Gastroenterology Research最新文献

Background: The ethnic Danish population has high frequencies of the hemochromatosis gene (HFE gene) variants H63D and C282Y and clinical hemochromatosis is quite common. The objective of the study was to examine the impact of the combination of the HFE variants wildtype (wt), H63D, and C282Y on body iron status markers in a population of 2,613 apparently healthy ethnic Danish men and women.

Methods: An epidemiological population study was performed in Copenhagen County comprising a randomly selected population consisting of 1,342 men and 1,271 women. Blood samples were drawn in the morning in the fasting state for analysis of HFE genotypes and hematological iron status markers (hemoglobin, serum iron, serum transferrin, transferrin saturation, and serum ferritin).

Results: The HFE gene variants, H63D and C282Y, in any combination as well as in any combination with the HFE wt genotype, had a significant influence on iron status markers, compared with the wt/wt genotype. When arranged according to their relative frequency in the population, individuals with the six different HFE genotypes, i.e. wt/wt, H63D/wt, C282Y/wt, H63D/H63D, C282Y/H63D, and C282Y/C282Y, displayed gradually increasing levels of serum iron, decreasing levels of serum transferrin, and increasing levels of transferrin saturation in both genders. In men, ferritin increased gradually according to the HFE genotype. In women, ferritin levels were by and large independent of the HFE genotypes.

Conclusions: Using the iron status markers in HFE wt/wt individuals as a baseline, any other combination of the HFE genotypes had a significant impact on iron status. The C282Y/C282Y genotype was associated with the highest impact on iron status markers including serum ferritin and thus body iron overload. Due to physiological iron losses with menstruations and pregnancies, women are partly protected against significant body iron overload, regardless of the HFE genotype.

When integrated into healthcare, large language models (LLMs) have transformative and revolutionary effects, including significant potential for improving patient care and streamlining clinical processes. However, one specialty that particularly requires data on LLM use is gastroenterology and gastrointestinal surgery, a gap we sought to address in our research. Advanced artificial intelligence (AI) systems like LLMs have demonstrated the ability to mimic human communication, assist in diagnosis, provide patient education, and support medical research simultaneously. Despite these advantages, challenges such as biases, data privacy concerns, and lack of transparency in decision-making remain critical. The role of regulations in mitigating these risks is widely debated, with proponents advocating for structured oversight to enhance trust and patient safety, while others caution against potential barriers to innovation. Rather than replacing human expertise, AI should be integrated thoughtfully to complement clinical decision-making. Ensuring a balanced approach requires collaboration between medical professionals, AI developers, and policymakers to optimize its responsible implementation in healthcare.

Background: Gastrointestinal bleeding (GIB) is a common cause for intensive care unit (ICU) admissions and is associated with high mortality rates. Effective resuscitation is essential prior to definitive procedural intervention. Thromboelastography (TEG) assesses patients' dynamic coagulation profiles and has been shown to reduce blood product usage and mortality in specific patient populations; however, its role in the management of GIB remains controversial.

Methods: We performed a retrospective study of patients who had TEG performed during resuscitation of GIB in the ICU between January 1, 2017 and December 31, 2020 at a single center. Patients were identified through ICD-10 codes and blood bank's database.

Results: A cohort of 244 patients was identified, of which 18 were excluded. The cohort was mainly represented by White (72%, n = 162) males (65%, n = 147) with a mean age of 61 (standard deviation (SD) 14) years. Alcoholic liver disease (31%, n = 69) and esophageal varices (30%, n = 65) were the most common comorbidities. Mean nadir systolic blood pressure was 75 (SD 18) mm Hg. Mean nadir hemoglobin concentration was 6.5 (SD 1.7) g/dL. Patients received a median of 5 packed red blood cells (pRBC) (interquartile range (IQR) 5.8), 1 fresh frozen plasma (FFP) (IQR 2), and 0 platelets and cryoprecipitate units (IQR 1 and 0, respectively). The median ICU length of stay was 3 (IQR 3) days. The observed mortality rate was 39% (n = 88).

Conclusion: Although TEG may help reduce unnecessary blood product transfusions, its overall clinical benefit remains uncertain given the high mortality observed among patients with hemorrhagic shock secondary to GIB. Further studies are warranted to better evaluate the efficacy and clinical utility of TEG-guided transfusion strategies in this patient population.

Background: Many of the patients with inflammatory bowel disease (IBD) are children and adolescents, and the incidence of pediatric IBD is increasing. However, understanding epidemiological trends is crucial for effective prevention and treatment and reducing the local and global burden of IBD. Little data exist regarding the incidence of IBD in the child population in the Kujawsko-Pomorskie Voivodeship. The aims of this study were to evaluate the incidence of IBD in the period 2011 - 2022 and to compare the data regarding three types of IBD, namely ulcerative colitis (UC), Crohn's disease (CD), and unclassified inflammatory bowel disease (IBD-U), from the first half, i.e. 2011 - 2016, to the second half, i.e. 2017 - 2022.

Methods: This retrospective study analyzed the medical records of 118 IBD patients hospitalized at the Department of Pediatrics, Allergology and Gastroenterology from the central-northern part of Poland.

Results: Of the 118 patients diagnosed with IBD, 48 (40.68%) had CD, 57 (48.31%) had UC, and 13 (11.01%) had IBD-U. Between 2011 and 2016, 48 new IBD patients were diagnosed, with a further 70 new cases added between 2017 and 2022, representing a significant increase over the period (P = 0.033). Also, a significant increase was seen for UC, i.e. rising from 19 new cases between 2011 and 2016, to 38 between 2017 and 2022 (P = 0.015). The increase in CD was not significant.

Conclusion: The incidence of pediatric IBD in the central-northern district of Poland is lower than other countries, it nonetheless appears to be increasing, particularly in children with UC. The number of IBD diagnoses in children has increased by nearly 50% over the last 6 years.

Background: The choice between transabdominal and transperineal approaches for full-thickness rectal prolapse repair remains controversial. This study compared the outcomes of these two approaches over a 14-year period in a real-world setting.

Methods: This retrospective cohort study was conducted at a tertiary hospital in Thailand and included data from surgeries performed between January 2010 and December 2023. All patients who underwent surgical repair were included, except those with rectal prolapse secondary to colorectal cancer or those who did not receive surgical treatment. Surgical approaches were categorized into transperineal and transabdominal repairs. Outcomes (recurrence, morbidity, fecal incontinence, and constipation) were compared using inverse probability treatment weighting of propensity scores.

Results: A total of 58 patients were included, with 33 undergoing transperineal and 25 transabdominal repairs. Thirty-day postoperative complications and recurrence rates were comparable between the two approaches, with a nonsignificant trend favoring the transabdominal approach (30-day postoperative complication and recurrence risk ratios (95% confidence interval (CI)): 0.67 (0.06, 7.65) and 0.62 (0.11, 3.53), respectively). Fecal incontinence and constipation rates were also comparable. However, among the 34 patients with at least a 1-year follow-up, the transabdominal approach showed a nonsignificant trend toward higher constipation and lower fecal incontinence (constipation and fecal incontinence risk ratios (95% CI): 2.24 (0.61, 8.19) and 0.50 (0.16, 1.60), respectively).

Conclusions: From our 14 years of experience, transperineal and transabdominal approaches for rectal prolapse repair have had comparable outcomes. The choice of approach should be based on patient conditions, surgeon expertise, and thorough discussion with all involved.

Background: Acute pancreatitis (AP) is a severe inflammatory disorder that begins with the inappropriate activation of pancreatic enzymes within acinar cells due to biliary reflux, alcohol abuse, gallstones, and autoimmune disease. Several biomarkers have been studied that may aid in the early detection of pancreatic necrosis. The aim of this project was to evaluate the usefulness of procalcitonin (PCT) in predicting mortality in patients with severe AP in Mexican population.

Methods: An observational study, including 59 patients diagnosed with AP from 2018 to 2023, was conducted in a tertiary care hospital. Serum PCT levels were assessed on the first and third days of hospitalization (24 and 72 h).

Results: A total of 59 patients were included, and the main etiologies were lithiasis (28 patients, 47.5%) and endoscopic retrograde cholangiopancreatography (ERCP) (nine patients, 15.3%). Of the total patients, 16 (27.1%) died during their hospital stay, and the main etiologies were septic shock of abdominal origin (10 patients, 62.5%) followed by extra-abdominal shock (six patients, 37.5%). The average PCT level was 4.54 ± 8.12 on the first day of hospital stay, and 5.20 ± 10.90 at 72 h. The cut-off point was 1.26 ng/mL with the best sensitivity and specificity of PCT as a predictor of mortality at 72 h of 75% and 68%, respectively (area under the curve 0.7, 95% confidence interval (CI): 0.61 - 0.88), and positive and negative predictive values of 0.46 and 0.87, respectively.

Conclusions: We propose the usefulness of PCT as a biochemical marker to predict mortality in patients with severe AP due to its accessibility in the hospital environment. We propose to carry out studies with more patients and follow-up times. In addition, it is necessary to consider other biomarkers associated with PCT to help us improve the positive predictive value of mortality in this disease.

Background: Ubiquitin-specific protease 34 (USP34) is a deubiquitinase that has been shown to play a critical role in the process of tumor drug-resistance. The objective of this study was to investigate the role of USP34 in cisplatin resistance in hepatocellular carcinoma (HCC).

Methods: Firstly, we analyzed the USP34 levels in cisplatin-sensitive and -resistant patients using The Cancer Genomic Atlas (TCGA) data from Gene Expression Profiling Interactive Analysis (GEPIA2). The cell viability and half-maximal inhibitory concentration (IC₅₀) were measured by Cell Counting Kit-8 (CCK-8) assay. The cell apoptosis of HepG2 and HepG2/DDP cells was detected by annexin V-fluorescein isothiocyanate/propidium iodide (FITC/PI) double staining. The expression levels of USP34, multidrug resistance-associated protein 1 (MRP1), p-glycoprotein (p-gp), pan-lysine lactylation (Pan-Kla), histone H3 lysine 18 lactylation (H3K18la), lactate dehydrogenase A (LDHA) and lactate dehydrogenase B (LDHB) were measured by Western blot. HCC samples from the GEPIA2 database were used to determine the correlation between USP34 with LDHA and LDHB expression.

Results: USP34 was significantly upregulated in cisplatin-resistant HCC tissues and cells. Functional studies found that knockdown of USP34 inhibited HepG2 and HepG2/DDP cell proliferation and survival. Importantly, knockdown of USP34 enhanced cisplatin sensitivity in HepG2 and HepG2/DDP cells. Mechanistically, lactylation of histones promoted the expression level of USP34 in HepG2/DDP cells.

Conclusion: USP34 promotes the progression of HCC by regulating histone lactylation levels and cisplatin resistance in HCC.

Background: Irritable bowel syndrome (IBS) is the major form of functional bowel disorders, where the diagnosis is based on set criteria and characterized by abdominal pain and changes in bowel habits. Epidemiological data, alongside self-reported outcomes, are of interest with regard to IBS, as these factors may need to be addressed to optimize underlying IBS. This study aims to examine the effect of IBS on certain aspects of life, including sleep quality alongside some epidemiological aspects with regards to the presence of IBS in the Jazan region of Saudi Arabia.

Methods: Individuals were invited to participate in the study by replying to a validated questionnaire, whereby respondents self-identified as having IBS or not. Non-parametric comparisons using Fisher's exact test, between those with self-reported IBS versus those without IBS, were performed, with P < 0.05 considered significant.

Results: Of 728 respondents, 244 (33.5%) had self-reported IBS, and 484 (66.5%) did not. Respondents with IBS were more likely female (P < 0.001), younger age (P = 0.002), city-dwelling (P = 0.028), divorced (P = 0.028) and smokers (P = 0.003). Overall, education level did not differ amongst the groups (P = 0.093). A minority (13.5%) of those with self-reported IBS were diagnosed by a gastroenterology specialist. Abdominal pain, distension, constipation and diarrhea were all more prevalent (P < 0.001) in the IBS group compared to the non-IBS group. The IBS group had poorer sleep quality compared to the non-IBS group (P = 0.006), although no difference in medications for sleep was present between the two groups (P = 0.271).

Conclusions: Self-reported IBS was highly prevalent in our region, with risk factors for its presence being similar to those reported in previous studies. Sleep deprivation was highly prevalent in IBS patients, albeit not leading to increased prescription of relevant therapies for aid of sleep in these patients. However, marital separation and city-dwelling seemed to confer a higher self-reported IBS status. These issues should be investigated using more robust, Rome IV criteria-centered questionnaires in the future.

Background: Gastrointestinal stromal tumors (GISTs) are associated with a substantial economic burden to the healthcare system despite their relatively low incidence and prevalence compared to other more common malignancies. This study aimed to evaluate trends in GIST-related hospitalizations, inpatient mortality, and the financial burden of GISTs in the United States.

Methods: The National Inpatient Sample (NIS) database from 2016 to 2020 was used to identify adult hospitalizations (age > 18 years) with a primary diagnosis of GIST. A multivariate logistic regression along with Chi-square and t-tests was performed using SAS 9.4 software to analyze inpatient GIST-associated mortality, inflation-adjusted total hospital charge (THC), and length of stay (LOS) during the study period.

Results: The study analyzed 48,690 hospitalizations (49.2% female, mean age 64.2 years, 38.2% elective admissions) with a primary diagnosis of GIST between 2016 and 2020. Annual GIST-related hospitalizations increased from 2,645 in 2016 to 11,565 in 2020 (P = 0.1208). The most common tumor location was stomach (48.5%), followed by small intestine (18.7%), large intestine (3.6%), and rectum (1.6%). There was a non-significant reduction in inpatient mortality from 4.16% in 2016 to 3.29% in 2020 (P = 0.807). Overall, 36.2% of patients had THC between $10,000 and $20,000 (36.5% in 2016 vs. 34.7% in 2020, P = 0.0001), and 9.8% of patients had a THC > $40,000 (8.3% in 2016 vs. 12.6% in 2020, P = 0.0001). Furthermore, 61.5% of patients had LOS of fewer than 5 days (59.16% in 2016 vs. 61.39% by 2020, P = 0.0001), and 38.5% had LOS of 5 days or more (40.84% in 2016 vs. 38.61% in 2020, P = 0.0001). The proportion of GISTs treated with endoscopic resection has remained stable with 13.02% in 2016 and 13.01% in 2020 (P = 0.08). Additionally, the proportion of surgical excisions decreased from 26.8% in 2016 to 21.4% in 2020 with a statistically significant trend (P = 0.004).

Conclusions: GIST-related inpatient mortality between 2016 and 2020 has remained stable, and endoscopic and surgical interventions have become more common for the management of GISTs. This has been accompanied by a significant rise in overall inflation-adjusted hospitalization costs in the study period. These findings highlight the need for continued optimization of care and resource allocation for GIST management.

Background: Endoscopic ultrasound (EUS)-guided lumen-apposing metal stent (LAMS) placement is increasingly being used in lieu of surgery for multiple procedures, including transmural fluid drainage. However, few studies have evaluated adverse events (AEs) associated with LAMS placement. Our aim was to characterize the rates of AEs associated with several LAMS placement strategies across different procedures and indications.

Methods: A single-center retrospective cross-sectional study was conducted on patients who underwent EUS-guided LAMS placement between 2015 and 2023 at a single institution. Technical and clinical success rates and rates of early and late AEs were analyzed. Comparisons of AE rates were determined for patients who had LAMS dilation versus those without dilation, patients who had plastic stent placement in addition to LAMS placement versus those with no plastic stents, and patients who had combined dilation and plastic stent procedures versus those with LAMS dilation only.

Results: A total of 243 patients underwent EUS-guided LAMS interventions: 110 (45.3%) women and 133 (54.7%) men (mean age 53.7 ± 15.9 years). There were 96 (39.5%) patients who had at least one AE. Abdominal pain was the most common early and late AE. Plastic stent placement alongside LAMS placement was associated with a significantly higher rate of overall AEs (48.3% vs 29.9%; P = 0.009), late AEs (33% vs 17.9%; P = 0.021), and stent occlusion (5.7% vs 0%; P = 0.046). LAMS dilation was associated with higher rates of late AEs (34.2% vs 20.6%; P = 0.022) and stent occlusion (6.2% vs 1.0%; P = 0.049).

Conclusions: LAMS placement showed high technical and clinical success rates across different indications with mostly mild AEs, suggesting that LAMSs may be safe and effective for pancreatic and biliary drainage.