Digestive Diseases and Sciences最新文献

Background: The primary indication for ERAT is acute uncomplicated appendicitis; however, in recent years, the successful treatment of appendiceal abscesses in adults has been reported in several cases. Further investigations are warranted to establish the feasibility of ERAT for the management of appendiceal abscesses.

Aims: This study aimed to evaluate the efficacy and safety of endoscopic retrograde appendicitis therapy (ERAT) for the treatment of acute periappendiceal abscess in adults.

Methods: This retrospective study included 30 adult patients with acute periappendiceal abscess who underwent ERAT at the Digestive Center of Suining Central Hospital between July 2021 and March 2025. The success rate (technical and clinical), procedure time, intervention time, visual analog scale (VAS) score, length of hospital stay, complications, and absorption condition of the abscesses 3 months after the procedure were recorded and analyzed.

Results: The technical success rate of ERAT was 80%, and the clinical success rate was 83.3%. The median procedure time was 14.5 (interquartile range [IQR], 11.8-16.5) minutes. The median ERAT intervention duration was 7.0 (IQR, 4.8-10.0) days. The postoperative VAS score was significantly decreased (P < 0.001), and the average length of hospital stay was 6.7 ± 2.4 days. Three months after the procedure, the abscesses were completely absorbed in 87.0% of the patients and partially absorbed in 13.0% of the patients. Two patients developed postoperative complications, namely, abscess dissemination and transient high fever.

Conclusion: In adult patients with acute periappendiceal abscess, ERAT may be an alternative and effective treatment option in the early stage.

Background: The prevalence of type 2 diabetes mellitus (T2DM) and its associated hepatic steatosis has surged with the obesity epidemic. The influence of T2DM on the natural history of primary biliary cholangitis (PBC) remains poorly characterized.

Aims: This study aims to assess the prevalence of T2DM in a PBC cohort and evaluate its impact on hepatic steatosis, liver fibrosis, and clinical outcomes.

Methods: A retrospective analysis was performed. The presence of hepatic steatosis was defined by a controlled attenuation parameter (CAP) ≥ 285 dB/m, and clinically significant liver fibrosis was defined by a liver stiffness measurement (LSM) ≥ 8.5 kPa assessed using vibration-controlled transient elastography (VCTE). The cohort was further stratified into four subgroups: PBC with T2DM (PBC/T2DM), PBC without T2DM (PBC/non-T2DM), PBC with hepatic steatosis (PBC/steatosis), and PBC without hepatic steatosis (PBC/no steatosis). Group comparisons were performed using t-tests, chi-squared analyses, and Kaplan-Meier survival curves.

Results: 562 patients with PBC were identified. The prevalence of T2DM was 14.8%. 158 (28%) patients had VCTE measurements. The PBC/T2DM sub-cohort was more likely to have concomitant hepatic steatosis compared to PBC/non-T2DM (54% vs 28%, p-value 0.010). The prevalence of clinically significant fibrosis was similar between these two groups (69% vs 52%, p-value 0.097). All-cause mortality rates were similar between PBC/T2DM vs PBC/non-T2DM (p-value 0.960) and PBC/steatosis vs PBC/no steatosis (p-value 0.895).

Conclusion: T2DM is a risk factor for the development of hepatic steatosis in patients with PBC; however, it does not increase the likelihood of clinically significant liver fibrosis or all-cause mortality.

Background: Fatigue is common in Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis remains poorly understood.

Aims: This study aimed to assess changes in fatigue prevalence during the first year after diagnosis and examine the association between disease course and substantial fatigue (SF) at the 1-year follow-up.

Methods: Adults with newly diagnosed CD or UC were recruited from the population-based IBSEN III cohort. Fatigue was assessed at diagnosis and the 1-year follow-up using the Fatigue Questionnaire. Associations between SF at the 1-year follow-up and disease-related factors were quantified using multivariate logistic regression adjusted for sex, age and comorbidities.

Results: In total, 596 patients were included (CD: 196, UC: 400). SF was present at both baseline and after one year of disease for 46.9% (n = 92/196) and 40.5% (n = 162/400) of patients with CD and UC, respectively. In CD, development of endoscopically non-passable stricture and/or surgically treated stricture within first year of disease (OR = 4.52, 95%CI [1.61;12.68]), self-reported flares since diagnosis (OR = 2.55, 95%CI [1.26;5.16]), female sex (OR = 3.12, 95%CI [1.53;6.37]) and comorbidities (OR = 4.05, 95%CI [1.89;8.69]) were independently associated with SF at the 1-year follow-up. In UC, SF was associated with current biological treatment (OR = 5.14, 95%CI [1.56;16.96]), increasing Mayo endoscopic score at the 1-year follow-up (OR = 1.54, 95%CI [1.01;2.35]), self-reported flares since diagnosis (OR = 2.66, 95%CI [1.24;5.72]) and female sex (OR = 2.20, 95%CI [1.06;4.57]).

Conclusions: Fatigue frequently persists through the first year after IBD diagnosis. Clinical factors reflecting a more severe disease course were associated with SF one year after diagnosis in both CD and UC.

Introduction: Patients with inflammatory bowel disease (IBD) are at higher risk of pneumonia due to the disease itself and the use of immune-modifying medications.

Methods: We conducted a retrospective analysis of TriNetX US Collaborative Network data on patients with IBD who received the 20-valent pneumococcal conjugate vaccine (PCV20). Propensity score matching was performed to adjust for differences in demographics and pneumonia-related risk factors.

Results: After propensity score matching, 12,796 patients were included in the analysis. The mean ages of the vaccinated and control groups were 55.2 ± 16.3 and 55.8 ± 17.1 years, respectively, with females comprising 53% of each group. The most commonly prescribed IBD therapies across both cohorts included prednisone, methylprednisolone, budesonide, and adalimumab. Compared to the control group, patients who received PCV20 experienced significantly lower risks of pneumonia, acute respiratory failure, hospital admissions, ICU admissions, and all-cause mortality.

Discussion: These findings align with current recommendations supporting pneumococcal vaccination in adult patients with IBD and highlight the importance of further studies to clarify the extent of vaccine-related benefit in this population.

Purpose: The gastrointestinal (GI) tract is a highly immunologically active organ where coordinated crosstalk between Toll-like receptor 4 (TLR4) and NLRP3 inflammasome maintains epithelial integrity, supports mucosal repair, and promotes immune tolerance. This review aims to summarize current understanding of TLR4-NLRP3 interactions in the gut, examine their in disease, examine their roles in disease, and evaluate emerging therapeutic strategies targeting this axis.

Methods: A comprehensive review of recent literature was conducted, focusing on regulatory mechanisms governing TLR4-NLRP3 signaling under homeostasis and dysregulation. Studies addressing epithelial barrier function, cytokine signaling, pyroptosis, metabolic endotoxemia, dysbiosis, and gut-brain axis communication were examined. Research using organoids, gut-on-chip system, microbiota modulation, and multi-omics approaches was also evaluated to understand therapeutic and translational advancements.

Results: Findings indicate that balanced TLR4-NLRP3 signaling preserves epithelial barrier integrity, regulates inflammatory responses, and supports immunological tolerance. Dysregulation disrupts these protective mechanisms and initiates feed-forward cycle of epithelial damage, metabolic endotoxemia, dysbiosis, and heightened cytokine-driven inflammation. Such aberrant activity contributes to major intestinal diseases-including inflammatory bowel disease, necrotizing enterocolitis, and colorectal cancer-as well as extraintestinal conditions such as obesity, type 2 diabetes, and neuroinflammation through gut-brain axis pathways. Novel therapeutic strategies, including selective small-molecule inhibitors and microbiota-based interventions, show potential for targeted modulation.

Conclusion: The TLR4-NLRP4 axis is a context-dependent regulator of gut and systemic immunity. Targeted modulation of this pathway represents a promising strategy to restore immune homeostasis while preserving host defense, supporting its relevance as a translational therapeutic target across multiple immune-mediated disorders.