Digestion最新文献

Background: In recent years, the effect of "intestinal-hepatic axis" in tumorigenesis of hepatocellular carcinoma (HCC) has been paid more and more attention, and the imbalance of gut microbiota is closely related to the pathogenesis of HCC. The Xiayuxue decoction has inhibitory effect on hepatic fibrosis, but the effect of Xiayuxue decoction (XYXD) on HCC is not clear.

Methods: We induced HCC mouse model by diethylnitrosamine (DEN) and CCL4. HCC mice were treated with XYXD gavage. Hematoxylin-eosin staining was used to detect the pathological changes of liver tissue in mice. Immunohistochemistry was used to detect the level of Ki-67 in liver tumor and ZO-1 in colon tissue. The level of inflammatory factors in plasma, liver and colon tissue of mice was detected by ELISA. The changes of macrophages and neutrophils in colorectal tissues of mice were counted by immunofluorescence. 16s sequencing was used to analyze the effect of XYXD treatment on gut microbiota of HCC mice.

Results: Our study found that XYXD could inhibit the progress of HCC. XYXD upregulated the expression levels of ZO-1, Occludin and claudin in colon tissue to repair intestinal mucosal barrier. XYXD could alleviate the infiltration of intestinal immune cells in HCC mice by inhibiting the data of macrophages and neutrophils in colon tissue and down-regulating SIgA level. XYXD also regulated the composition of intestinal microorganisms and improve the diversity of gut microbiota, thus affecting the progress of HCC.

Conclusion: XYXD inhibits the progress of HCC by influencing gut microbiota to regulate intestinal and liver inflammation and intestinal immune response.

Introduction: The mucin-rich variant of traditional serrated adenoma (MR-TSA), pathologically defined by the presence of goblet cells comprising over 50% of the lesion compared to the absorptive epithelial eosinophilic cytoplasm, was recently introduced as one morphological variants of traditional serrated adenoma (TSA). This study aimed to characterize the endoscopic and clinicopathological characteristics of MR-TSAs.

Methods: Lesions pathologically diagnosed as TSAs at our hospital between 2011 and 2023 were reviewed. We analyzed the endoscopic and clinicopathological features of 49 MR-TSAs and 236 conventional TSAs (C-TSAs). Furthermore, immunohistochemical and genetic analyses were performed to ensure that there were no discrepancies with our previous study.

Results: MR-TSAs, like C-TSAs, were often located in the sigmoid colon and rectum, with no significant difference in lesion size. Macroscopically, MR-TSAs frequently appeared as type 0-Is with a weak reddish color and had a mucous cap, less often exhibiting a pinecone-like or coral-shaped appearance compared to C-TSAs (p < 0.001). Magnifying endoscopy showed expanded crypt openings in 80% of MR-TSAs (p < 0.001). Both groups had similar IIIH and IVH pit patterns. Immunohistochemical analysis revealed that MUC5AC was expressed more frequently in MR-TSAs than in C-TSAs. Additionally, genetic analysis showed that MR-TSAs more frequently harbored the BRAF mutation than C-TSAs (p < 0.001), whereas MR-TSAs less frequently harbored the KRAS mutation than C-TSAs (p = 0.047).

Conclusion: MR-TSAs, frequently harboring the BRAF but not KRAS mutation, exhibited several distinct endoscopic findings, including a sessile morphology, lack of pinecone-like or coral-like appearance, weak reddish color, and mucous cap.

Introduction: Immunomodulating effects of Helicobacter pylori (H. pylori) have been shown to inhibit antitumor immunity. Resistance to immune checkpoint inhibitor (ICI)-based therapies is common among patients with hepatocellular carcinoma (HCC). This study aimed to assess the effect of H. pylori on the outcomes of ICI in patients with HCC.

Methods: We conducted a multicenter study in patients with HCC across a broad range of treatments. Patients received either ICI-based combination regimens or sorafenib-based therapy. H. pylori serostatus and virulence factors were determined and correlated with overall survival (OS), progression-free survival (PFS), and safety across the treatment modalities.

Results: 180 patients with HCC were included; among these, 64 were treated with ICI-based regimen and 116 with sorafenib-based regimen. In patients treated with ICI, median OS was shorter in H. pylori-positive patients (10.9 months in H. pylori-positive vs. 18.3 months; p = 0.0384). H. pylori positivity was associated with a shorter PFS in ICI recipients (3.9 months vs. 6.8 months, p = 0.0499). In patients treated with sorafenib, median OS was not shorter among H. pylori-positive patients (13.4 months in H. pylori-positive vs. 10.6 months; p = 0.3353). Immune-related adverse events and rates of gastrointestinal bleeding were comparable between H. pylori-positive and -negative patients.

Conclusion: H. pylori seropositivity was linked to poorer outcomes in patients with HCC treated with ICI. This association was not observed among patients receiving sorafenib-based therapies.

Introduction: Helicobacter pylori is a highly prevalent pathogen affecting approximately 50% of the world population, causing chronic gastritis and subsequently adenocarcinoma. Antibiotic resistance rates in H. pylori are increasing, thus demanding alternative treatment options. Some beneficial bacteria, including probiotics and gastrointestinal commensals, were shown to inhibit H. pylori growth, viability, and initial attachment to the gastric epithelium.

Methods: In this review we systematically summarized the currently available literature for in vitro inhibition of H. pylori through beneficial bacteria from the Lactobacillales order. We performed research on PubMed and Google scholar in accordance with the PRISMA guidelines.

Results: A multitude of species was shown to possess anti-H. pylori activity although the majority of investigated bacteria belonged to only one bacterial genus: Lactobacillus. Anti-H. pylori activity was mediated through transcriptional modulation of virulence factors, a competition for binding sites, an induction of a dormancy state of H. pylori and the secretion of anti-H. pylori compounds.

Conclusion: Many bacterial compounds that show probiotic properties are capable of inhibiting H. pylori in in vitro experiments. However, a huge variety of test methods to detect anti-H. pylori effects demands for a standardization.

Introduction: Eosinophilic gastrointestinal disease (EGID) is divided into eosinophilic esophagitis (EoE) and non-eosinophilic esophagitis eosinophilic gastrointestinal disease (non-EoE-EGID), based on the involved gastrointestinal organs. The present survey was performed to provide an overview of the current status of the epidemiology, diagnosis, and treatment of EGID in Asia.

Methods: Responses to the questionnaire were obtained from 228 doctors at various institutions in eight Asian countries. The questionnaire consisted of 52 questions on EoE and non-EoE EGID.

Results: Responses to Questionnaire were obtained from 228 doctors from eight countries. The most common participation facilities were university hospitals, followed by public hospitals, private hospitals, and private clinics. 1-10 were the most frequent patients per year in each institution for both EoE and non-EoE-EGIDs. 30's and 40's are common age groups for both EoE and non-EoE-EGID. Although endoscopic findings vary among countries, 15 or more eosinophil infiltrations in high-power fields as a diagnostic criterion are used in all countries for EoE. As treatments, the prescription rates of Proton pump inhibitor (PPI), diet, topical and systemic steroids, and biologics were similar among the eight countries in EoE. Non-EoE-EGID showed a similar trend to EoE in epidemiology, symptoms, diagnosis, and treatment.

Conclusion: The questionnaire survey partially revealed the current status of the epidemiology, symptoms, diagnosis, and treatment of EGID in Asian countries.

Introduction: Colonoscopy has a crucial role in reducing colorectal cancer incidence and mortality. Different artificial intelligence (AI) systems were developed to further improve its quality assurance (computer-aided quality improvement, CAQ), lesion detection (computer-aided detection, CADe) and lesion characterization (computer-aided characterization, CADx). There were studies investigating the roles of these AI systems in different domains of standard colonoscopies.

Methods: In this state-of-the-art narrative review, we summarize the current evidence, discuss existing limitations, as well as explore the future directions of AI in colonoscopy.

Results: CAQ enhances colonoscopy quality through real-time feedback and quality monitoring systems, but the studies have inconsistent results due to small training datasets and varied methodologies. CADe increases adenoma detection rate and reduces adenoma missed rates but there are concerns about false positives, unnecessary polypectomies, potential de-skilling of endoscopists, and cost-effectiveness. CADx systems have mixed results and accuracies in differentiating polyp types, its use is further hindered by inadequate representation of sessile serrated lesions and a lack of rigorous trials comparing it with standard colonoscopy.

Conclusion: Despite the emerging evidence of AI-assisted colonoscopy, its potential drawbacks and limitations may hinder the further implementation in real-world clinical practice. Long-term data on clinical efficacy, cost effectiveness, liability and data sharing are the key areas to be addressed.

Background: Colorectal cancer (CRC) is a significant global health issue, ranking as the third most commonly diagnosed cancer and the second leading cause of cancer-related deaths. Countries with a high Human Development Index (HDI) report the highest incidence rates, driven by dietary and lifestyle factors. In contrast, low-to-middle HDI countries are experiencing rising CRC rates due to urbanization and westernization. Japan exemplifies this shift, with increasing CRC incidence linked to the adoption of westernized diets. Despite advances in screening and treatment, CRC-related mortality remains substantial, with 53,088 deaths reported in Japan.

Summary: This review examines global and regional CRC trends, focusing on incidence, mortality, and risk factors such as genetic predispositions, diet, and lifestyle influences. The review highlights the growing burden of CRC in Japan and other regions where dietary changes and urbanization are prevalent. Key findings include the significant impact of processed foods, sugary beverages, obesity, alcohol, and smoking on CRC risk, as well as the protective effects of vitamin D, calcium, and fermented foods. The role of inflammatory bowel disease and diabetes in CRC risk is also discussed. Furthermore, the review emphasizes the importance of public health initiatives, including organized screening programs, in mitigating the CRC burden.

Key messages: Understanding the interplay between genetic, lifestyle, and environmental factors is crucial for developing effective prevention strategies. Enhancing CRC screening, early detection, and public health interventions can significantly reduce CRC-related mortality. Continued research and collaboration are essential for advancing CRC prevention and improving global health outcomes.

Background: Patients with a long history of ulcerative colitis (UC) are at risk of developing a serious complication known as UC-associated neoplasia (UCAN). Because the treatment strategy for UCAN greatly differs from that for sporadic tumors, UCAN needs to be distinguished from sporadic tumors. This article provides an overview of the current status and future challenges regarding the surveillance colonoscopy (SC) and endoscopic submucosal dissection (ESD) of neoplastic lesions in patients with UC.

Summary: To reduce the risk of associated mortality, the current guidelines recommend initiating SC using chromoendoscopy with high-definition colonoscopy 8-10 years after the confirmation of a UC diagnosis. However, the endoscopic diagnosis of UCAN is occasionally challenging and requires a stepwise approach using multiple endoscopic modalities. The worldwide consensus is that a diagnosis of high-grade dysplasia or higher is an indication for proctocolectomy. Although the management of low-grade dysplasia (LGD) remains controversial, the SCENIC consensus statement recommends the complete removal of "endoscopically resectable" LGD, followed by monitoring. ESD was developed in Japan, allows for the removal of complex gastrointestinal lesions, facilitates the treatment of LGD, and enables precise pathological evaluations to differentiate between UCAN and sporadic tumors and to determine the grade of dysplasia in UCAN. Close endoscopic surveillance should follow complete endoscopic resection. A Japanese expert consensus meeting recommended the performance of follow-up SC 6-12 months after complete resection with ESD.

Key messages: The roles of ESD for UCAN are to treat LGD and to enable the histopathological examination of complete excisional biopsy specimens to differentiate between UCAN and sporadic tumors and grade the dysplasia of UCAN. In future, prospective cohort studies are needed to better assess the clinical outcomes of ESD in patients with UC.

Crohn's disease (CD) is an inflammatory bowel disease characterized by chronic inflammation of the entire digestive lining. Although the pathogenesis of CD remains unclear, multiple factors especially altered microbiota are among its causes. In this study, an experimental CD model was established by TNBS-enema. Then the dynamic changes of colonic tissue lesions, tight junctions, inflammation response, and oxidative stress are respectively tested by H&E staining, immunofluorescence staining, and commercial kits. 16S rRNA and ITS sequencing of colonic feces were applied to analyze the composition and diversity of the microbiome and mycobiome for lasting 5 weeks. As a result, despite TNBS being applied only once time, the stimuli-caused injury reached a peak in the second week (the most severe period), after which symptoms began to gradually return to the normal stage. Additionally, consistent with the TNBS-caused colonic damage, deaths were also concentrated within two weeks after modeling, with only one death occurring in the subsequent period despite ongoing inflammation and other typical symptoms. In terms of gut bacteria, microbiome diversity decreased significantly while mycobiome diversity increased, along with the enrichment of harmful microbiota and shrinkage of probiotic microorganisms. Therefore, the data suggested that TNBS-induced CD can be roughly divided into two phases: the acute inflammatory phase (weeks 1 to 2) and the chronic inflammatory phase (weeks 3 to 5). However, the microbiome and mycobiome dysbiosis did not return to normal within the trial period. Hence, our findings may facilitate a better comprehension of the dynamic progress of experimental TNBS-induced CD.

Accurate endoscopic diagnosis is crucial for determining the appropriate treatment strategy for colorectal lesions, which may include cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD). While white light imaging (WLI) serves as the basic and initial method for endoscopic diagnosis, additional techniques such as narrow-band imaging (NBI), blue laser/light imaging (BLI), and magnified observation using pit patterns are necessary when WLI results are inconclusive. These advanced diagnostic methods enable precise identification of lesions such as adenoma, T1 cancer, and sessile serrated lesion (SSL). Furthermore, recent advancements in endoscopic systems have enhanced image clarity and detail, thereby improving diagnostic accuracy. This review provides an in-depth discussion on how magnified endoscopy, utilizing the Japan NBI Expert Team (JNET) classification with NBI/BLI and pit pattern classification with chromoendoscopy, aids in the accurate diagnosis of colorectal lesions.