Gastroenterology Research最新文献

Primary intestinal lymphangiectasia (PIL) is a rare disease characterized by the loss of lymphatic fluid in the intestinal lumen and is a known cause of protein-losing enteropathy (PLE). Although uncommon, few cases of secondary hyperparathyroidism (SHPT) have been reported in patients with PIL. This study summarizes the characteristics of four cases diagnosed with PIL. Notably, all cases were confirmed to have hyperparathyroidism secondary to vitamin D deficiency and hypocalcemia. Recurrent diarrhea and limb convulsions were also observed in all patients, with one patient diagnosed with osteoporosis. Simultaneously, hypomagnesemia was detected in three cases. Treatment with vitamin D and calcium supplements relieved symptoms, elevated serum calcium levels, and decreased parathyroid hormone (PTH) levels. In patients with PIL, evaluation of 25-hydroxyvitamin D, calcium, and PTH levels is crucial. Bone diseases should be considered in patients with SHPT, and appropriate vitamin D3 and calcium supplementation is highly recommended.

Background: Northern Central America is unique in the Western Hemisphere, with a high incidence of gastric cancer, low/middle-income country (LMIC) status, and a substantial emigration to the United States. The two primary Helicobacter pylori (H. pylori) virulence factors related to carcinogenesis are cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA). The prevalence of these factors may help delineate gastric cancer risk in the region. We aimed to characterize the H. pylori seroprevalence and virulence factors in two Central American Countries (Honduras and Guatemala).

Methods: Healthy volunteers from Western Honduras and Central-Western Guatemala were recruited and tested for antibodies against 13 H. pylori antigens using a novel multiplex serology assay. H. pylori seropositivity was defined as positivity for ≥ 4 antigens, and active infection was defined as positivity for a combination of 2/4 antigens: VacA, GroEl, HcpC, and HP1564, based upon the literature. Multivariate logistic regression models were used to estimate the odds ratios for the association between H. pylori and CagA positivity.

Results: A total of 1,143 healthy adults were tested using the H. pylori multiplex serology assay (444 in Guatemala and 699 in Honduras). Mean age was 54.2 ± 14.5 years, 46.2% were male, 60% were from rural settings, and 56% lived > 1,000 meters above sea level. H. pylori prevalence was 87%, and 83% with active infection. The CagA and VacA seropositivity rates were 82% and 75%, respectively. No significant differences were noted according to country, age group, sex, or rural/urban location. None of the socioeconomic variables were significantly associated with the presence of H. pylori or CagA.

Conclusions: A high prevalence of H. pylori, CagA, and VacA is observed in Honduras and Guatemala, with implications for Northern Central America and immigrants from the region. Innovative and resource-appropriate primary and secondary prevention programs are needed.

Background: Gastrointestinal (GI) tract malignancies represent a significant global health burden, being major contributors to cancer-related morbidity and mortality globally, with over 7.7 million cases reported. While aspirin is a well-studied chemopreventive agent for GI neoplasms, its use may be limited due to the underlying bleeding risk. Eflornithine (DFMO) is an inhibitor of the ornithine decarboxylase (ODC) which inhibits polyamine synthesis, and has shown promise as an alternative chemopreventive agent, particularly in animal studies and limited clinical trials.

Methods: Following PRISMA guidelines, we conducted a systematic review of studies evaluating DFMO alone or in combination for chemoprevention in premalignant GI lesions including chronic gastritis, atrophic gastritis, intestinal metaplasia, and dysplasia. The protocol was registered in Prospero (CRD42022309307). Randomized controlled trials (RCTs) and cohort studies in English or Spanish were included.

Results: Nine studies (six RCTs and three phase I-II trials) met inclusion criteria. Phase I-II trials involving Barrett's esophagus and gastric cancer did not report significant benefits. Phase III-IV trials combining DFMO with nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with reductions in adenoma recurrence, size, and polyamine levels in high-risk GI cancer populations. Side effects included ototoxicity, reversible upon discontinuation, and mild GI events, both occurring at higher doses.

Conclusion: While aspirin remains a frontline chemopreventive agent for GI neoplasms, this review shows that phase III-IV trials suggest promising outcomes in combination with NSAIDs, warranting further investigation. Notably, DFMO's low cost and favorable toxicity profile may position it as a viable alternative, emphasizing the need for additional RCTs to delineate its efficacy and safety in GI cancer prevention. Further investigation into DFMO's optimal dosage, duration, and side effect management is essential to establish it as a safe and effective chemopreventive agent.

Background: Inflammatory bowel disease (IBD) has been associated with increased risk of developing pancreatitis. We analyzed data from the National Inpatient Sample (NIS) with the aim of evaluating the outcomes of acute pancreatitis (AP) in patients with co-existent Crohn's disease (CD) or ulcerative colitis (UC).

Methods: This was a cross-sectional study using the 2020 NIS database. Patients were included if they were more than 18 years old with a principal diagnosis of AP. Main outcome measurements of our study were in-hospital mortality, length of hospital stay, hospital total charges, incidences of hypovolemic shock, severe sepsis with and without shock, acute kidney failure (AKI), and the need for intensive care unit (ICU) care. Statistical analyses were performed on STATA version 18.0.

Results: There were 258,965 (0.8%) admissions with the primary diagnosis of AP among the 32 million discharges in 2020 NIS database. Among patients with AP, a total of 1,930 (0.75%) and 1,170 (0.45%) hospitalizations had co-existing CD and UC, respectively. The overall in-hospital mortality for AP was 1,560 (0.62%). Patients with UC hospitalized for AP had increased odds of in-hospital mortality (adjusted odds ratio (aOR): 3.62, 95% confidence interval (CI): 1.310 - 9.978, P = 0.013) while for patients with CD, there were no in-hospital mortality. Patients with CD had increased odds of developing comorbid AKI (aOR: 1.37, 95% CI: 1.005 - 1.880, P = 0.047) when they present with AP but not those with UC.

Conclusions: Patients hospitalized with AP had increased odds of in-hospital mortality and comorbid AKI when they have co-existent UC and CD, respectively.

Background: Achalasia is a rare motility disorder of the esophagus. The diagnosis involves clinical suspicion based on history details and results of high-resolution manometry (HRM) as recommended by the Chicago classification (CCv4.0). Interpreting data obtained through HRM can be complex especially for the novice user.

Methods: We propose therefore a color-based algorithm involving the "reversed red-green-blue (RGB)" rule as a simplified way to establish the diagnosis based on colors obtained through the HRM pressure sensors. The rule is based on the simple acknowledgment of the dominant color present in the mid-portion of the HRM figure such that, for type I (classic) achalasia, the blue color illustrates the minimal pressurization and absent peristalsis. In type II (pan-pressurized) achalasia, the green color illustrates pan-esophageal pressurization, while in type III (spastic) achalasia, red color illustrates the spastic contractions.

Results: This rule, which we present as a conceptual framework and has not yet been prospectively validated, provides an intuitive tool for clinicians dealing with HRMs diagnosing achalasia.

Conclusion: Further studies are required to assess the diagnostic accuracy of this rule, alongside the potential for incorporating such rules into artificial intelligence (AI)-based models for manometric diagnosis of esophageal motility disorders.

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.