Digestion最新文献

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.

Background: Microbes residing in the gastrointestinal tract are intertwined with the immune development and overall health of the host throughout stages of life. It is well established that these microbes can have both positive and negative impacts on host health. Having foundational knowledge of these interactions with the host is critical in understanding gastrointestinal health.

Summary: This review discusses the importance of high-resolution study of the gut microbiota, which includes potential modern approaches for analyzing the gut microbiota and considers the challenges and aspects necessary for robust investigation of the gut microbiota. Here, we highlight the complex and highly individualized relationship of microbes interacting within the host results in an ever-changing landscape in the gastrointestinal tract, whether due to host conditions or microbial conditions including microbe-microbe and microbe-host interactions. The vastness and complexity of the gut microbiota contribute to the challenge of quantifying not only a community of microbes in the gut environment, but also maintaining resolution to investigate individual microbes, capturing the network of interactions coinciding in the gastrointestinal tract. Furthermore, the review emphasizes the importance of microbial functions and products to host health outcomes in the context of inflammatory diseases.

Key messages: Consideration for microbial functions and interactions with the gut immune system is critical for developing effective treatment strategies of inflammatory disorders. Employing high-resolution microbial techniques to investigate microbes with environmental relevance and community functions are a major challenge in the microbiome field. With new techniques and improvements on existing methodologies, investigating microbes at various community levels is feasible and becoming critical in understanding the community interactions with the host influencing the immune status and overall health outcomes.

Introduction: Studies have demonstrated clinical benefits of fecal microbiota transplantation (FMT) for treatment of irritable bowel syndrome (IBS). This study aimed to evaluate the cost-effectiveness of FMT versus standard drug treatment for patients with moderate-to-severe IBS who failed to respond to first-line therapy from the US payer's perspective.

Methods: Two 1-year Markov models were developed to examine the outcomes of FMT versus standard drug treatment in patients with constipation-predominant IBS (IBS-C) and diarrhea-predominant IBS (IBS-D). The primary model outcomes included direct medical cost and quality-adjusted life-years (QALYs) gained. Model inputs were obtained from literature and public data. Sensitivity analyses were performed to examine the robustness of model results.

Results: In the base-case analysis, FMT gained higher QALYs (by 0.0159 QALYs for IBS-C and 0.0166 QALYs for IBS-D) with cost savings (USD 7,835 for IBS-C and USD 9,015 for IBS-D) when compared to standard drug treatment. Key influential parameters identified by one-way sensitivity analysis were response probabilities of FMT and first-line treatment, the utility values of therapeutic response and nonresponse, and FMT cost. The probabilities of FMT to be accepted as the preferred strategy at a willingness-to-pay threshold of USD 50,000/QALY were 99.86% and 99.89% for IBS-C and IBS-D, respectively.

Conclusion: FMT appears to be cost-effective for patients with moderate-to-severe IBS who failed to respond to first-line therapy from the US payer's perspective.

Introduction: Early detection of duodenal neoplasms is crucial because of the complications associated with their treatment and their increasing recognition. However, standardised protocols for duodenal observation during screening esophagogastroduodenoscopy (EGD) have not been established. This study was performed to survey the current practical status of duodenal observation and to evaluate the clinical relevance of our systematic photo-documentation protocol, known as the Seven Pictures Rule (7 PR).

Methods: A cross-sectional survey using a web-based self-administered questionnaire was conducted among endoscopists in a regional area of Japan. The questionnaire included items on respondents' professional background, duodenal observation practices during screening EGD (observed locations, observation time, ampulla visualisation, and patient discomfort), as well as awareness, application, and perceived effects of the 7 PR, and preferences for future protocols. Data were anonymised and analysed descriptively.

Results: Of the 99 endoscopists included, 96.7% reported observing the duodenum based on their own individual methods. The intentional observation rates by location were highest in the following order: bulb (99%), ampulla in descending (94%), contralateral ampulla in descending (84%), superior duodenal angle (77%), contralateral superior duodenal angle (79%), and transverse duodenum (33%). However, only 14% of respondents reported successfully observing the ampulla in more than 75% of cases. While 62% were aware of the 7 PR, only one-fourth had implemented it in practice. Notably, 43% of respondents familiar with the 7 PR felt that it had led to an increased detection of duodenal neoplasms.

Conclusions: Current duodenal observation practices vary among endoscopists. The establishment of a systematic photo-documentation protocol such as the 7 PR may serve as a useful strategy for improving the detection of duodenal neoplasms. Further optimisation of the protocol is warranted to support broader adoption in clinical settings.

In the article entitled "Colonization of Streptococcus pyogenes Is Associated with Functional Dyspepsia and Exacerbates Functional Dyspepsia in Mice by Inhibiting the RhoA/ROCK1 Pathway through the Skin-Gut Axis" by Lin et al. [Digestion. 2025; https://doi.org/10.1159/000545005], an error occurred in the author details listed in the supplementary material.The corrected supplementary material has been updated accordingly.

Background: Artificial intelligence (AI) has progressed rapidly in gastroenterology, especially in colonoscopy, which is well positioned to benefit from AI due to the high global procedure volume and variability in quality across operators. In this review, we summarise the latest updates in the field, its current benefits, and further work required to accelerate its translation in day-to-day clinical practice.

Summary: Computer-aided detection systems are the most established AI system in colonoscopy, with robust evidence from randomised controlled trials showing significant improvements in adenoma detection rates. However, translation into real-world clinical practice has been less impactful, hindered by implementation challenges and lack of reimbursement pathways. Computer-aided diagnosis systems aim to support histological decision-making for diminutive polyps but have shown inconsistent benefits in clinical trials, reflecting complex human-computer interactions. Computer-aided quality systems, while in earlier stages, hold promise for standardising quality metrics. Novel applications in IBD demonstrate the potential of AI to standardise disease activity scoring and predict relapse, while therapeutic applications remain in proof-of-concept phases.

Key messages: Successful adoption of AI will depend on seamless workflow integration, better understanding of human-AI interaction, cost-effectiveness, establishing reimbursement and training pathways, clinician endorsement, and frameworks addressing fairness, accountability, and bias. The more distant future directions are likely to involve fully integrated multi-modal AI systems, personalised surveillance, and AI-assisted therapeutic interventions.