Digestive Diseases and Sciences最新文献

Esophageal cancer is a common and often deadly malignancy, with treatment success depending largely on the stage at the time of diagnosis. Recently, studies have examined the role of non-coding RNAs in esophageal cancer pathogenesis, prognosis and therapy. This perspective specifically examines interactions long non-coding RNAs have with other RNA molecules in various facets of esophageal cancer.

Aims: Small bowel capsule endoscopy, which has been widely used to evaluate small bowel disease, has a risk of capsule retention (CR). The present systematic review and meta-analysis evaluated the accuracy of patency capsule (PC) and cross-sectional imaging (CSI) for predicting CR.

Methods: Databases, including MEDLINE/PubMed, EMBASE, Web of Science and the Cochrane library, were searched for articles through August 15, 2023, that investigated the diagnostic accuracy of PC or CSI for predicting CR. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. The false-negative rates of PC and CSI were separately analyzed and compared using a single-proportion meta-analysis based on random-effects modeling.

Results: Twenty-three articles (covering 3273 patients) including 17 assessing PC (involving 3051 patients), 4 assessing CSI (involving 140 patients), and 2 assessing both PC and CSI (involving 82 patients) were identified. CSI had a pooled sensitivity and specificity for predicting CR of 54% (95% confidence interval [CI], 21-84%) and 88% (95% CI, 67-97%), respectively, whereas PC had a pooled sensitivity and specificity for predicting CR of 75% (95% CI, 43-92%) and 94% (95% CI, 90-96%), respectively. PC showed a significantly higher specificity (P = 0.05) and lower pooled false-negative rate than CSI (2.7% [95% CI, 1.3-5.4%] vs. 12.8% [95% CI, 6.1-25.0%]; P = 0.001).

Conclusions: PC showed demonstrated comparable sensitivity, significantly higher specificity, and significantly lower false-negative rate than CSI. PC may be a more reliable modality for predicting CR than CSI.

Background and aims: Alcoholic liver disease (ALD) is the leading cause of death among alcohol-related diseases, yet its pathogenesis remains incompletely understood. This article employs data mining methods to conduct an indepth study of articles on ALD published in the past three decades, aiming to elucidate the pathogenesis of ALD.

Methods: Firstly, articles related to the pathogenesis of ALD were retrieved from the Web of Science (WOS) database. CiteSpace 6.1.R2 and VOSviewer 1.6.18 were used to visually analyze the authors, institutions, journals, and keywords of the published articles. Secondly, by thoroughly reading the top 100 most cited articles and focusing on research hotspots such as cytochrome P450 2E1 (CYP2E1), gut microbiota, acetaldehyde dehydrogenase (ALDH), and alcohol dehydrogenase (ADH), the pathogenesis of ALD was preliminarily explored. Finally, the pathogenesis of ALD was further analyzed based on disease databases.

Results: A total of 1521 articles were retrieved from the WOS database, and 384 of these were selected for in-depth reading. From GeneCards, 9084 genes related to ALD were identified. KEGG enrichment analysis was performed using DAVID, and the hsa04936: Alcoholic liver disease pathway was selected for visualization.

Conclusions: This study preliminarily elucidates the pathogenesis of ALD, which may be associated with the release of acetaldehyde, reactive oxygen species (ROS), and various pro-inflammatory factors during alcohol metabolism. It is also closely related to gut microbiota dysbiosis and increased intestinal permeability induced by multiple factors.

Background: Pouchitis is common among patients with ulcerative colitis (UC) who have had colectomy with ileal pouch-anal anastomosis. Antibiotics are first-line therapy for pouch inflammation, increasing the potential for gut colonization with multi-drug resistant organisms (MDRO). Fecal microbial transplant (FMT) is being studied in the treatment of pouchitis and in the eradication of MDRO. Prior work using aerobic antibiotic culture disks suggests that some patients with chronic pouchitis may regain fluoroquinolone sensitivity after FMT. However, gut MDRO include anaerobic, fastidious organisms that are difficult to culture using traditional methods.

Aim: We aimed to assess whether FMT reduced the abundance of antibiotic resistance genes (ARG) or affected resistome diversity, evenness, or richness in patients with chronic pouchitis.

Methods: We collected clinical characteristics regarding infections and antibiotic exposures for 18 patients who had previously been enrolled in an observational study investigating FMT as a treatment for pouchitis. Twenty-six pre- and post-FMT stool samples were analyzed using FLASH (Finding Low Abundance Sequences by Hybridization), a CRISPR/Cas9-based shotgun metagenomic sequence enrichment technique that detects acquired and chromosomal bacterial ARGs. Wilcoxon rank sum tests were used to assess differences in clinical characteristics, ARG counts, resistome diversity and ARG richness, pre- and post-FMT.

Results: All 13 of the patients with sufficient stool samples for analysis had recently received antibiotics for pouchitis prior to a single endoscopic FMT. Fecal microbiomes of all patients had evidence of multi-drug resistance genes and ESBL resistance genes at baseline; 62% encoded fluoroquinolone resistance genes. A numerical decrease in overall ARG counts was noted post-FMT, but no statistically significant differences were noted (P = 0.19). Richness and diversity were not significantly altered. Three patients developed infections during the 5-year follow-up period, none of which were associated with MDRO.

Conclusion: Antibiotic resistance genes are prevalent among antibiotic-exposed patients with chronic pouchitis. FMT led to a numerical decrease, but no statistically significant change in ARG, nor were there significant changes in the diversity, richness, or evenness of ARGs. Further investigations to improve FMT engraftment and to optimize FMT delivery in patients with inflammatory pouch disorders are warranted.

Background: Although clinicians frequently encounter incidentally detected gastroduodenal extrinsic compressive lesions (GDECLs) on upper gastrointestinal endoscopy (UGE), the optimal management approach for GDECLs has not been fully established. This study aimed to stratify and identify important factors associated with clinically significant GDECLs that require regular follow-up or further treatment.

Methods: Between June 2007 and December 2015, a total of 73 patients with suspected GDECLs on UGE at Kyung Hee University Hospital at Gangdong were identified and studied retrospectively. After the final diagnosis, patients were divided into the following two groups: clinically significant GDECLs, which requires regular follow-up or further treatment, and clinically non-significant GDECLs.

Results: Among 73 GDECLs, 23 (31.5%) lesions were classified as clinically significant GDECLs and 50 (68.5%) as clinically non-significant GDECLs. In multivariate analysis, clinical and endoscopic parameters that were independently associated with clinically significant GDECLs included older age (≥ 60 years), large size (≥ 4 cm) of extrinsic compression, previous history of intra-abdominal malignancy, and symptoms of abdominal distension (all p < 0.05).

Conclusions: Several clinical and endoscopic parameters showed significant association with the identification of clinically significant GDECLs on endoscopy. These predictive factors might be useful in determining whether to perform further diagnostic work-up in patients with GDECLs.

Background and aims: Peroral endoscopic myotomy (POEM) has become the treatment of choice for achalasia. However, the impact of myotomy length on POEM outcomes remains unclear. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short versus standard-length myotomy in achalasia patients.

Methods: We conducted a comprehensive search in PubMed, Embase, and Web of Science databases to identify all RCTs that compared POEM using short myotomy with standard myotomy. The primary outcomes were clinical success and post-operative gastroesophageal reflux disease (GERD). The secondary outcomes were procedural time, length of hospital stay, and intraprocedural complications. Pooled odds ratio (OR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were calculated.

Results: Three RCTs with 365 achalasia patients treated with short (n = 179) or standard (n = 186) myotomy were included. Short and standard myotomies showed similar clinical success (OR 1.95, 95% CI 0.61-6.23, p = 0.26; I² = 41%), reflux symptoms (OR 0.97, 95% CI 0.49-1.89, p = 0.92; I² = 20%), pathologic acid exposure on pH monitoring (OR 0.70, 95% CI 0.33-1.50, p = 0.36; I² = 58%), reflux esophagitis on upper endoscopy (OR 0.82, 95% CI 0.40-1.70, p = 0.59; I² = 42%), intraprocedural complications (OR 1.22, 95% CI 0.53-2.79, p = 0.65; I² = 0%), and length of hospital stay (MD - 0.01, 95% CI - 0.72 to 0.69, p = 0.97, I² = 73%). Procedural time was shorter in short myotomy (MD - 16.11 min, 95% CI - 26.04 to - 6.19, p = 0.001; I² = 84%).

Conclusions: POEM using short myotomy for achalasia is non-inferior to standard myotomy for efficacy, safety, and post-operative GERD but is associated with a shorter procedural time.