontinuation of TAF (vs. ETV, HR = 2.279; p = 0.005) and HBsAg levels at EOT (HR = 1.540; p = 0.005) were independently associated with virological relapse. Discontinuation of TAF (vs. ETV, HR = 3.003; p = 0.011) was independently associated with clinical relapse. HBsAg levels at EOT (<3 vs. ≥3 log10 IU/mL) had significant interactions with the treatment regimen (TAF vs. ETV) in terms of the risk of clinical relapse after treatment cessation (p for interaction <0.05).

Conclusion: Patients who discontinued TAF had a higher risk of virological relapse and clinical relapse than those who discontinued ETV. HBsAg levels at EOT may be an appropriate predictor to distinguish the different risks of clinical relapse between patients who have discontinued TAF or ETV.

Introduction: Endoscopic submucosal dissection (ESD) has become a widely adopted treatment for early esophageal cancer. However, extensive mucosal defects resulting from ESD pose a significant risk of post-procedural strictures. Despite efforts to prevent strictures through various means, including steroid administration, they remain a challenge, significantly impacting patients' quality of life and healthcare costs. Thus, identifying risk factors for refractory strictures following entire circumferential esophageal ESD (EC-E-ESD) is imperative.

Methods: Between July 2013 and September 2023, 49 patients who underwent EC-E-ESD were retrospectively analyzed. Patients were classified based on the presence of refractory or non-refractory strictures. A refractory stricture was defined as requiring six or more endoscopic balloon dilation procedures before stricture improvement. Clinicopathological features and outcomes were examined using multivariate logistic regression analysis.

Results: Refractory strictures were observed in 51% of patients. A comparison showed that the refractory group had a significantly higher percentage of muscular injury (52% vs. 8%, p = 0.002) and mucosal defect length ≥50 mm (68% vs. 37%, p = 0.047) than the non-refractory group. Multivariate analysis showed that muscular injury (odds ratio 16.2; 95% confidence interval: 2.04-129.1) was an independent risk factor for refractory strictures after EC-E-ESD.

Conclusions: Muscular injury during EC-E-ESD is a risk factor for refractory strictures. Strategies to prevent injury, such as meticulous dissection techniques and effective steroid administration, may mitigate this risk. However, current prophylactic measures are inadequate, highlighting the need for further research into preventive strategies.

Introduction: Endoscopic submucosal dissection (ESD) has become a widely adopted treatment for early esophageal cancer. However, extensive mucosal defects resulting from ESD pose a significant risk of post-procedural strictures. Despite efforts to prevent strictures through various means, including steroid administration, they remain a challenge, significantly impacting patients' quality of life and healthcare costs. Thus, identifying risk factors for refractory strictures following entire circumferential esophageal ESD (EC-E-ESD) is imperative.

Methods: Between July 2013 and September 2023, 49 patients who underwent EC-E-ESD were retrospectively analyzed. Patients were classified based on the presence of refractory or non-refractory strictures. A refractory stricture was defined as requiring six or more endoscopic balloon dilation procedures before stricture improvement. Clinicopathological features and outcomes were examined using multivariate logistic regression analysis.

Results: Refractory strictures were observed in 51% of

Introduction: Colorectal non-polypoid lesions (NPLs) are flat, hard-to-detect, and mainly right-sided lesions. We aimed to assess the prevalence and endoscopic features of NPL lesions in a large cohort of screening patients in Northern Italy.

Methods: Fecal immunochemical test (FIT)-positive subjects between 50 and 69 years old who had undergone at least a screening colonoscopy from March 2005 to December 2017 at the Endoscopy Unit of Ferrara were included. We selected only non-diminutive (>5 mm) and neoplastic polyps (i.e., adenomas, serrated adenomas, and carcinomas). Patients' demographics and polyps' endoscopic-histopathological data were collected. Categorical variables were compared using the Pearson's χ2 test and Fisher's exact test, while odd ratios and confidence intervals were estimated with univariate analysis.

Results: A total of 6,676 FIT-positive subjects underwent 7,616 colonoscopies during the study period. Total lesions were 3,231, of which 133 were NPLs and among these 123 were neoplastic. The prevalence of NPLs among total lesions was 4.1%, while prevalence of neoplastic NPLs among total neoplastic lesions was 4.6%. The prevalence of NPLs and neoplastic NPLs among total colonoscopies was 1.7% and 1.6%, respectively. Neoplastic NPLs were more frequent between 60 and 64 years old (p = 0.03) and associated with other colonic polyps in subjects older than 60 years (p = 0.016). Cancerized NPLs were more likely in younger patients (50-59 years old, p = 0.04).

Conclusions: Prevalence of NPLs is low among the screening population, but NPLs are frequently associated with other colorectal polyps in patients older than 60 years and carry a higher risk of cancer in patients younger than 60 years old.

Introduction: Genetic abnormalities specific to post-Helicobacter pylori eradication gastric cancer (GC), especially those associated with undifferentiated post-eradication GC, are unknown. We conducted next-generation sequencing of GC diagnosed either before or after eradication to investigate the carcinogenesis of post-eradication GC.

Methods: Five cases of post-eradication differentiated GC [HP(-)-D group], five cases of H. pylori-positive differentiated GC [HP(+)-D group], four cases of post-eradication undifferentiated GC [HP(-)-U group], and six cases of H. pylori-positive undifferentiated GC [HP(+)-U group] underwent analysis. DNA was extracted from tumor samples, and non-tumor samples of all subjects. Next-generation target sequencing was conducted using the Ion AmpliSeq Library Kit 2.0 with the Ion AmpliSeq Cancer Hotspot Panel v2. Next-generation targeted sequencing results of the cancer part were subtracted from the results of the non-cancer part.

Results: The HP(-)-D group displayed significantly fewer SNPs in hotspot than the other groups (p < 0.01). Definitive DNA mutations were identified by sequencing of cancerous and non-cancerous tissues. 5 of 20 patients had specific somatic mutations, with different TP53 mutations in the HP(+)-D and HP(-)-U groups, CTNNB1 mutations in the HP(+)-U group, and ATM mutations in the HP(+)-U group, but no mutations in the HP(-)-D group.

Conclusion: Several definite genetic mutations involved in GC were observed. Mutations were less frequent in post-eradication differentiated GC. However, because of small number of cases analyzed to identify carcinogenic differences, further analysis with a large number of cases and with strictly grading GC samples is needed.

Introduction: Genetic abnormalities specific to post-Helicobacter pylori eradication gastric cancer (GC), especially those associated with undifferentiated post-eradication GC, are unknown. We conducted next-generation sequencing of GC diagnosed either before or after eradication to investigate the carcinogenesis of post-eradication GC.

Methods: Five cases of post-eradication differentiated GC [HP(-)-D group], five cases of H. pylori-positive differentiated GC [HP(+)-D group], four cases of post-eradication undifferentiated GC [HP(-)-U group], and six cases of H. pylori-positive undifferentiated GC [HP(+)-U group] underwent analysis. DNA was extracted from tumor samples, and non-tumor samples of all subjects. Next-generation target sequencing was conducted using the Ion AmpliSeq Library Kit 2.0 with the Ion AmpliSeq Cancer Hotspot Panel v2. Next-generation targeted sequencing results of the cancer part were subtracted from the results of the non-cancer part.

Results: The HP(-)-D group displayed significantly fewer SNPs in hotspot than the other groups (p < 0.01). Definitive DNA mutations we

Introduction: Previous studies reported inconsistent results of the association between Helicobacter pylori infection and nonalcoholic fatty liver disease (NAFLD).

Methods: A cohort study of 2,063 adults without NAFLD at baseline, who participated in a repeated health checkup including a 13C-urea breath test and abdominal ultrasonography, was conducted to evaluate the link between H. pylori infection and NAFLD development.

Results: During a mean follow-up period of 1.7 years, we did not find a significant association between H. pylori infection and NAFLD (hazard ratio = 1.10 (0.86, 1.40), p = 0.4689). We also found that higher age, body mass index (BMI), systolic blood pressure (systolic BP), diastolic blood pressure (diastolic BP), fasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were risk factors, and high-density lipoprotein cholesterol (HDL-C) was a protective factor for NAFLD development.

Conclusion: H. pylori infection might not be positively related to NAFLD development.

Introduction: The appropriate use of benzodiazepines for sedation during prolonged therapeutic endoscopy has not yet been established. This retrospective observational study compared the safety and efficacy of diazepam (DZP) and midazolam (MDZ) under moderate sedation during gastric endoscopic submucosal dissection (ESD).

Methods: We studied 554 patients who underwent gastric ESD under sedation with DZP or MDZ combined with pentazocine. Sedation depth was assessed and recorded using the Richmond Agitation-Sedation Scale (RASS). According to the American Society of Anesthesiologists definition of sedation levels, RASS scores of -4 to -2 points indicated moderate sedation, whereas a score of -5 points indicated deep sedation. Sedation levels, respiratory and circulatory dynamics during the procedure, and the incidence of ESD-related pneumonia were compared.

Results: Of these, 273 and 281 patients received DZP and MDZ, respectively. No significant differences were observed in the occurrence of deep sedation (DZP:MDZ = 12.1%:15.4%) or in the proportion of patients who maintained moderate intraoperative sedation (76.2%:80.4%). Respiratory parameters showed no significant differences; however, blood pressure reduction was more common in the MDZ group (4.8%:11.0%, p = 0.007). Multivariate analysis identified MDZ as a significant factor associated with blood pressure reduction. The incidence of ESD-related pneumonia did not differ between the two groups.

Conclusions: DZP and MDZ were similarly effective in maintaining adequate sedation levels during gastric ESD. Respiratory depression did not differ between the groups; however, circulatory depression was more pronounced in the MDZ group.

Background: Due to aging of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence-free survival (RFS), and complication rates in elderly HCC patients undergoing resection.

Methods: We searched PubMed, Embase, and Cochrane databases from inception to November 10, 2020, for studies reporting outcomes in elderly (age ≥65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.

Results: We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI: 72.89-76.02), 75.54% were male (95% CI: 72.53-78.32) and 66.73% had cirrhosis (95% CI: 43.93-83.96). The mean tumor size was 5.50 cm (95% CI: 4.71-6.29) and 16.01% had multiple tumors (95% CI: 10.74-23.19). The 1-year (86.02% vs. 86.66%, p = 0.84) and 5-year OS (51.60% vs. 53.78%) between non-elderly and elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% vs. 73.26%, p = 0.11) and 5-year RFS (31.57% vs. 30.25%, p = 0.67) between non-elderly and elderly patients. There was a higher rate of minor complications (21.95% vs. 13.71%, p = 0.03) among elderly patients compared with non-elderly patients, but no difference in major complications (p = 0.43).

Conclusion: These data show that OS, recurrence, and major complications after liver resection for HCC are comparable between elderly and non-elderly patients and may inform clinical management of HCC in this population.

Background: Due to aging of the global population, hepatocellular carcinoma (HCC) is increasingly common among elderly patients, but outcomes after curative hepatic resection are unclear. Using a metanalytic approach, we aimed to estimate overall survival (OS), recurrence-free survival (RFS), and complication rates in elderly HCC patients undergoing resection.

Methods: We searched PubMed, Embase, and Cochrane databases from inception to November 10, 2020, for studies reporting outcomes in elderly (age ≥65 years) patients with HCC undergoing curative surgical resection. Pooled estimates were generated using a random-effects model.

Results: We screened 8,598 articles and included 42 studies (7,778 elderly patients). The mean age was 74.45 years (95% CI: 72.89-76.02), 75.54% were male (95% CI: 72.53-78.32) and 66.73% had cirrhosis (95% CI: 43.93-83.96). The mean tumor size was 5.50 cm (95% CI: 4.71-6.29) and 16.01% had multiple tumors (95% CI: 10.74-23.19). The 1-year (86.02% vs. 86.66%, p = 0.84) and 5-year OS (51.60% vs. 53.78%) between non-elderly and elderly patients were similar. Likewise, there were no differences in the 1-year (67.32% vs. 73.26

Introduction: Leucine-rich alpha-2 glycoprotein (LRG) is a useful serum biomarker for monitoring disease activity during remission in ulcerative colitis (UC). Because LRG levels differ among patients, it is necessary to assess them after profiling patients, especially in patients with refractory UC undergoing treatment with molecular-targeted drugs. This study aimed to analyze LRG levels that indicate mucosal healing according to clinical characteristics and molecular-targeted drugs.

Methods: Among 214 patients with UC treated with biologics or Janus kinase (JAK) inhibitors, this study evaluated 111 patients (174 measurements) who achieved mucosal healing based on colonoscopy performed within 2 months before and after LRG measurement and experienced no changes in disease status or treatment during the same period. We analyzed the relationship of LRG with clinical characteristics (including sex, age, body mass index, and disease type and duration) and molecular-targeted drugs.

Results: Compared with men, women had significantly higher LRG levels (9.5 μg/mL vs. 11.3 μg/mL, p < 0.001). In addition, LRG levels were significantly higher in older patients (12.0 μg/mL vs. 9.8 μg/mL, p < 0.01). LRG levels were the highest in patients treated with vedolizumab and lower in patients treated with JAK inhibitors (vedolizumab: 12.7 μg/mL; tofacitinib: 8.9 μg/mL; upadacitinib: 8.5 μg/mL; and filgotinib: 9.1 μg/mL; p < 0.0001).

Conclusion: Among the patients who achieved mucosal healing, LRG levels were significantly higher in women and older patients. LRG levels differed according to the molecular-targeted drug used and were higher with vedolizumab and lower with JAK inhibitors.