Digestion最新文献

Objective: Eosinophilic enteritis (EoN) remains underrecognized because of nonspecific symptoms and difficulty obtaining deep small intestinal biopsies. We evaluated the diagnostic utility of double-balloon enteroscopy (DBE)-guided multisite biopsy and explored tissue and blood eosinophil thresholds distinguishing EoN from non-EoN conditions.

Methods: This single-center retrospective cohort included consecutive patients who underwent DBE with small intestinal biopsies (January 2021-December 2024). Biopsies were obtained from up to six predefined segments (duodenum, upper/lower jejunum, upper/lower ileum, terminal ileum). EoN diagnosis required abdominal pain and/or diarrhea, exclusion of competing diagnoses, and small intestinal biopsy-proven eosinophilic infiltration. Peripheral eosinophil percentage and computed tomography findings were recorded. The primary outcome was the extent of small intestinal eosinophil infiltration in patients with EoN. Secondary outcomes were the peripheral blood eosinophil count, clinical background, and exploratory comparisons with non-EoN cases.

Results: Eighteen patients were included (5 EoN, 13 non-EoN). Computed tomography showed small intesinal wall edema in three patients with EoN. Peripheral eosinophil counts were significantly higher in EoN (median, 15.2% vs. 1.9%; P < 0.01). Across 83 biopsy specimens (25 EoN, 58 non-EoN), patient-level peak eosinophil counts were greater in EoN (median, 77/HPF [22-213] vs. 23/HPF [12-111]; P < 0.01). All patients with EoN had at least one segment with ≥50 eosinophils/HPF, while two with non-EoN reached this threshold. No DBE-related serious adverse events occurred.

Conclusions: EoN exhibits significantly greater eosinophil infiltration than non-EoN. DBE-guided multisite biopsy enables accurate recognition of EoN. Prospective multicenter studies are needed to refine site-specific thresholds and standardize HPF reporting.

Introduction: Patients with constipation often experience impaired quality of life (QOL). A previous open-label study of Bifidobacterium bifidum G9-1 (BBG9-1) in patients with chronic constipation reported a significant improvement in defecation-related QOL. Thus, we conducted a multicenter, randomized controlled study to assess the efficacy of BBG9-1 in patients with chronic constipation.

Methods: Patients diagnosed with or being treated for chronic constipation between July 2020 and January 2022 and having an overall score of ≥1 on the Japanese version of the patient assessment of constipation quality of life scale (JPAC-QOL) were included. Following a 2-week baseline period, BBG9-1 or placebo was administered for 8 consecutive weeks. The primary endpoint was the change in the JPAC-QOL overall score pre-administration and 8 weeks post-administration of BBG9-1; secondary endpoints were changes in JPAC-QOL subscale scores, number of days of defecation, stool consistency, straining during defecation, and feeling of incomplete evacuation after defecation pre-administration and 8 weeks post-administration.

Results: Data from 140 patients (83 women) were analyzed. The JPAC-QOL overall score improved by 0.65±0.56 in the treatment group and 0.54±0.67 in the placebo group, with no significant difference (P=0.282). However, the physical discomfort subscale showed a nominally significant improvement in the treatment group (P=0.041). Stratified analysis revealed increased defecation frequency and reduced straining in those with high baseline straining scores. No adverse events were reported.

Conclusion: BBG9-1 administration reduced physical discomfort but did not significantly improve the JPAC-QOL overall score, indicating its limited effect on chronic constipation.

Background: The increasing global incidence of Helicobacter pylori-naive gastric cancer (HPnGC) has established it as a clinical entity warranting further study of its diagnosis, pathogenesis, etiologies, classifications, and management.

Summary: HPnGC Helicobacter pylori-naive gastric cancer (HPnGC) is an emerging and distinct clinical entity, with its relative burden increasing as global efforts for Helicobacter pylori (HP) eradication succeeds. The cancer is linked to specific etiologies such as Epstein-Barr virus, autoimmune gastritis, and certain hereditary cancer predisposition syndromes, and is characterized by more aggressive histological subtypes, unfavorable anatomical locations, advanced stages at diagnosis, and ultimately poorer prognosis compared to its H. pylori-positive counterpart. Diagnosis requires stringent multi-modal confirmation of absent infection. Currently, endoscopic, surgical, and systemic treatments are similar to those for Helicobacter pylori-positive gastric cancer.

Key messages: This review demonstrates wide knowledge gaps and areas requiring further clarification. Accurate diagnosis remains challenging due to the absence of standardized criteria, highlighting the need for a robust diagnostic framework. Furthermore, it is imperative for further research into the different molecular subtypes and carcinogenic mechanisms to identify cost-effective surveillance methods and effective treatment strategies that contribute to the development of a comprehensive and practical clinical guideline.

Introduction: Mirikizumab (MIR), a selective IL-23p19 inhibitor, has shown efficacy in clinical trials for ulcerative colitis (UC). However, real-world data, especially on long-term outcomes and in treatment-experienced populations, remain limited.

Methods: We conducted a multicenter retrospective cohort study involving 85 patients with moderate-to-severe UC who initiated MIR between July 2023 and December 2024 across 12 Japanese centers. Co-primary endpoints were clinical remission (Simple Clinical Colitis Activity Index [SCCAI] ≤2 and with no rectal bleeding) at weeks 12 and 52. Secondary outcomes included corticosteroid (CS)-free remission, CRP normalization, treatment persistence, and safety.

Results: Clinical remission was achieved in 62.4% at week 12 and 55.3% at week 52. CS-free remission rates were identical to overall remission at both time points. MIR maintained effectiveness regardless of prior exposure to biologics or JAK inhibitors. Early clinical response at week 4 independently predicted week 52 remission, while steroid dependence was a predictor at week 12. Among patients receiving extended induction, 27.3% of initial nonresponders achieved remission by week 24. Treatment was generally well tolerated, with 17.6% experiencing adverse events and 9.4% discontinuing due to these events. No serious infections or hospitalizations occurred.

Conclusion: MIR demonstrated durable effectiveness and a favorable safety profile over 52 weeks in a real-world UC population, including those with prior treatment failures. These findings support MIR as a viable long-term therapeutic option in routine clinical practice.

Recent therapeutic advances have yielded higher remission rates than before in patients with inflammatory bowel disease (IBD), while many patients in remission still experience gastrointestinal symptoms. These persistent symptoms could be caused by functional bowel disorders and are associated with increased psychological distress. Patients with IBD may have symptoms like functional gastrointestinal disorders (FGID) even before the disease onset, and distinguishing between disease flare and functional symptoms is often difficult. Gastrointestinal infections such as Campylobacter infection may contribute to the onset of both IBD and FGID. The pathophysiology of FGIDs in IBD is complex and multifactorial, involving genetic predisposition, dysregulation of the gut-brain axis, intestinal dysbiosis, impaired mucosal permeability, and low-grade inflammation. These factors further interact with each other to cause symptoms. Management of patients with IBD who present symptoms of FGIDs requires a multifaceted approach based on the principles of FGID treatment under the premise of complete control of intestinal inflammation. In this review, we discuss the clinical overlap, pathophysiology, diagnostic challenges, and a structured approach for patients with IBD who are complicated by symptoms of FGIDs.

Background: Functional dyspepsia (FD) is a common disorder of gut-brain interaction characterized by postprandial distress and epigastric pain, which significantly impairs quality of life and increases healthcare burden. Although the Rome IV criteria and Japanese guidelines have refined its definition, the pathophysiology remains multifactorial, involving gastric motility abnormalities, visceral hypersensitivity, and autonomic dysfunction. Traditional diagnostic approaches, mainly based on clinical history and exclusion of organic diseases, are limited in elucidating the underlying mechanisms.

Summary: Recent advances in gastrointestinal functional assessments have enabled more detailed evaluation of gastric accommodation, emptying, motility, and sensory function. Techniques such as barostat, antroduodenal manometry, gastric scintigraphy, and gastric emptying breath tests have been established in research settings, while newer modalities-including cine magnetic resonance imaging, body surface gastric mapping, and wireless motility capsule-offer noninvasive and comprehensive insights into gastric motor and sensory function. Furthermore, the use of endoscopy-based functional testing has expanded diagnostic capabilities. Autonomic nervous system testing, including heart rate variability analysis and exploratory wearable-device approaches, provides additional perspectives on the gut-brain axis. Collectively, these tools have advanced the understanding of FD pathophysiology; nonetheless, their availability and standardization remain limited.

Key messages: FD is highly prevalent and burdensome, with a complex and multifactorial pathophysiology. A wide range of gastrointestinal functional tests has been developed, from established barostat and scintigraphy to emerging noninvasive methods such as cine magnetic resonance imaging, endoscopy-based functional testing, wireless motility capsule, and body surface gastric mapping. These novel approaches can capture both motor and sensory abnormalities, offering new opportunities for personalized management of FD. Standardization, validation, and wider clinical implementation of these functional assessments are needed to translate research advances into routine practice.

Introduction: Dietary factors, including fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs), have been implicated in symptom generation among patients with functional dyspepsia (FD). Accordingly, a low-FODMAP diet (LFD) has been proposed as a potential therapeutic approach. However, a systematic review in this field has not yet been conducted. This study aimed to evaluate the effects of an LFD on gastrointestinal symptoms and quality of life (QoL) in patients with FD.

Methods: Following PRISMA guidelines, MEDLINE, Embase, and CENTRAL were searched through October 2025. Studies involving adults or children diagnosed with FD and treated with a structured LFD or lower habitual FODMAP intervention were included. Randomized controlled trials (RCTs) and non-RCTs were assessed for methodological quality using the Cochrane RoB 2 tool and the Newcastle-Ottawa Scale, respectively.

Results: Ten studies involving 4,329 patients (two RCTs and eight non-RCTs) met the inclusion criteria. Both RCTs demonstrated significant improvements in dyspeptic symptoms and QoL following an LFD compared with the control or baseline. Non-RCTs consistently showed symptom relief and improved QoL in adults and children under dietitian supervision, whereas lower habitual FODMAP intake was associated with a higher risk of FD prevalence in cross-sectional studies. Overall, the studies exhibited a predominantly moderate risk of bias.

Conclusion: Current evidence suggests that an LFD may alleviate gastrointestinal symptoms and enhance QoL in patients with FD. However, existing studies remain few and heterogeneous. High-quality, adequately powered clinical and mechanistic studies are warranted to confirm its therapeutic efficacy and clarify the underlying physiological mechanisms.

Background/aims: Duodenal neuroendocrine tumors (DNETs) are rare neoplasms with malignant potential, and the optimal strategy between endoscopic resection (ER) and surgical resection (SR) remains debated. This study evaluated the clinical outcomes of ER and SR in patients with DNETs at a single tertiary center.

Methods: We retrospectively reviewed patients diagnosed with DNETs at Seoul St. Mary's Hospital between 2009 and 2025. The clinical features, treatment modalities, pathology, complications, and long-term outcomes were analyzed. Median follow up was 4.76 years (0.03-13.70) Results: Sixty-five patients were included (mean age, 62.9 years; 31 men). Fifty patients underwent ER (26 EMR, 9 EMR-L, 11 EMR-P, 1 ESD, 2 ampullectomy, and 1 removal with hot biopsy), while 15 underwent SR (10 wedge resections and 5 pancreatoduodenectomy/Whipple). The en bloc resection rate for ER was 93.9% (46/49), with a histopathologically curative resection rate of 69.4%. Fourteen ER patients had positive margins; one underwent additional surgery with a confirmed residual tumor, but the others showed no recurrence during a median follow-up of 6.8 years. Perforation occurred in three ER cases (6%), all of whom were successfully treated. Among the wedge resections, R1 resection occurred in 3/10 cases. One patient developed lymph node recurrence 12 years after wedge resection, whereas the others remained disease-free. Overall, recurrence was rare in both groups.

Conclusions: ER and local surgical resection are effective, minimally invasive treatments for small DNETs, with high resection rates and acceptable safety. However, positive margins and lymphovascular invasion are risk factors for remnant tumors or late recurrence, underscoring the importance of long-term surveillance in high-risk patients.

Background: Cronkhite-Canada syndrome (CCS) is a rare, nonhereditary gastrointestinal disorder with unclear etiology and limited treatment consensus. Given the scarcity of data, we aimed to construct a pooled literature-based cohort to analyze survival outcomes and identify prognostic factors to inform future therapeutic strategies.

Methods: We developed a literature-based cohort of Cronkhite-Canada syndrome by extracting individual patient data from published case reports and two in-house cases. Articles were selected through a systematic screening process based on relevance and data availability. Information collected included age, sex, clinical symptoms, laboratory findings, endoscopic and histological features, treatment approaches, and outcomes. The compiled dataset was used to explore clinical characteristics, treatment patterns, and survival trends across reported cases.

Results: A total of 200 CCS patients were analyzed, including 198 from literature and 2 in-house cases. Most patients presented with diarrhea, weight loss, skin pigmentation, and alopecia. Polyps were commonly found in the stomach and colon. Survival analysis showed a 1-year survival rate of 92.3% and a 3-year survival rate of 79.9%. Male sex was associated with poor prognosis. However, multivariate analysis showed no significant predictors. Treatment with corticosteroids significantly improved survival, especially with high doses (≥ 40 mg/day). Surgical intervention tended to correlate with poorer outcomes. These findings suggest that appropriately dosed corticosteroid therapy may enhance long-term prognosis in CCS.

Conclusions: Using a comprehensive analysis of literature-based Cronkhite-Canada syndrome cases and our in-house cases, this study demonstrated the clinical characteristics of CCS. Our data showed the prognostic value of sex and surgical intervention, and the significance of high dose corticosteroid therapy on the treatment of CCS.

Background and aims: In patients with acute cholecystitis and choledocholithiasis undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by interval cholecystectomy (6 weeks-3 months), preoperative biliopancreatic events are reported in 18.3-41.8%. Endoscopic Transpapillary Gallbladder Drainage (ET-GBD) is indicated in this patient group if there are comorbidities preventing surgery. This study compared biliopancreatic events during the interval to cholecystectomy in patients who underwent ET-GBD despite being surgically fit versus those treated with ERCP alone.

Methods: In this retrospective study conducted between 2018 and 2023, 121 patients with cholecystitis secondary to choledocholithiasis underwent ERCP. Surgical candidates expected to undergo delayed cholecystectomy were divided into two groups: those who received ET-GBD (study group) and those who did not (control group, from the first half of the study period).

Results: The ET-GBD group had a mean age of 54.54 (56.7% female), while the non-ET-GBD group had a mean age of 63.18 (50% female). During the waiting period, biliopancreatic events occurred in 1/34 (2.9%) of ET-GBD patients versus 18/34 (52.9%) of controls (absolute risk reduction 50.0%, 95% CI 21.8-68.0; relative risk 0.056, 95% CI 0.0079-0.39; p < 0.001). Specifically, biliary colic (2.9% vs. 47.1%; p < 0.001), cholecystitis (0% vs. 17.6%; p = 0.009), and choledocholithiasis (0% vs. 26.4%; p = 0.001) were significantly less frequent in the ET-GBD group.

Conclusion: ET-GBD was associated with significantly lower biliopancreatic complications during the interval to surgery in operable patients with acute cholecystitis and choledocholithiasis.