Gastroenterology Research最新文献

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and alterations in bowel habits. Previous studies show variability in its prevalence according to region and diagnostic criteria used. The objective was to conduct a systematic review and meta-analysis of the global prevalence of IBS, considering studies that used Rome III and IV criteria.

Methods: A systematic search was conducted in Scopus, Embase, PubMed, Web of Science, and Scielo through March 2024. Observational studies reporting IBS prevalence using Rome III or IV criteria were included. Studies in specific populations, conference abstracts, and gray literature were excluded. Methodological quality was assessed using Munn's tool for prevalence studies. Meta-analyses were performed using random-effects models with Freeman-Tukey double arcsine transformation, subgroup analyses by probabilistic sampling, meta-regressions by year, and publication bias assessment through funnel plots.

Results: Forty-three studies (26 Rome III, 17 Rome IV) with 188,885 participants were included. The global prevalence was 13.21% (95% confidence interval (CI): 10.70-15.94%) with Rome III and 17.14% (95% CI: 12.00-22.99%) with Rome IV. When considering only studies with probabilistic sampling, prevalences adjusted to 11.19% and 13.28%, respectively. Higher prevalence was found in women (Rome III: 15.69% vs. 11.10% in men; Rome IV: 20.17% vs. 11.45%). Meta-regression showed a trend toward increased prevalence in recent years.

Conclusion: Rome IV showed a higher prevalence than Rome III, possibly due to a more precise definition of abdominal pain. The heterogeneity found suggests the need to standardize methodologies and conduct more studies with probabilistic sampling, especially in underrepresented regions.

Background: HFE-C282Y/C282Y hemochromatosis patients have lower serum transferrin levels than normal individuals, but the reason for this discrepancy has drawn little scientific attention and remains unclarified. The objective of this study was to examine transferrin levels and their correlations with other biochemical iron status markers in Danish patients with the C282Y/C282Y variant and compare with corresponding correlations in a population of healthy Danes with the HFE-wt/wt genotype.

Methods: The study comprised 21 patients (11 men) who completed a questionnaire about age, number of years with hemochromatosis, and at least 10 consecutive blood sample results, including ferritin, iron, transferrin and transferrin saturation (TSAT). The control group consisted of 958 persons (441 men).

Results: The findings were comparable in both genders: 1) All but one patient had significantly lower transferrin levels than controls; 2) Serum iron and ferritin showed negative correlations with transferrin; 3) TSAT displayed strong negative correlations with transferrin; 4) Positive correlations were present between iron and ferritin, iron and TSAT, and ferritin and TSAT.

Conclusions: Hemochromatosis patients had lower transferrin levels than controls, contributing to a higher TSAT; the explanation for this remains unsolved. Patients displayed negative correlations between iron and ferritin vs. transferrin, as well as negative correlations between TSAT and transferrin, suggesting that high TSAT levels may accelerate the degradation of transferrin. In HFE-patients, transferrin metabolism is not clarified, and the potential influence of the C282Y/C282Y variant is unknown. Contrary to "normal" metabolism, which is primarily regulated by iron levels, many patients maintain low transferrin and high TSAT even after iron depletion. It would be valuable to explore whether this decrease in transferrin reflects reduced hepatic synthesis or increased degradation. There is a need for further investigation of this important dilemma in HFE-hemochromatosis.

Background: Chronic pancreatitis (CP) is a complex disease with various underlying etiologies, including alcohol consumption, smoking, autoimmune disorders, genetic predispositions, and other less common causes. Despite extensive research, the impact of these different etiologies on disease progression, complication rates, and long-term outcomes remains insufficiently understood. In particular, the distinction between alcohol-related chronic pancreatitis (ARCP) and non-alcohol-related chronic pancreatitis (NARCP) is not well established in terms of prognosis and therapeutic needs.

Methods: We conducted a retrospective cohort study utilizing the TriNetX US Collaborative Network to compare baseline characteristics and clinical outcomes of ARCP versus NARCP. Propensity score matching (PSM) was applied to balance baseline characteristics between both cohorts. Primary outcome was mortality, while secondary outcomes included exocrine pancreatic insufficiency (EPI), pseudocyst formation, development of diabetes and pancreatic cancer, and need for endoscopic retrograde cholangiopancreatography (ERCP) and celiac plexus injection.

Results: A total of 203,432 patients with CP were identified, including 11,696 ARCP and 200,560 with NARCP. After PSM (11,678 per group), ARCP was associated with significantly lower rates of mortality (13.0% vs. 16.2%; risk ratio (RR) 0.80), diabetes (22.9% vs. 35.8%; RR 0.64), exocrine pancreatic insufficiency (2.0% vs. 6.1%; RR 0.32), pancreatic cancer (1.1% vs. 8.4%; RR 0.14), and pseudocyst formation (7.1% vs. 9.7%; RR 0.73) compared to NARCP (all P < 0.001). ARCP patients also had lower rates of celiac plexus injection (0.1% vs. 0.8%; RR 0.12) and ERCP (2.3% vs. 10.2%; RR 0.23) (both P < 0.001).

Conclusion: In this large, retrospective cohort study, patients with ARCP demonstrated lower rates of mortality, complications, and need for interventions compared to those with NARCP. These findings highlight potential differences in disease progression and clinical management between ARCP and NARCP. Further studies are needed to elucidate underlying mechanisms contributing to these disparities and to refine patient-specific treatment approaches.

Background: Acetylcholine (ACh), a crucial neurotransmitter for gastric contractions, induces triphasic contraction in stomach. However, the precise mechanism of ACh-induced phasic contractions (AiPCs) remains unclear. Recent data suggest the chloride channel (Cl^- channel) may be the principal channel for AiPC in the stomach. Previous studies demonstrated that the opening of the ATP-sensitive potassium (K_ATP) channel inhibits AiPC. However, it has not been studied whether inhibition of energy metabolism can regulate AiPC in gastric smooth muscles via this channel. This study investigated whether AiPC in gastric smooth muscle are mediated by chloride channels and modulated by K_ATP channels under conditions of energy metabolism inhibition.

Methods: Isolated gastric smooth muscle strips from mice and humans were used to record isometric contraction. The subunits of Cl^- and K_ATP channels were evaluated by Western blot.

Results: Niflumic acid and 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS), known to block the Cl^- channel, inhibited AiPC in gastric smooth muscles of mice. Sodium cyanide (NaCN) and dextro-mannitol, which inhibit energy metabolism, reduced AiPC in gastric smooth muscles of mice. NaCN also lowered AiPC in gastric smooth muscles of humans and vasomotion in human arterial smooth muscles. By Western blot, subunits of the K_ATP and Cl^- channels were identified in gastric smooth muscles of mice and arterial smooth muscles of humans.

Conclusions: This is the first study to demonstrate that suppression of energy metabolism reduces AiPC through activation of K_ATP channels in both murine and human gastric smooth muscle, linking metabolic state to excitatory neurotransmission. Vasomotions in arterial smooth muscles of humans are also decreased by inhibition of energy metabolism.

Background: Acute severe ulcerative colitis (ASUC) is associated with a high risk of colectomy. About 30% of patients do not respond to steroids, requiring rescue therapy. This study aims to evaluate the efficacy and safety of tofacitinib in ASUC.

Methods: MEDLINE, Embase, and Cochrane Library were systematically searched. We used random-effects model to calculate pooled proportions with 95% confidence intervals (CIs). For outcomes with ≥ 2 comparative studies, we conducted pairwise meta-analyses and calculated pooled odds ratios (ORs) with 95% CIs.

Results: We included six studies. Tofacitinib had a 90-day colectomy rate of 15.1% (95% CI: 8.5-25.3%). The clinical response rate at weeks 12 - 14 was 45.4% (95% CI: 32.6-58.9%), and at week 52 was 30.0% (95% CI: 17.4-46.5%). The clinical remission rate at weeks 12 - 14 was 38.1% (95% CI: 28.7-48.5%), and at week 52 was 27.1% (95% CI: 15.2-43.5%). Steroid-free clinical remission rate was 28.6% (95% CI: 22.2-36.1%) at weeks 12 - 14 and 33.1% (95% CI: 25.6-41.6%) at week 52. The most common adverse events were Clostridioides difficile infection, nausea, cardiovascular events, arthralgia or myalgia, herpes zoster infection, venous thromboembolism, and pneumonia. There was no significant difference in 90-day colectomy rate between tofacitinib and control (OR: 0.52; 95% CI: 0.25 - 1.08; P = 0.08).

Conclusion: Tofacitinib demonstrated high clinical response and remission rates, and low adverse events rate. Additionally, there was a trend toward a lower 90-day colectomy rate compared to controls.

Background: Histologic remission is increasingly recognized as an important endpoint in ulcerative colitis (UC) management. Consensus guidelines on adopting histologic scoring systems in clinical practice are lacking in the United States. This study aimed to assess the knowledge, attitudes, and practices of pathologists, primarily located in North America, regarding histologic evaluation in UC.

Methods: This study surveyed a group of pathologists who have completed postdoctoral medical training with demonstrated interest and involvement in the field of gastrointestinal pathology to evaluate their knowledge, practices, and perspectives on histologic assessment using standardized scoring systems in clinical practice in UC patients. The survey was hosted on an online platform, and responses were recorded anonymously.

Results: A total of 57 responses were included in the analysis. Nearly two-thirds of pathologists acknowledged a lack of familiarity with the criteria for histologic remission as defined by the Nancy Index (NI), Robarts Histopathology Index (RHI), and Geboes score (GS). A majority (37/57; 65%) of pathologists did not support routine inclusion of a histologic score in pathology reports. The remaining 20/57 (35%) pathologists advocated for the incorporation of a standardized index, with the NI favored by 10/20 (50%) followed by the GS (n = 3; 15%) and the IBD-Distribution, Chronicity and Activity score (n = 3; 15%). Nearly a half (27/57; 47%) of the respondents acknowledged a favorable role for artificial intelligence in this setting.

Conclusions: The current survey highlights the need for collaborative efforts among pathologists, gastroenterologists, and professional societies to establish a consensus guideline for routine histologic assessment in UC. Additional guidance from professional societies and research are required to integrate artificial intelligence-driven approaches into routine clinical practice.

Background: Diverticulitis is a common colon pathology that contributes a significant healthcare burden due to hospitalizations, colonoscopies, and operations. Although recent clinical practice guidelines (CPGs) advocate for less frequent and selective use of antibiotics, colonoscopies, admissions, and operations, rates of admissions and elective operations for diverticulitis have paradoxically increased over time. Understanding where patients seek care for diverticulitis can identify areas where CPGs are or are not being followed. This study aimed to describe care settings, treating providers, and characterize treatment patterns for diverticulitis.

Methods: This prospective cohort study included patients with diverticulitis diagnosed via computed tomography (CT) scan at a single institution between 2019 and 2020. The CT scan setting (outpatient, emergency department, or inpatient), main treating provider specialty (medicine, surgery, gastroenterology, or emergency medicine), and clinical characteristics were identified. For each patient, antibiotic prescription, screening colonoscopy within a year of diagnosis, and surgical referrals were characterized.

Results: A total of 310 patients (mean age 62, 60.3% female) were included, with 71.3% being new diagnoses of diverticulitis. Eighteen percent of diagnoses were complicated diverticulitis. Most diagnoses occurred in the outpatient setting (60%), followed by the emergency department (36.5%), then inpatient (3.5%). Complicated diverticulitis cases more frequently presented to the emergency department than outpatient (25% vs. 12.9%, P = 0.002). Antibiotics were prescribed in 91% of cases, with the highest rate in the emergency department (96.5%) compared to outpatient (87.6%) or inpatient (90.9%, P = 0.036). Colonoscopy was up to date in 45.1% of uncomplicated and 54.4% of complicated cases (P = 0.137). Surgical referrals occurred in 38.7% of patients, with higher rates for complicated diverticulitis (84.2% vs. 28.6%, P < 0.001).

Conclusion: Most episodes of diverticulitis are uncomplicated and occur in the outpatient setting. However, care remains fragmented across multiple specialties, making it challenging to measure the appropriate delivery of CPG-concordant care for diverticulitis. The variation in management of diverticulitis highlights the need for a more coordinated, system-level approach to enable high-quality care delivery.

Background: Identifying risk factors for poor outcomes in patients with hepatocellular carcinoma (HCC) treated with transarterial radioembolization (TARE) can aid in developing personalized management strategies, such as the early use of immune checkpoint inhibitors (ICIs).

Methods: In this retrospective review, we included HCC patients who received TARE at The Ohio State University Comprehensive Cancer Center from January 1, 2015, to August 30, 2022. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Cox proportional hazard analysis was conducted to find the independent predictors of PFS and OS.

Results: We included 141 patients (median age of 65 years; 80% Caucasian; 80% male). Better PFS was associated with higher albumin (alb) (hazard ratio (HR) = 0.58, P = 0.005) and lower total bilirubin (T bili) levels (HR = 0.70, P = 0.034). Better OS was associated with a history of ablation (HR = 0.35, P < 0.001) and higher pre-TARE alb (HR = 0.63, P = 0.01); OS was worse in those with hepatic encephalopathy (HR = 2.01, P = 0.006). There was a notable trend toward worse OS in patients with ascites (HR = 1.71, P = 0.06) and metabolic-dysfunction-associated fatty liver disease (MAFLD)-associated HCC (HR = 1.86, P = 0.08). The receipt of ICI therapy was associated with a significantly better OS (P = 0.016), with a median OS of 1,102 days (95% confidence interval (CI): 884 - 1,509) compared to 614 days (95% CI: 493 - 829).

Conclusion: We present pretreatment risk factors (low alb, high T bili, MAFLD, hepatic encephalopathy, and ascites) that can predict poor outcomes in HCC patients treated with TARE. Preemptively treating such high-risk patients with ICI could improve their outcomes.

Background: Functional dyspepsia (FD) is a prevalent gastrointestinal disorder characterized by upper abdominal discomfort, often refractory to standard acid suppression therapy. Potassium-competitive acid blockers (PCABs), such as vonoprazan and tegoprazan, provide rapid and sustained gastric acid inhibition and may represent a therapeutic alternative. However, their efficacy in FD remains unclear. This systematic review and meta-analysis aimed to evaluate the effect of PCAB therapy on symptom outcomes in adults with FD.

Methods: A systematic search of PubMed, EMBASE, and Cochrane CENTRAL was conducted from inception to June 13, 2025, to identify studies evaluating PCABs in adult FD patients. Eligible studies included randomized controlled trials and prospective or retrospective cohorts reporting validated symptom scores before and after PCAB therapy. Studies were included in meta-analysis if they reported 4-week outcomes with sufficient data for effect size calculation. Standardized mean differences (SMDs) were pooled using a DerSimonian-Laird random-effects model. Heterogeneity was assessed with the I² statistic, and robustness was evaluated with leave-one-out sensitivity analysis and Baujat plots.

Results: Five studies comprising 366 patients were included. Four treatment arms from three studies (n = 276) were eligible for meta-analysis. The pooled SMD for symptom improvement at 4 weeks was 1.09 (95% confidence interval (CI): 0.67 - 1.52), indicating a moderate-to-large treatment effect in favor of PCABs. Heterogeneity was substantial (I² = 77.8%), but sensitivity analyses showed that no single study unduly influenced results. The remaining two studies, excluded from quantitative pooling due to incompatible timepoints or outcome structures, also demonstrated statistically significant symptom improvement, supporting consistency of effect across the evidence base.

Conclusion: PCABs may offer clinically meaningful symptom relief in FD, with pooled data suggesting a moderate-to-large effect size. While heterogeneity and limited sample size temper generalizability, findings were consistent across studies and robust to sensitivity testing. PCABs show promise as a potential therapeutic option in FD, particularly in patients who do not respond to or cannot tolerate proton pump inhibitors. Further placebo-controlled trials are needed to confirm efficacy and define long-term outcomes.

Background: Drug-induced liver injury (DILI) presents a significant diagnostic challenge, often leading to delayed detection. Unstructured clinical notes contain comprehensive medication data vital for DILI surveillance but are difficult to analyze systematically. Large language models (LLMs) show promise for automated extraction but require real-world clinical data validation to assess feasibility for clinical applications like DILI surveillance.

Methods: We retrospectively validated an LLM system on 100 randomly sampled Medical Information Mart for Intensive Care IV (MIMIC-IV) discharge summaries. Gold standard unique medication lists were derived via manual annotation and manual deduplication based on normalized drug names. LLM outputs underwent identical deduplication. Performance was assessed using precision, recall, and F1-score comparing deduplicated lists. MIMIC-IV data use agreement (DUA) compliance was ensured.

Results: Comparison yielded a precision of 0.85, recall of 1.00, and an F1-score of 0.92 for unique medication identification. The 174 false positives resulted from parsing or normalization errors; no medication hallucinations occurred. A subsequent DILI database lookup failed for approximately 6.2% of correctly identified unique medications, evaluated as a separate feasibility measure.

Conclusions: The LLM demonstrates high accuracy and perfect recall for unique medication extraction and identification from complex clinical notes, establishing technical feasibility. This represents a feasible and possible integration of LLM towards developing automated tools for enhanced DILI surveillance and improved patient safety.