Digestive Diseases and Sciences最新文献

Background and aim: Stent placement for biliary drainage in patients with malignant hilar biliary obstruction (MHBO) has been a topic of long-standing debate, and the best approach remains controversial. Therefore, we aimed to evaluate the efficacy, safety, and removability of multi-hole fully covered self-expandable metal stents (MH-FCSEMSs) in a preclinical experiment using swine hilar bile duct obstruction (HBDO) models and to assess the feasibility and safety of stent placement in patients with MHBO.

Methods: Three minipigs underwent endoscopic retrograde cholangiopancreatography (ERCP)-guided endobiliary-radio frequency ablation (EB-RFA) to establish Bismuth type II hilar bile duct stenosis models. Four weeks after EB-RFA, 10-mm diameter and 4-cm length MH-FCSEMSs were endoscopically inserted into the left intrahepatic bile duct of the models. Stent patency and migration, as well as adverse events including cholangitis and endoscopic stent removability, were assessed three months after stent placement. Additionally, clinical applications of MH-FCSEMS were performed in two patients with MHBO to determine feasibility, safety, and stent patency.

Results: MH-FCSEMSs were successfully inserted into the left main intrahepatic bile duct and common hepatic duct of the models under ERCP in all three animals without any technical difficulties. Cholangiograms performed 12 weeks after MH-FCSEMS placement showed no stent migration, and all were successfully removed from the animal models. The functional success rate, defined as a decrease in serum total bilirubin level of more than 50% at 12 weeks after stent placement, was 100%. Moreover, MH-FCSEMSs were successfully inserted in two patients with hilar cholangiocarcinoma. The procedures were technically feasible, and no major periprocedural complications were noted.

Conclusion: The preliminary long-term results of both preclinical and clinical pilot studies suggest that endoscopic biliary drainage using MH-FCSEMS may be a safe and effective treatment option for stenting and stent revision in the management of HBDO. Further studies comparing clinical outcomes to those of MH-FCSEMS without multi-hole in malignant hilar biliary obstruction will be needed to verify the clinical benefits.

Background: Fecal lipocalin-2 (LCN2) is a biomarker of neutrophil activation, which is elevated in patients with inflammatory bowel disease (IBD); however, its dynamic changes during pregnancy and early life are largely unknown. We characterized LCN2 levels by maternal IBD diagnosis, offspring feeding behavior, and gut microbiota composition.

Methods: In the prospective MECONIUM (Exploring Mechanisms of Disease Transmission In Utero through the Microbiome) study, we analyzed 559 fecal samples from 91 pregnant women with IBD, 78 healthy controls, and their 147 offspring for LCN2 levels at each trimester of pregnancy and multiple time points during early life using linear mixed-effects model and multiple logistic regression analyses. Gut microbiota community compositions were evaluated following 16S rRNA gene sequencing.

Results: IBD cases had higher LCN2 levels throughout pregnancy compared to controls. In offspring, significantly higher LCN2 was found in babies born to mothers with IBD, compared to those without IBD, at 3 months, 1 year, and 4 years (all p < 0.03), with offspring LCN2 levels being predictive of maternal IBD case status with > 85% accuracy at ages 1 and 4. We also detected correlations between LCN2 levels and certain IBD-associated bacterial taxa in both mothers and babies. Exclusively breastfed babies had lower LCN2 in the first weeks of life compared to formula or mixed-fed counterparts.

Conclusions: Babies born to mother with IBD had significantly higher LCN2 during early life compared to controls with exclusive breastfeeding impacting LCN2 levels early on. LCN2 levels correlated with IBD-associated microbial taxa in both mothers and babies. Future studies should identify the biological drivers and health-related consequences of elevated LCN2 during early childhood.

Like all interventions in health care, novel non-invasive tests for colorectal cancer should be properly evaluated before they can be recommended. Such evaluations should be performed in well-designed studies, of which the results can serve as the evidence base for recommendations. While the methods for evaluating novel tests have been slower to develop, there is now a solid base for developing suggestions and even strong recommendations for their assessment. These include advice for study design, analysis of results, and clear and informative reporting. These considerations should be guided by the intended use of the new test and its role in the testing pathway. We distinguish between tests proposed as a replacement for an existing test, as a triage test, before an existing test, or as an add-on test, after an existing test. We recommend the definition of explicit, a priori defined, minimally acceptable performance criteria for the intended use of the new test and rigorous statistical hypothesis testing, to prevent "spin" in the interpretation of the findings.

Background: The effect of maternal smoking around birth (MSAB) on gastrointestinal (GI) diseases in the offspring is still not fully understood.

Aim: We conducted a rigorous Mendelian randomization (MR) study to examine the association between MSAB and 24 GI diseases in offspring.

Methods: Single nucleotide polymorphisms (SNPs) associated with MSAB were obtained from a recent study. SNPs of GI diseases were all from the FinnGen project. We performed two-sample MR analyses (TSMR) using three methods, predominantly the inverse variance weighting (IVW) method. We performed sensitivity analyses and false discovery rate (FDR) to confirm the accuracy and robustness of the results.

Results: Genetically determined MSAB significantly influenced offspring GI diseases according to the IVW method (OR 1.251; 95% CI 1.111-1.408; P = 2.111e-04; P_FDR = 5.278e-03). We then found that genetic predisposition to MSAB was significantly associated with an increased risk of 5 of 24 GI diseases, including three upper GI diseases (esophageal ulcer, gastroduodenal ulcer, and its subtype gastroduodenal ulcer) and two lower GI diseases (inflammatory bowel disease (IBD) and its subtype, ulcerative colitis (UC)) in offspring.

Conclusions: This comprehensive TSMR analysis demonstrated that genetically predicted MSAB is a risk factor for GI disorders, including IBD, UC, and peptic ulcer, in offspring. Individuals whose mothers smoked during pregnancy are subject to increased health surveillance for GI diseases. And we need more research to explore the mediating mechanisms involved.

Background: The care of inflammatory bowel disease (IBD) requires special attention among immigrants due to different disease incidence, phenotype, and risk profiles. We aimed to highlight key themes among existing literature to inform equitable care in all immigrants living with IBD.

Methods: A systematic literature search was conducted in MEDLINE, EMBASE, the Cochrane library, Scopus, and ProQuest from inception to February 2023 to identify studies capturing the care of IBD among immigrants who moved from one country to another, irrespective of the timing of IBD diagnosis. Studies on immigrant children and children of immigrants were also included. We reported qualitative and quantitative data as reported in each individual study, and where applicable, we noted comparisons between immigrants and non-immigrants, defined as natives of the adopted country.

Results: This review included 50 eligible studies. 12/19 (63.1%) studies reported lower incidence of IBD among immigrants, although rates increased from first- to second-generation immigrants in five studies. Most immigrants had significant changes in their diet after immigration, and their gut microbiota was different compared to non-immigrants. Immigrants had different environmental exposures and in certain populations, more severe IBD phenotypes and extra-intestinal manifestations (EIMs). Medical and surgical treatments were lower among immigrants in certain regions, although they had appropriate healthcare utilization and similar hospitalization rates compared to non-immigrants.

Conclusions: IBD care among immigrants is unique due to their different risk profiles and disease phenotypes, and the potential barriers with healthcare access. Understanding IBD among immigrants is key to ensure equitable care in this unique population.

Background: Colorectal cancer screening with fecal immunochemical testing (FIT) is a process that depends on diagnostic colonoscopy for those with a positive test and completion of colonoscopy after positive FIT is an essential element of program effectiveness.

Aims: We examined how the COVID-19 pandemic influenced completion of diagnostic colonoscopy after positive FIT in our integrated healthcare system.

Methods: This was a retrospective study of all positive FIT over a 5-year period. FITs were characterized as being done in pre-pandemic, early pandemic, or late pandemic time periods. The primary outcome was proportion of timely diagnostic colonoscopy completed within 6 months of positive FIT.

Results: Among 2157 patients with positive FIT, 50% received diagnostic colonoscopy within 6 months, 20% received colonoscopy after 6 months, and 30% received no colonoscopy. 56% of patients had timely colonoscopy during the pre-pandemic period as compared to 39% in the early pandemic and 49% in the late pandemic (p value < 0.01 for all comparisons). Those who had their colonoscopy done via community care referral were less likely to do so within 6 months. Among patients with no colonoscopy, the most common reasons included patient declined (48%), clinicians deferred due to comorbid conditions (26%), or the patient died (21%).

Conclusions: Before and during the pandemic, we found low rates of completion of colonoscopy after a positive FIT, which highlights an important barrier to program effectiveness. Many FIT were inappropriate given the high proportion of patients who either died or were recommended not to complete a colonoscopy.