Digestive Diseases and Sciences最新文献

Background: Colorectal cancer (CRC) is a significant health challenge with high incidence and mortality rates. While SERPINE1 is overexpressed in CRC and linked to poor patient outcomes, the detailed mechanisms by which it promotes tumor progression remain poorly understood.

Methods: SERPINE1 was identified as a cuproptosis-related angiogenic protein using the GEO database. Expression and prognostic impact of SERPINE1 in CRC were analyzed with the TCGA database. To forecast the pathways SERPINE1 might enrich, we deployed gene set enrichment analysis. SERPINE1 mRNA levels were quantified via qPCR. Co-immunoprecipitation (Co-IP) assay was performed to analyze the interaction between SERPINE1 and uPA/uPAR. Western blot (WB) was conducted to gauge protein expression of MAPK signaling components, cuproptosis markers, and SERPINE1 itself. Changes in cell viability were assessed using CCK-8. Angiogenesis assays probed how SERPINE1 may impact the angiogenic ca of CRC cells. Xenograft tumor models were established in adult nude mice to track tumor growth and volume changes.

Results: SERPINE1 was highly expressed in CRC, with substantial enrichment in the MAPK signaling pathway, and this overexpression is associated with unfavorable prognoses. CRC cells overexpressing SERPINE1 showed increased cell viability and angiogenic capacity, while expression of cuproptosis-related genes was markedly reduced. Mechanistically, SERPINE1 activates p38/MAPK pathway, thereby enhancing angiogenesis and cuproptosis resistance in CRC. This process may be associated with the interaction between SERPINE1 and uPA/uPAR.

Conclusion: Our study illuminates how SERPINE1, often overexpressed in CRC, leverages the p38/MAPK pathway to bolster cuproptosis resistance and angiogenesis, offering a promising avenue for anti-angiogenic strategies in CRC treatment.

Background: Endoscopic full-thickness resection (EFTR) can effectively remove extraluminal tumors, overcoming limitations of endoscopic submucosal dissection (ESD). However, optimal post-EFTR feeding timing lacks standardized guidelines for patients with gastric tumors. This study aims to assess the safety of early feeding after EFTR.

Methods: Retrospective analysis was conducted on patients who underwent EFTR at our hospital between January 2014 and January 2019. Based on actual fasting duration, patients were categorized: short fasting (≤ 2 days, n = 72) and long fasting (> 2 days, n = 431) group. Using 1:1 propensity score matching, postoperative complications and hospital stay were compared between balanced groups.

Results: A total of 503 patients were included in this study, among which 72 were in the short fasting group and 431 were in the long fasting group. After matching, the baseline characteristics of 68 patients in the short fasting group and 68 patients in the long fasting group reached equilibrium (P > 0.05). The average age was 53.82 ± 10.98 years old. There was no significant difference in clinicopathological conditions or lesion size between the two groups. There was no statistically significant difference in the rates of postoperative bleeding, fever and abdominal distension between the two groups of patients after EFTR. However, compared with the long fasting protocol, a trend of shorter hospitalization was observed in the short fasting group.

Conclusions: Compared with the long fasting protocol, early feeding after EFTR for gastric tumors did not increase the incidence of discomfort or postoperative complications. In addition, short fasting protocol has a tendency to shorten hospital stays, which represents potential clinical benefits.

Objective: Timed-barium esophagogram (TBE) is established test for assessing bolus clearance in achalasia post-treatment. However, radiation exposure is an important disadvantage. Esophageal bolus transit can be evaluated by HRIM. Previous studies comparing Impedance bolus height (IBH) using saline and TBE showed fair correlation. We compared bolus clearance by TBE versus HRIM using yogurt (viscosity matched to barium-calculated using Ostwald viscometer) in patients treated for achalasia.

Methods: HRIM was performed using solid-state system (MMS, Netherlands). Twenty patients (age 45.1 years; 8 men) treated with pneumatic dilatation (Rigiflex, Boston Scientific) were evaluated with TBE (200 ml Barium) and HRIM (200 ml yoghurt) two weeks after dilation. Both tests were performed in upright position. Barium column height and impedance bolus height (IBH) were measured at 0, 1 and 5 min. Analysis of IBH was performed with spatial impedance variation plot overlayed on esophageal pressure topography. All patients gave consent, and protocol was approved by the IRB.

Results: At baseline, 5, 11 and 4 patients had type I, II and III achalasia, respectively. Eckardt score showed an improvement of 5 (range 1-9) points. The mean column height as measured by IBH and TBE at 5 min was similar (4.6 [range 0-12.5] cm vs. 4.25 [0-16] cm). Pearson correlation between the TBE column and IBH was 0.73 at 5 min. Bland Altman plot for bolus clearance as measured by TBE and HRIM showed good agreement between the modalities.

Conclusions: There is good agreement between HRIM (performed using yoghurt) and TBE for evaluation of bolus clearance after therapy in achalasia patients. Single HRIM study done with viscosity matched liquid to barium can give information about bolus clearance and motor function in treated achalasia patients, avoiding radiation exposure.

Purpose: Achalasia is an uncommon primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and esophageal body peristalsis, with a rising prevalence among the elderly due to global population aging. This review summarizes the current evidence on the clinical presentation, diagnostic algorithm, and management of achalasia in geriatric patients.

Methods: A literature search was conducted focusing on age-related differences in symptoms, endoscopic and functional testing, and outcomes of available therapeutic modalities.

Results: Clinical presentation of achalasia differs among younger and geriatric patients, with the latter presenting less pronounced symptoms. Geriatric patients experience a higher risk of malnutrition and aspiration and exhibit more often advanced disease stages, including sigmoid esophagus. High-resolution manometry represents the gold standard for diagnosis, and upper gastrointestinal endoscopy should precede it in order to exclude causes of mechanical obstruction. The treatment remains non-causative and encompasses botulinum toxin injection, pneumatic dilation, peroral endoscopic myotomy, and laparoscopic Heller's myotomy with fundoplication.

Conclusion: Considering the evolving potential of minimally invasive techniques, advanced age should not be regarded as a contraindication for the definitive treatment of achalasia, and evidence-based, age-specific recommendations should be developed for optimizing clinical outcomes.

Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with inflammatory bowel disease (IBD) present in 60-80% of affected individuals. We aimed to investigate whether concurrent IBD worsens outcomes in PSC patients.

Methods: We conducted a retrospective cohort study using the TriNetX database to identify patients (≥ 18 years) with PSC. Patients were then divided into two groups: PSC with IBD (PSC-IBD cohort) and PSC without IBD (isolated PSC cohort). Propensity score matching (PSM) was used to control for covariates between both cohorts. The primary outcome was the risk of developing liver-related decompensation (combined ascites, hepatic encephalopathy, and variceal hemorrhage). Secondary outcomes included colorectal cancer (CRC), hepatobiliary malignancy, liver transplantation, and overall mortality. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CIs).

Results: We identified 6,690 patients with PSC, including 3,012 patients (45%) with isolated PSC and 3,678 patients (55%) with PSC-IBD. After PSM, 1,714 pairs were well-balanced. Over an average of 5-year follow-up, PSC-IBD patients had a higher risk of liver-related decompensation (HR 1.26, 95% CI 1.09-1.46, p = 0.001), cholangiocarcinoma (HR 1.38, 95%CI 1.08-1.76, p = 0.008), and liver transplantation (HR 1.50, 95%CI 1.28-1.78, p < 0.001) compared to those with isolated PSC, with no difference in overall mortality. CRC was more common in IBD-PSC patients (HR 3.91, 95%CI 2.46-5.21, p < 0.001). Subgroup analysis revealed that patients with ulcerative colitis had more severe liver disease than Crohn's disease patients.

Conclusion: Concurrent IBD was associated with adverse clinical outcomes in patients with PSC, including an increased risk of liver-related decompensation and cholangiocarcinoma.

Severe acute pancreatitis (SAP) is associated with a broad spectrum of local and systemic complications, among which gastrointestinal bleeding (GIB), although relatively uncommon, confers a disproportionately high mortality risk. The underlying pathogenic mechanisms remain incompletely elucidated and are distinctly multifactorial, involving acute gastric mucosal lesions, stress-induced ulcers, esophageal and gastric varices, and pseudoaneurysm formation and rupture. This review aims to systematically synthesize current evidence on the pathogenesis of SAP-associated GIB, thereby informing the development of targeted intervention strategies, improving the precision of individualized therapeutic decision-making, and ultimately providing a robust theoretical basis to optimize patient outcomes.

Objective: Post-ERCP pancreatitis (PEP) is the most common complication of ERCP. Identifying simple and accessible biomarkers to predict PEP risk may enhance patient safety and guide clinical decisions.

Material and methods: This retrospective, single-center study included 613 adult patients who underwent ERCP between January 2017 and December 2024. Demographic data, comorbidities, procedural details, and preoperative laboratory parameters were collected from institutional electronic health records. The primary outcome was the development of PEP, defined by standard diagnostic criteria.

Results: Post-ERCP pancreatitis occurred in 52 patients (8.5%). Demographic characteristics and comorbidities, including age, sex, body mass index, diabetes mellitus, and hypertension, were not significantly associated with PEP. Pancreatic duct cannulation was significantly more frequent among patients with PEP (53.8% vs. 24.8%, p < 0.001) and remained an independent risk factor in multivariable analysis (aOR: 3.05, 95% CI: 1.65-5.64, p < 0.001). Patients who developed PEP had higher preoperative neutrophil-to-lymphocyte ratio (NLR) (3.7 ± 1.9 vs. 2.9 ± 1.5, p = 0.001) and C-reactive protein (CRP) levels (18.5 ± 11.2 vs. 11.4 ± 8.3 mg/L, p = 0.001). In adjusted analysis, both NLR (aOR: 1.14, 95% CI: 1.02-1.28, p = 0.02) and CRP (aOR: 1.04, 95% CI: 1.01-1.08, p = 0.008) remained statistically significant but modest independent predictors of PEP. ROC analysis demonstrated limited discriminative ability for both NLR (AUC: 0.64) and CRP (AUC: 0.66), with moderate sensitivity and specificity.

Conclusion: Elevated preoperative NLR and CRP levels, together with pancreatic duct cannulation, were independently associated with an increased risk of post-ERCP pancreatitis. Although these inflammatory markers demonstrated statistically significant associations, their predictive strength was modest. Therefore, NLR and CRP should be interpreted as supportive parameters rather than standalone predictors and may contribute to pre-procedural risk stratification when integrated with established clinical and procedural risk factors. Further prospective, multicenter studies are warranted to validate these findings and clarify their role in clinical practice.