Digestion最新文献

Introduction: Oral lichen planus (OLP) is a chronic inflammatory condition and a precancerous lesion of OLP based oral squamous cell carcinoma (OSCC), with possible esophageal involvement (esophageal lichen planus, ELP), though the latter prevalence and clinical significance remain uncertain. This study aimed to determine ELP prevalence in OLP/OSCC patients, assess the diagnostic performance of white-light endoscopy (WLE), narrow-band imaging (NBI), and Lugol's iodine staining based chromoendoscopy, and evaluate histologic findings for potential prognostic implications.

Methods: In this prospective single-center study (2011-2020), 81 adults with confirmed OLP and about 50 % history of OSCC underwent esophagogastroduodenoscopy (EGD) using WLE, NBI, and chromoendoscopy. Biopsies were taken from visually suspicious areas and from normal-appearing mucosa throughout the esophagus, stomach and duodenum.

Results: ELP was identified in only four patients (4,9 %), all of whom were asymptomatic or had minimal symptoms. In three cases, ELP was detected only via random biopsies despite normal endoscopic appearance. The sensitivity of WLE, NBI, and chromoendoscopy was low, with Lugol´s staining yielding false positives due to benign changes like glycogen acanthosis. No dysplasia or carcinoma was observed.

Conclusion: Even in one of the largest prospective studies, ELP remained a rare finding, often clinically silent, and frequently undetectable on endoscopy. Step biopsies are essential for diagnosis. EGD screening in OLP may be considered as a one-time index endoscopy, supplemented by symptom-based evaluation in selected cases. ELP does not appear to increase short-term malignancy risk, and management should focus on symptom control and avoiding complications.

Introduction: Immune-related adverse events (irAEs), which occur due to loss of immune tolerance, represent a significant challenge when using immune checkpoint inhibitors (ICIs). As the indications for ICIs continue to expand, the incidence of irAEs has been increasing. Immune-mediated diarrhea and colitis (IMDC) is one of the most frequent irAEs. Although important for the management of IMDCs, colonoscopy is highly invasive for patients with cancer, and development of noninvasive alternatives is needed.

Methods: We prospectively enrolled patients diagnosed with IMDC between May 2019 and May 2025, and a total of 34 patients were included in the final analysis. Blood and stool samples were collected, and biomarker levels were measured. Endoscopic activity was defined as a Mayo Endoscopic Subscore of ≥2, as evaluated during colonoscopy. The relationship of each biomarker with endoscopic activity was examined using Spearman's rank correlation and receiver operating characteristic curve analysis.

Results: Fecal calprotectin (FC), fecal lactoferrin (FL), and fecal immunochemical test (FIT) were significantly correlated with the Mayo Endoscopic Subscore, with correlation coefficients of 0.50, 0.51, and 0.74, respectively. These biomarkers effectively detected endoscopic activity, with high area under the curve values of 0.79, 0.81, and 0.94, respectively. Furthermore, certain combinations of fecal biomarkers enhanced accuracy, as demonstrated by FC (+) or FIT (+), which achieved a sensitivity of 95.5% and a specificity of 75.0%.

Conclusion: Fecal biomarkers were correlated with endoscopic activity and effectively identified patients with endoscopically active IMDC. Our findings suggest that these biomarkers may be valuable tools for the diagnosis and assessment of treatment response in IMDC.

Introduction: Endoscopic submucosal dissection (ESD) is a technically demanding curative treatment for early gastric cancer. The EndoTrac traction device was designed to enhance maneuverability during ESD. This study evaluated whether EndoTrac-assisted ESD (ET-ESD) improves outcomes versus conventional ESD (C-ESD) in patients with superficial gastric neoplasms.

Methods: In this multicenter, single-blind, randomized controlled trial, 142 patients from 11 Japanese centers were assigned to undergo ET-ESD (n = 72) or C-ESD (n = 70). The primary endpoint was ESD procedure time. Secondary endpoints included efficacy, safety, and device-related outcomes. Operator experience, lesion characteristics, knife type, and institutional ESD volume were recorded and analyzed.

Results: Median procedure times were 53.5 min for ET-ESD and 57.0 for C-ESD (p = 0.56). Among trainees, ET-ESD was associated with a shorter procedure time than C-ESD (59.0 vs. 85.5 min; p = 0.02). In subgroup analyses of trainee cases, shorter times with ET-ESD were associated with several scenarios (e.g., lesions ≤20 mm, upper/middle third of the lesser curvature, needle-type knife, and low-volume centers). In a multivariable analysis among trainees, ET-ESD remained independently associated with shorter procedure time (B = -24.8 min; 95% CI: -43.8 to -5.8; p = 0.012). In the overall cohort, en bloc and R0 resection rates, adverse events, and device-related complications were similar between groups.

Conclusion: ET-ESD did not significantly shorten procedure time in the overall cohort. Nonetheless, exploratory subgroup analyses suggested potential benefits among trainees, small lesions, technically challenging locations, and low-volume centers.

Introduction: The novel double-balloon enteroscope (DBE), EN-840T, is the first DBE system to incorporate image-enhanced endoscopy (IEE) technologies, such as blue laser imaging (BLI) and linked-color imaging (LCI). This study aimed to evaluate the efficacy of IEE in improving the visibility of small-bowel lesions using EN-840T.

Methods: We conducted a retrospective analysis of 49 patients with 120 lesions who underwent double-balloon enteroscopy using EN-840T between March and June 2024. Lesion visibility and color differences were compared among BLI, LCI, and white light imaging (WLI). Five physicians assessed lesion visibility by assigning scores. Additionally, color differences between normal mucosa and the patchy reddish lesions <5 mm in diameter, including angioectasia and erythema, were calculated for each IEE and WLI image. The primary and secondary outcomes were the visibility of small-bowel lesions on IEE and the color differences in these lesions, respectively.

Result: Lesions were classified as inflammatory (n = 71), tumorous (n = 39), and vascular (n = 10). LCI improved lesion visibility by 75% (53/71) for inflammatory lesions, 72% (28/39) for tumorous lesions, and 80% (8/10) for vascular lesions compared with WLI. Furthermore, the mean color difference (mean ± SD) of reddish lesions was significantly greater in LCI than in WLI for both angioectasia (25.2 ± 1.83 vs. 20.6 ± 2.14 [p < 0.001]) and erythema (25.3 ± 2.25 vs. 19.8 ± 1.82 [p < 0.001]).

Conclusions: IEE using EN-840T enhanced the visibility of small-bowel lesions. Specifically, LCI improved lesion visibility and may contribute to detecting small lesions.

Introduction: It is plausible but not yet proven that early celiac disease diagnosis prevents long-term complications of untreated disease. Our aim was to compare phenotype and health outcomes in currently adult celiac disease patients diagnosed either in childhood (<18 years) or adulthood.

Methods: Data on 1,059 patients were collected from medical records at diagnosis and with questionnaires and structured interviews after long-term follow-up. Associations between timing of diagnosis and long-term health were studied with regression models.

Results: Patients diagnosed in childhood (n = 239) were more often males (32% vs. 23%, p = 0.004), currently younger (27 vs. 54 years, p < 0.001), more often screen-detected (20% vs. 14%, p < 0.001), and reported lower adherence to gluten-free diet in adulthood (92% vs. 97%, p < 0.001) than those diagnosed in adulthood (n = 820). After adjusting for clinico-demographic variables and dietary adherence, patients diagnosed in childhood had fewer miscarriages (odds ratio 0.41 [95% confidence interval: 0.21-0.80]) but more allergies (1.75 [1.11-2.76]), dermatological diseases excluding dermatitis herpetiformis (1.99 [1.11-3.58]), asthma (2.28 [1.16-4.48]), and depression (2.84 [1.24-6.50]) in adulthood. The groups were comparable in other comorbidities including type 1 diabetes and autoimmune thyroidal diseases, persistent symptoms, and quality of life.

Conclusion: Diagnosis in childhood compared to adulthood was associated with disease phenotype and its effects on long-term comorbidities are complex.

Introduction: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), imposes a global health burden. Observational studies suggest links between IBD and sarcopenia as well as obesity, but establishing causality is challenging due to confounding factors.

Methods: This study utilized two-sample Mendelian randomization (MR) analyses to explore bidirectional causality between obesity, sarcopenia, and IBD, using genetic instruments from summary-level data. The primary causal estimates were derived using the inverse-variance weighted method. To ensure robustness, we performed a range of sensitivity analyses, including MR-Egger regression and the weighted median method to detect and adjust for horizontal pleiotropy, and MR-PRESSO to identify and remove potential outliers.

Results: MR analysis revealed significant associations between obesity, sarcopenia, and IBD, especially CD. Trunk fat percentage, body fat percentage, and abdominal subcutaneous adipose tissue volume were positively associated with an increased risk of CD, whereas hand grip strength showed a negative association, highlighting the role of obesity and sarcopenia in CD risk. Conversely, CD was causally linked to lower abdominal fat, muscle mass, and strength. For UC, only visceral adipose tissue volume showed an association with disease risk. Mediation analysis indicated the gut microbiome might mediate the causal effect of CD on sarcopenia-related traits.

Conclusion: This MR study confirms bidirectional causality between sarcopenia, obesity, and IBD, particularly CD. It highlights the complex interplay between body composition and IBD pathogenesis. Moreover, the gut microbiome may mediate the relationship between CD and sarcopenia. These findings underscore the importance of managing obesity and sarcopenia in IBD treatment and suggest potential therapeutic targets related to the gut-muscle axis.

In the article by Ruan et al. entitled "Clinical Application of Confocal Laser Endomicroscopy in the Diagnosis of Gastrointestinal Diseases" [Digestion. 2025; https://doi.org/10.1159/000548414], there is an error in the affiliation of the first author. The correct affiliation of the first author, Wenli Ruan, is:The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.

Introduction: Anal imaging improves the diagnosis of perianal diseases in Crohn's disease (CD) patients, especially those with no perianal symptoms. However, the clinical characteristics and outcomes of CD patients with asymptomatic perianal fistula are unknown. This study aims to explore the prevalence and clinical course of Chinese CD patients with asymptomatic perianal fistula in a hospital-based cohort.

Methods: We performed a retrospective cohort study of consecutive hospitalized patients with newly diagnosed CD in China. Asymptomatic perianal fistula patients with CD were defined as those who exhibited fistula tracts on magnetic resonance imaging scans, absence of reported perianal symptoms, or any prior history of perianal fistula. Their clinical features and prognosis were reviewed and analyzed.

Results: Among 376 patients who underwent anal imaging, 93 (24.73%) had asymptomatic perianal fistula, 187 (49.73%) had symptomatic perianal fistula, and 67 patients (17.82%) showed no perianal involvement. There were significant differences among patients without perianal lesions, patients with symptomatic perianal fistula, and patients with asymptomatic perianal fistula in the proportion of male sex (49.25% vs. 84.49% vs. 64.52%, respectively; p < 0.001), age at diagnosis (median 32.00 vs. 26.00 vs. 24.00, p < 0.01), disease location (p < 0.05), and laboratory examination. Patients with asymptomatic perianal fistula had a higher cumulative incidence of abdominal surgery (p < 0.001) and intestinal obstruction (p < 0.05).

Conclusion: Patients with asymptomatic perianal fistulas account for a certain proportion of CD patients at diagnosis, with a higher proportion of stricturing behavior and cumulative incidence of intestinal obstruction and CD-related bowel surgery.

Background: Helicobacter pylori eradication is one of the most well-established strategies for the prevention of gastric cancer and is recommended in several countries, particularly in high-risk countries. However, gastric cancer can still develop even after successful eradication. As H. pylori eradication has become more prevalent, the characterization, surveillance, and management strategies for gastric cancers that arise following eradication have emerged as important clinical challenges.

Summary: Gastric cancers that develop after H. pylori eradication typically arise in the context of preexisting atrophic gastritis or intestinal metaplasia, high-risk background mucosa rather than obligate precursor lesions, reflecting a field effect that predispose gastric stem cells to malignant transformation. Although H. pylori eradication reduces the overall risk of gastric cancer, residual risk depends on the extent and severity of atrophy or intestinal metaplasia. Molecular changes, including persistent CpG island hypermethylation and aberrant miRNA expression, particularly within intestinal metaplasia, may persist after eradication. These cancers are mainly the intestinal type and frequently present as small, depressed, gastritis-like appearance or lesions covered by epithelium with low-grade atypia, making endoscopic diagnosis challenging. Risk prediction can be improved through endoscopic assessment of precancerous lesions, advanced high-resolution imaging endoscopy techniques, and molecular biomarkers. Given the persistent risk, individualized, risk-based long-term surveillance strategies are recommended, particularly for patients with extensive atrophy or intestinal metaplasia.

Key messages: (1) Despite H. pylori eradication, the risk of gastric cancer persists in patients with atrophic mucosal changes and intestinal metaplasia. (2) Gastric cancers after H. pylori eradication exhibit distinct endoscopic and pathological features compared to those without prior eradication, making early diagnosis challenging. (3) Risk stratification based on endoscopic assessment, advanced imaging, and molecular biomarkers can refine surveillance strategies, emphasizing the importance of long-term, personalized follow-up after eradication.

Background: The incidence of Barrett's esophagus-related neoplasia is increasing worldwide, with a growing number of cases reported in Japan. While early stage lesions are suitable for endoscopic resection, accurate endoscopic detection, and histological assessment remain difficult, particularly in long-segment Barrett's esophagus (LSBE), where lesions often exhibit flat morphology and indistinct margins. These characteristics reduce endoscopic visibility and are associated with lower endoscopic R0 resection rates compared with short-segment Barrett's neoplasias. In Japan, image-enhanced magnifying endoscopy with targeted biopsy is the preferred diagnostic approach, whereas Western guidelines recommend random biopsies according to the Seattle protocol. This review discusses current diagnostic approaches and challenges from a Japanese perspective.

Summary: Current diagnostic strategies for superficial Barrett's esophagus-related neoplasia (SBERN) incorporate high-resolution modalities such as white-light endoscopy and magnifying narrow-band imaging with or without acetic acid enhancement. The Japan Esophageal Society Barrett's Esophagus (JES-BE) classification provides a standardized framework for evaluating mucosal and vascular patterns in magnifying endoscopy, thereby improving diagnostic consistency. Nevertheless, histological interpretation, particularly for SBERNs arising in LSBE, poses major challenges due to interobserver variability in differentiating true dysplasia from inflammation-associated atypia and in grading dysplasia, even among expert gastrointestinal pathologists. In Japan, immunohistochemical markers such as p53 and Ki-67 are widely used in routine practice to support histological assessment, particularly for lesions indefinite for dysplasia.

Key messages: Given the increasing clinical burden of SBERN, further standardization of endoscopic criteria and histological assessment is expected to establish more reliable surveillance strategies tailored to segment extent of BE.