Digestion最新文献

Introduction: Functional abdominal bloating (FAB) is a bowel disorder of gut-brain interaction (DGBI) characterized by predominant bloating symptom. Given gas dynamics in the digestive tract, gas-related symptoms (belching and flatulence) and behaviors may contribute to the development of FAB. This study aimed to examine their relationships.

Methods: We conducted an Internet survey for individuals aged from 18 to 79 years using a questionnaire including items on demographic and clinical characteristics, lifestyle, and gas-related symptoms and behaviors. DGBIs including FAB were diagnosed based on the Rome IV criteria. The severity of bloating was assessed using visual analog scale. Health-related quality of life (HRQOL) was evaluated using the SF-8. Logistic and multiple regression analyses identified factors associated with FAB and their bloating severity.

Results: A total of 9,995 individuals were included in the analysis, in which 123 (1.2%) were classified as having FAB. HRQOL was significantly impaired in the FAB group compared to the non-FAB group. Multivariable analysis demonstrated that gas-related symptoms and behaviors such as frequent flatulence (OR: 2.55, 95% CI: 1.74-3.72, p < 0.001), frequent suppression of flatulence (OR: 2.09, 95% CI: 1.32-3.32, p = 0.002), and resisting the urge to defecate (OR: 2.77, 95% CI: 1.57-4.90, p < 0.001) were significantly and independently associated with an increased odds of FAB, in addition to lower BMI and gastroesophageal reflux disease. Younger age and resisting the urge to defecate were related to increased severity of bloating in patients with FAB.

Conclusion: Gas-related symptoms and behaviors may contribute to the pathophysiology of FAB.

Introduction: Gastric subepithelial tumors (SETs) including gastrointestinal mesenchymal tumors (GIMTs) - which often appear as similar hypoechoic lesions originating from the fourth layer of the gastric wall - are difficult to distinguish with endoscopic ultrasound (EUS). We aimed to prospectively validate the utility of circularity, a surrogate indicator of roundness, as a diagnostic method for SETs.

Methods: Among 100 patients with potential GIMTs sized 1-5 cm prospectively recruited at two institutions between 2020 and 2023, those who experienced pathological diagnosis were included in the final analysis. One representative EUS image showing the tumors' maximum cross-sectional surface was selected, and the circularity was measured using an image analysis software. The circularity of the leiomyoma and other SETs suspected GIMTs was compared, and the diagnostic performance at the optimal cutoff value was evaluated.

Results: In the 62 patients, the number of GIST, leiomyomas, and other SETs were 46, 10, and 6, respectively. Circularity was significantly lower in the leiomyoma group than in the other SETs group (0.846 vs. 0.924). The area under the receiver operating characteristic curve of circularity for predicting leiomyomas was 0.822 when the cutoff value was set to 0.869. When the lesion was diagnosed as leiomyoma with a circularity of <0.869, the accuracy, sensitivity, and specificity were 82.3%, 70%, and 84.6%, respectively.

Conclusion: The noninvasive diagnostic method for SETs based on circularity is useful for excluding leiomyomas in lesions of 1-5 cm in size. This diagnostic method may be a potential adjunctive option for differentiating SETs.

Background: With the improvement in living standards, metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease worldwide, garnering increasing concern due to its significant health risks. MASLD encompasses a spectrum of pathological processes ranging from simple steatosis to nonalcoholic steatohepatitis, liver fibrosis, cirrhosis, and even hepatocellular carcinoma, and it has become a leading cause of liver-related mortality. Due to the lack of specific therapeutic targets, current diagnostic, treatment, and management strategies for MASLD remain inadequate.

Summary: This review aims to explore the pathophysiological manifestations of MASLD, the mechanisms through which hypoxia-inducible factor-1α (HIF-1α) contributes to disease progression, and the potential therapeutic approaches targeting HIF-1α, offering feasible strategies for treating advanced MASLD.

Key message: Studies suggest that hepatocytes in MASLD are often in a hypoxic state, which activates HIF-1α, playing a crucial role in disease progression. During hypoxia, the expression of HIF-1α increases throughout the different stages of MASLD, interacting with various genes and pathways, influencing lipid metabolism, steatosis, and fibrosis progression.

Introduction: Colorectal serrated adenocarcinoma (SAC), a subtype of colorectal adenocarcinoma determined histologically, has characteristics of epithelial serrations. Here, we examined the immunohistochemical and clinicopathological characteristics of colorectal SAC.

Methods: Thirty-three specimens, pathologically diagnosed as SAC in our hospital between 2013 and 2022, were collected for immunohistochemistry of MLH1/MUC2/MUC5AC/p53 and sequencing of BRAF/KRAS mutations.

Results: The proximal colon contained 25 lesions and the distal colon had 8. Patients with proximal SACs were predominantly female, whereas those exhibiting distal SACs were predominantly male (p = 0.003). Overall, lymph node and distant metastasis were present in 17 (52%) and 11 (33%) cases, respectively, with no significant differences between the proximal and distal groups. MLH1 expression loss was more frequent in proximal cases (40%) than distal SACs (13%). Most cases (97%) were MUC2+. MUC5AC+ was significantly more frequent in proximal cases (92%) than distal SACs (37%, p = 0.004). Significantly less p53 overexpression was present in proximal cases (40%) vs. distal SACs (75%). Genetically, the 12 cases of SAC harboring BRAF mutations were all located in the proximal colon, with a significantly greater frequency (p = 0.030), whereas more frequent KRAS mutations were noted in distal SACs. Throughout 5 years of follow-up, 3 patients (2 proximal SAC cases; 1 distal SAC case) died (mean 6.7 months after surgery) because of their disease.

Conclusion: Proximal SACs exhibit distinct clinicopathological and molecular features compared to distal SACs, largely aligning with the sessile serrated and traditional serrated pathways, respectively.

Introduction: Colorectal cancer remains one of the most prevalent gastrointestinal malignancies. This study aims to identify key genes associated with colorectal cancer recurrence, offering novel insights for prognostic assessment and personalized treatment strategies.

Methods: Leveraging the TCGA dataset, we conducted a comprehensive analysis of differentially expressed genes between recurrent and nonrecurrent colorectal cancer patients. We developed a recurrence-associated gene signature (RAGS) model for prognostic evaluation and employed nine machine learning algorithms to predict recurrence risk. Furthermore, we performed extensive functional studies on the most significant genes, examining their expression patterns, prognostic relevance, and effects on cellular proliferation, metastasis, and chemoresistance.

Results: Our analyses identified 45 key genes linked to colorectal cancer recurrence and prognosis. Using LASSO regression, we constructed the RAGS model, incorporating TMEM213, SAP25, POU4F1, RSPO4, and PAGE2B. This model demonstrated exceptional performance in predicting overall prognosis and post-chemotherapy outcomes. Among the machine learning algorithms tested, XGBoost exhibited the highest diagnostic accuracy for recurrence prediction, with POU4F1 emerging as the most significant predictive gene. Functional experiments revealed that POU4F1 knockdown substantially inhibited colorectal cancer cell proliferation and metastasis both in vitro and in vivo, while also reducing resistance to 5-fluorouracil and oxaliplatin.

Conclusion: This study successfully identified crucial genes associated with colorectal cancer recurrence and developed a robust RAGS prognostic model. The XGBoost algorithm underscored the importance of POU4F1 in predicting colorectal cancer recurrence. Our functional analysis of POU4F1 provides fresh insights into colorectal cancer progression mechanisms and informs the development of targeted therapeutic approaches. These findings not only enhance our understanding of colorectal cancer's molecular underpinnings but also establish a solid foundation for advancing precision diagnosis and treatment in clinical practice.

Background: Gastroesophageal reflux disease (GERD) is a common and heterogeneous condition that has traditionally been assessed using endoscopy for visual identification of mucosal injury. In recent years, advances in endoscopic technology have significantly reshaped both the diagnostic and therapeutic approaches to GERD.

Summary: Modern imaging modalities, such as high-resolution and image-enhanced endoscopy, now allow for the detection of subtle mucosal changes. Functional endoscopic techniques, including the Endoscopic Pressure Study Integrated System (EPSIS), enable real-time physiological assessment of esophageal function and contribute to a better understanding of GERD pathophysiology. On the therapeutic front, endoscopy has emerged as a viable, minimally invasive alternative to surgery in managing refractory or proton pump inhibitor (PPI)-dependent GERD. Techniques such as anti-reflux mucosectomy, anti-reflux mucosal ablation (ARMA), and endoscopic submucosal dissection for GERD are increasingly recognized for their safety and efficacy.

Key messages: (a) Modern endoscopic techniques improve the detection of subtle mucosal and functional abnormalities in GERD. (b)Functional endoscopy techniques offer insights into the mechanisms of GERD symptoms and lower esophageal sphincter dysfunction. (c) Endoscopic therapies are minimally invasive treatment options for patients with PPI-refractory or PPI-dependent GERD. (d) Endoscopy is expected to play a central role in the comprehensive management of GERD.

Introduction: We aimed to identify the long-term outcomes and predictive factors for failure of conventional therapy (CT), including 5-aminosalicylic acid, azathioprine, and glucocorticoid (GC), in patients with intestinal Behçet's disease (i-BD).

Methods: This retrospective study included 63 patients with i-BD receiving CT at the University of Tokyo Hospital between April 2005 and July 2024. Patients requiring anti-tumor necrosis factor-alpha (TNF-α) agents due to CT failure were categorized into the advanced therapy (AT) group, whereas those controlled with CT were classified as the CT group. Risk factors for CT failure were analyzed using Cox proportional hazards regression, and cumulative failure rates were using the Kaplan-Meier method.

Results: Twenty-eight patients (44.8%) required AT during a median follow-up of 93 months. The cumulative 1-, 3-, 5-, and 10-year failure rates of CT were 22.6%, 35.9%, 40.0%, and 50.8%, respectively. Multivariate analysis identified maximum ulcer size ≥3 cm (hazard ratio [HR]: 2.68, 95% confidence interval [CI]: 1.05-6.84, p = 0.030), concomitant proton pump inhibitor (PPI) use (HR: 2.65, 95% CI: 1.06-6.58, p = 0.036), C-reactive protein ≥4 mg/dL (HR: 2.56, 95% CI: 1.04-6.31, p = 0.042), and hematochezia (HR: 2.40, 95% CI: 1.05-5.46, p = 0.037) as independent predictors of CT failure. A predictive model using all four factors demonstrated good accuracy (area under the receiver operating characteristic curve = 0.877) for predicting AT requirement. Regarding AT efficacy, 22 patients (78.6%) in the AT group continued AT for at least 1 year, with most achieving clinical and endoscopic remission. Concomitant GC use significantly decreased from 12.7 ± 11.7 mg/day at baseline to 2.4 ± 2.5 mg/day at 1 year (p < 0.001).

Conclusion: Large ulcer size, PPI use, high CRP, and hematochezia are risk factors for CT failure. Anti-TNF-α agents are effective in patients with CT failure, and risk-based treatment strategies may improve disease control in patients with i-BD.

Introduction: No studies have investigated the prognostic effect of skeletal muscle mass and quality and adipose tissue distribution in patients who undergo endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC). Thus, this study aimed to evaluate their association.

Methods: We retrospectively collected data from patients who underwent ER for ESCC at our institution between 2005 and 2020. Multivariate Cox analysis was performed to investigate the association of 17 candidate factors, including indices for skeletal muscle mass and quality and adipose tissue distribution assessed with computed tomography (CT) images, with prognosis. Further, we evaluated the association of impaired skeletal muscle, characterized by the combination of low skeletal mass index (SMI) and high intramuscular adipose tissue content (IMAC), with prognosis and early and late mortality.

Results: Among 450 patients, 116 (25.8%) died during the median follow-up of 111.6 months. Multivariate analyses revealed low SMI (hazard ratio [HR], 1.65) and high visceral adipose index (HR, 0.48) showed significant association with mortality, in addition to male sex, performance status, Charlson comorbidity index, American Society of Anesthesiologists physical status, and prognostic nutrition index. Conversely, no significant association was revealed in other indices. Impaired skeletal muscle was a risk factor for mortality (HR, 2.87) but not the combination of low SMI and low IMAC. It was significantly associated with late mortality (HR, 4.53) but not with early mortality.

Conclusion: Impaired skeletal muscle assessed with CT images was a risk factor for late mortality in patients who underwent ER for ESCC.

Background: Confocal laser endomicroscopy (CLE) is a real-time microscopic imaging technique based on laser scanning technology. It enables subcellular histological visualization in vivo with a resolution of up to 1 μm and demonstrates over 90% sensitivity for detecting early gastrointestinal cancers and precancerous lesions. In recent years, the integration of CLE with fluorescence staining and artificial intelligence (AI) has further improved its image interpretation capabilities in identifying gastrointestinal inflammation and early cancer.

Summary: This review provides an overview of CLE's clinical applications in gastric and intestinal diseases. It also discusses the synergistic role of AI in enhancing CLE and highlights the clinical relevance of CLE in the detection of digestive tract disorders.

Key messages: CLE is a high-resolution real-time imaging technology that can identify early gastrointestinal cancers and precancerous lesions with high sensitivity, providing important basis for diagnosis and treatment. The integration of CLE with fluorescent staining and AI significantly improves its real time in vivo interpretation of inflammation and early cancerous lesions in the gastrointestinal tract. CLE is valuable in the auxiliary diagnosis and dynamic monitoring of gastrointestinal diseases, and the integration of AI further expands its clinical application potential.

Introduction: This single-center retrospective study compared underwater clip closure (UCC) with conventional clip closure (CCC) under routine gas insufflation for post-endoscopic submucosal dissection (ESD) ulcers of colorectal lesions measuring ≤5 cm.

Methods: Between May 2021 and June 2023, 89 patients were enrolled. Since March 2022, all cases underwent UCC. Patients were divided into the UCC group (n = 52) and the CCC group (n = 37). Primary outcomes were complete closure rate and incidence of post-ESD coagulation syndrome (PECS), delayed bleeding, and perforation. Secondary outcomes included closure time and number of clips used.

Results: Complete closure was achieved in all cases, with no PECS, delayed bleeding, or perforation in either group. Median closure time was significantly shorter in the UCC group (10 min [IQR, 7-14]) than in the CCC group (11 min [IQR, 8.5-19]; p = 0.044). The number of clips used was similar (median 10 in both groups; p = 0.290). Multiple regression analysis identified both resection area (p < 0.001) and closure method (p = 0.002) as independent factors affecting closure time.

Conclusion: UCC may decrease the time required for post-ESD closure of colorectal lesions measuring ≤5 cm, while using a comparable number of clips to CCC, with no serious complications.