Digestion最新文献

Background: Gastric cancer (GC) has a significant impact in Asia. Delay in diagnosis and treatment leads to increased mortality and morbidity. The detection of gastric intestinal metaplasia (GIM) has the potential to be an early sign of GC, but there are controversies. Differences in GC and pre-cancerous lesions between Asians and non-Asians have also contributed to this controversy.

Summary: GIM is a risk factor for developing GC in Asian adults, with more recent meta-analyses demonstrating a 3-4 risk in such patients. Certain GIM subtypes are more likely to develop GC, with Asian patients appearing to have more severe, diffuse, and high-risk subtypes of GIM compared to non-Asians. As a result, most international guidelines recommend endoscopic surveillance in adults with GIM, but this review article suggests it should be targeted towards those with high-risk features. This review also highlights other factors, apart from gastric histology, which are relevant in the development of GC. Factors such as Helicobacter pylori virulence, molecular and genetic mechanisms, gut microbiota, specific dietary components, and social habits as risk factors for GC are discussed.

Key messages: GIM is a risk factor for GC in the Asian population. Surveillance in a targeted population is beneficial.

Introduction: The most frequent cause of portal hypertension is liver cirrhosis (LC). Chronic hepatitis C virus (HCV) is a major cause of death and morbidity globally because of the consequences of LC, hepatocellular carcinoma, and portal hypertension, oral direct-acting antivirals (DAAs) are the effective treatment for HCV, offering a high cure rate. A virological response is also anticipated to improve portal hypertension. The aim of the study was to assess how DAA medication affects the hemodynamics of the portal circulation in patients with cirrhosis who have been infected with HCV.

Methods: A total of 120 patients with LC linked to chronic HCV were included in this study. They received treatment using regimens based on sofosbuvir combined with daclatasvir and either ribavirin or neither. Prior to beginning therapy and 2 years later, all patients underwent the following tests: complete blood count, PCR for HCV RNA, liver and renal function, abdominal ultrasonography, and colored duplex for assessment of portal hypertension.

Results: When compared to Doppler parameters prior to treatment, there is a notable improvement in Doppler metrics following DAA therapy (p = 0.006), including portal vein (PV) diameter, portal congestive index, PV cross-sectional area, splenic vein diameter, and span. Only roughly 69 patients (or 57% of the total) showed an improvement in portal pressure, whereas the percentage of sustained virological response is 95%. Numerous characteristics, such as the existence of splenomegaly and varices, a history of bilharzias, a high degree of fibrosis, and a low platelet count prior to treatment, are linked to non-changes in portal hypertension.

Conclusion: We infer that sustained virological response in HCV related cirrhotic patients following DAAs may lead to decrease in portal hypertension after an extended period of time, as adopted from portal congestion index Doppler parameters.

The article "DYRK2 regulates epithelial-mesenchymal transition restriction in pancreatic cancer liver metastasis by inhibiting Twist" [Digestion 2024; https://doi.org/10.1159/000541039] by Hang Pan, Yin Liu, Kejiu Bao, Yulin Wang, Yuping Zhang and Lina Zhou has been retracted by the Publisher and the Editor.After peer review, the accepted, unedited manuscript was published online as Early View. The authors did not respond to our requests and communication regarding the production process of their article despite extensive attempts at contact. As the article has not been approved by the authors for publication, we cannot publish the final version. To avoid confusion for readers we are retracting the Early View accepted, unedited manuscript.The authors did not respond to correspondence about the retraction.

Background: Ulcerative colitis is a diffuse, non-specific inflammatory bowel disease of unknown etiology with recurrent relapse and remission. The mechanisms of immune-mediated inflammation as a pathogenesis of ulcerative colitis have been increasingly elucidated, leading to development of biological agents and low-molecular-weight agents that target specific molecules or disease processes.

Summary: Integrin inhibitors impede ulcerative colitis pathogenesis by selectively inhibiting integrin, an adhesion molecule expressed on leukocytes, thereby suppressing lymphocyte infiltration into gastrointestinal tissues and controlling excessive immune responses at the inflammation site: the intestinal tract.

Key message: This article describes the mechanism of integrin inhibitors' action, the usefulness, and positioning of vedolizumab and carotegrast methyl, which are currently available for clinical use to treat ulcerative colitis, and the status of integrin inhibitor development.

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 4 patients (4.9%), all of whom were asymptomatic or had minimal symptoms. In 3 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.