Digestive Diseases and Sciences最新文献

Background and aims: Dietary restrictions are critical for effective bowel preparation before colonoscopy. Milk has traditionally been considered to impair the quality of bowel preparation, and endoscopy centers commonly advise patients to avoid milk consumption prior to the procedure. However, no robust evidence currently supports this practice. We investigated whether milk intake affects bowel preparation quality and colonoscopy outcomes.

Methods: This prospective randomized controlled trial enrolled patients undergoing colonoscopy, randomizing them into either milk-inclusive low-residue diet group (Milk group) or standard low-residue diet group (LRD group). The primary outcome was the bowel preparation adequacy rate, evaluated using the Boston Bowel Preparation Scale. The secondary outcomes included colonoscopy quality metrics (polyp detection rate, adenoma detection rate, BBPS score, and cecal intubation rate), patient tolerability, participant preferences, and adverse event incidence.

Results: A total of 486 participants were randomly allocated to two groups. Non-inferiority of the Milk group to the LRD group was demonstrated, as the lower limits of the one-sided 97.5% confidence intervals for the difference in adequate bowel preparation rates (mITT: - 0.6%; PPS: - 1.7%) were both above the - 10% margin. Bowel preparation quality was slightly higher in the Milk group than in the LRD group ( mITT: P = 0.049; PPS: P = 0.030). The incidence rate of nausea (21.2 vs. 30.1%, P = 0.046) was lower in the Milk group than those in the LRD group, and the satisfaction scores (3.79 ± 0.86 vs. 3.61 ± 0.84, P = 0.005) were higher in the Milk group. No significant differences were observed in polyp and adenoma detection rates between the two groups.

Conclusion: During colonoscopy preparation, milk-inclusive low-residue diet is non-inferior to a standard LRD for bowel preparation and is associated with better patient-reported tolerability. Allowing milk consumption on the day before colonoscopy is a safe and patient-friendly strategy that can be adopted to enhance comfort without compromising the quality of the examination.

Registration number: ChiCTR2500103886, Registration date: 06 June 2025 (retrospectively registered).

Introduction: Inflammatory bowel disease (IBD) is associated with an increased risk of major adverse cardiovascular events (MACE). Janus kinase inhibitors (JAKi) are approved to treat IBD, but there are concerns over whether they increase the risk of MACE or venous thromboembolism (VTE) in patients with IBD. We aimed to compare the incidence risk of MACE and VTE in patients with IBD treated with JAKi agents versus anti-TNFs.

Methods: We conducted a retrospective cohort study using the TriNetX database to identify patients  ≥ 18 years with IBD and treated with JAKi or anti-TNF therapy. Patients in the JAKi cohort were matched with patients treated with anti-TNF by using 1:1 propensity score matching. Patients with a history of a prior cardiovascular event were excluded from the analysis. Co-primary outcomes were MACE and VTE within 1-year after medication initiation. Additional subgroup analyses were performed based on age, sex, and IBD type. Kaplan-Meier analysis with adjusted hazard ratios (HRs) and 95% CIs were used to compare time-to-event rates.

Results: In total, there were 8942 patients in the JAKi cohort matched with 8942 patients in the anti-TNF cohort. There was no difference between the two cohorts in the development of MACE (aHR: 1.08; 95% CI: 0.87-1.33; p = 0.49) or VTE (aHR: 1.06; 95% CI: 0.84-1.36; p = 0.61). In patients aged ≥ 65 years, there was no statistically significant difference between the two cohorts in MACE outcomes (aHR: 0.95; 95% CI: 0.69-1.31; p = 0.75). Consistent findings were observed when comparing ulcerative colitis to Crohn's disease, upadacitinib to tofacitinib, or JAKi to infliximab.

Conclusion: Our results suggest that patients with IBD, including patients ≥ 65 years, who are treated with JAKi, were not at increased risk of MACE or VTE over a 12-month period as compared to those treated with anti-TNF therapy. Further prospective studies are warranted to confirm these findings.

Background: Better ways to predict and prevent delayed post-polypectomy-induced ulcer hemorrhage (DPPIUH) are needed.

Aims: (1) To correlate Doppler endoscopic probe (DEP) detection of PPIU blood flow with polyp artery size on histology. (2) To report risk factors which predict DPPIUH and prevent it.

Methods: 96 high-risk patients with benign colon polyps and 10-40 mm PPIUs were included in this cohort study which analyzed prospectively collected data. Coded polyps were analyzed by expert GI pathologists to report artery size at resection margins. 28 patients with severe DPPIUH's all DEP positive (+) for arterial blood flow including 15 with prior empiric hemoclip (HC) closure were compared with 68 similar high-risk patients without DPPIUHs: 34 DEP+ treated to obliterate blood flow; 22 DEP negative not treated; and 12 DEP+ not treated. 16 potential risk factors for DPPIUH were simultaneously assessed using multivariable logistic analysis and a classification tree model.

Results: The odds ratio (95% CI's) of DEP positivity predicting medium or large polyp arteries was 23.4 (5.73, 11.0)-p < 0.001. Risk factors predicting DPPIUH were DEP positivity, medium, or large size polyp artery, right colon polyp location, and empiric HC closure. DEP-guided treatment predicted the absence of DPPIUH.

Conclusions: (1) DEP positivity and medium or large artery size on polyp histology highly correlated and were new risk factors predicting DPPIUH. (2) Other significant risk factors predicting DPPIUH were right colon polyp location and empiric PPIU HC closure. (3) DEP-guided treatment prevented DPPIUH.

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.