Pub Date : 2025-01-15DOI: 10.1053/j.gastro.2024.12.033
Alexander C. Ford, Yuhong Yuan, Jin Young Park, David Forman, Paul Moayyedi
Background & aims
Screening for, and treating, Helicobacter pylori (H. pylori) in the general population or patients with early gastric neoplasia could reduce incidence of, and mortality from, gastric cancer. We updated a meta-analysis of randomized controlled trials (RCTs) examining this issue.
Methods
We searched the literature through 4th October 2024, identifying studies examining effect of eradication therapy on incidence of gastric cancer in H. pylori-positive adults without gastric neoplasia at baseline or H. pylori-positive patients with gastric neoplasia undergoing endoscopic mucosal resection (EMR) in either RCTs or observational studies. The control arm received placebo or no eradication therapy in RCTs and no eradication therapy in observational studies. Follow-up was ≥2 years. We estimated relative risks (RR) of gastric cancer incidence and mortality.
Results
Eleven RCTs and 13 observational studies were eligible. For RCTs, RR of gastric cancer was lower with eradication therapy in healthy H. pylori-positive individuals (eight RCTs: 0.64; 95% CI 0.48-0.84) and H. pylori-positive patients with gastric neoplasia undergoing EMR (three RCTs: 0.52; 95% CI 0.38-0.71). RR of death from gastric cancer was lower with eradication therapy in healthy H. pylori-positive individuals (five RCTs: 0.78; 95% CI 0.62-0.98). In observational studies, RR of future gastric cancer was lower with eradication therapy in H. pylori-positive subjects without gastric neoplasia at baseline (11 studies: 0.56; 95% CI 0.43-0.73) and H. pylori-positive patients with gastric neoplasia undergoing EMR (two studies: 0.19; 95% CI 0.06-0.61).
Conclusions
This meta-analysis provides further evidence that administering eradication therapy prevents gastric cancer in H. pylori-positive individuals, with consistency in results among studies of different design.
背景,目的在普通人群或早期胃肿瘤患者中筛查和治疗幽门螺杆菌（H. pylori）可以降低胃癌的发病率和死亡率。我们更新了一项随机对照试验（rct）的荟萃分析，研究了这一问题。方法：我们检索了截至2024年10月4日的文献，通过随机对照试验或观察性研究，确定了根除治疗对基线时未发生胃瘤的幽门螺杆菌阳性成人或内镜下粘膜切除术（EMR）的幽门螺杆菌阳性胃瘤患者胃癌发病率的影响。对照组在随机对照试验中接受安慰剂或无根除治疗，在观察性研究中接受无根除治疗。随访≥2年。我们估计胃癌发病率和死亡率的相对危险度（RR）。结果6项随机对照试验和13项观察性研究符合条件。在随机对照试验中，健康的幽门螺杆菌阳性个体接受根除治疗后胃癌的RR较低(8项随机对照试验：0.64；95% CI 0.48-0.84)和幽门螺旋杆菌阳性胃肿瘤患者行EMR(3个随机对照试验：0.52；95% ci 0.38-0.71)。在健康的幽门螺杆菌阳性个体中，接受根除治疗后胃癌死亡的RR较低(5个rct: 0.78；95% ci 0.62-0.98)。在观察性研究中，在基线时无胃瘤的幽门螺杆菌阳性受试者中，根治治疗后未来胃癌的RR较低(11项研究：0.56；95% CI 0.43-0.73)和幽门螺旋杆菌阳性胃肿瘤患者行EMR(两项研究：0.19；95% ci 0.06-0.61)。结论：本荟萃分析提供了进一步的证据，证明给予根除治疗可以预防幽门螺杆菌阳性个体的胃癌，不同设计的研究结果一致。
{"title":"Eradication Therapy to Prevent Gastric Cancer in H. pylori-positive individuals: Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies.","authors":"Alexander C. Ford, Yuhong Yuan, Jin Young Park, David Forman, Paul Moayyedi","doi":"10.1053/j.gastro.2024.12.033","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.033","url":null,"abstract":"<h3>Background & aims</h3>Screening for, and treating, <em>Helicobacter pylori</em> (<em>H. pylori</em>) in the general population or patients with early gastric neoplasia could reduce incidence of, and mortality from, gastric cancer. We updated a meta-analysis of randomized controlled trials (RCTs) examining this issue.<h3>Methods</h3>We searched the literature through 4<sup>th</sup> October 2024, identifying studies examining effect of eradication therapy on incidence of gastric cancer in <em>H. pylori</em>-positive adults without gastric neoplasia at baseline or <em>H. pylori</em>-positive patients with gastric neoplasia undergoing endoscopic mucosal resection (EMR) in either RCTs or observational studies. The control arm received placebo or no eradication therapy in RCTs and no eradication therapy in observational studies. Follow-up was ≥2 years. We estimated relative risks (RR) of gastric cancer incidence and mortality.<h3>Results</h3>Eleven RCTs and 13 observational studies were eligible. For RCTs, RR of gastric cancer was lower with eradication therapy in healthy <em>H. pylori</em>-positive individuals (eight RCTs: 0.64; 95% CI 0.48-0.84) and <em>H. pylori</em>-positive patients with gastric neoplasia undergoing EMR (three RCTs: 0.52; 95% CI 0.38-0.71). RR of death from gastric cancer was lower with eradication therapy in healthy <em>H. pylori</em>-positive individuals (five RCTs: 0.78; 95% CI 0.62-0.98). In observational studies, RR of future gastric cancer was lower with eradication therapy in <em>H. pylori</em>-positive subjects without gastric neoplasia at baseline (11 studies: 0.56; 95% CI 0.43-0.73) and <em>H. pylori</em>-positive patients with gastric neoplasia undergoing EMR (two studies: 0.19; 95% CI 0.06-0.61).<h3>Conclusions</h3>This meta-analysis provides further evidence that administering eradication therapy prevents gastric cancer in <em>H. pylori</em>-positive individuals, with consistency in results among studies of different design.","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"37 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142986882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1053/j.gastro.2024.12.031
L. Godny, S. Elial-Fatal, J. Arrouasse, T. Sharar Fischler, L. Reshef, Y. Kutukov, S. Cohen, T. Pfeffer-Gik, R. Barkan, S. Shakhman, A. Friedenberg, M.H. Pauker, K.M. Rabinowitz, E. Shaham-Barda, I. Goren, U. Gophna, H. Eran-Banai, J.E. Ollech, Y. Snir, Y. Broitman, I. Dotan
Background
To decipher the mechanisms underlying the protective role of the Mediterranean diet (MED) in Crohn’s disease (CD), we explored the implications of adherence to MED on CD course, inflammatory markers, microbial and metabolite composition.
Methods
Patients with newly diagnosed CD were recruited and followed prospectively. MED adherence was assessed by repeated food frequency questionnaires (FFQ), using a predefined IBDMED score, alongside validated MED adherence screeners. Crohn’s disease activity index (CDAI), C-reactive protein (CRP), fecal calprotectin and microbial composition (16S-rRNA-sequencing) were assessed each visit. Baseline serum and fecal samples were analyzed for targeted quantitative metabolomics.
Results
Consecutive patients: 271 (52% males, average age- 31±12 years, B1 phenotype- 75%). FFQ collected: 636 (range 1-5 FFQ per patient). Adherence to MED was associated with a non-complicated CD course, and inversely correlated with CDAI, fecal calprotectin, CRP and microbial dysbiosis index (all P < .05). Increasing adherence to MED over time correlated with reduced CDAI and inflammatory markers (P < .05). Adherence to MED correlated with a microbial cluster of commensals and short-chain fatty acid producers including Faecalibacterium, and with plant metabolites, vitamin derivatives and amino acids. Conversely, adherence to MED inversely correlated with a cluster of oral genera, Escherichia coli and Ruminococcus gnavus, known CD-associated species, and with tryptophan metabolites, ceramides and primary bile acids (FDR < .2).
Conclusion
Adherence to MED is associated with beneficial clinical outcomes and decreased inflammatory markers. These may be driven by lower levels of primary bile-acids and microbial dysbiosis and a beneficial microbial and metabolite composition. Randomized controlled trials are needed to evaluate the role of MED in CD management.
{"title":"Mechanistic implications of the Mediterranean diet in patients with newly diagnosed Crohn's disease- multi-omic results from a prospective cohort","authors":"L. Godny, S. Elial-Fatal, J. Arrouasse, T. Sharar Fischler, L. Reshef, Y. Kutukov, S. Cohen, T. Pfeffer-Gik, R. Barkan, S. Shakhman, A. Friedenberg, M.H. Pauker, K.M. Rabinowitz, E. Shaham-Barda, I. Goren, U. Gophna, H. Eran-Banai, J.E. Ollech, Y. Snir, Y. Broitman, I. Dotan","doi":"10.1053/j.gastro.2024.12.031","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.031","url":null,"abstract":"<h3>Background</h3>To decipher the mechanisms underlying the protective role of the Mediterranean diet (MED) in Crohn’s disease (CD), we explored the implications of adherence to MED on CD course, inflammatory markers, microbial and metabolite composition.<h3>Methods</h3>Patients with newly diagnosed CD were recruited and followed prospectively. MED adherence was assessed by repeated food frequency questionnaires (FFQ), using a predefined IBDMED score, alongside validated MED adherence screeners. Crohn’s disease activity index (CDAI), C-reactive protein (CRP), fecal calprotectin and microbial composition (16S-rRNA-sequencing) were assessed each visit. Baseline serum and fecal samples were analyzed for targeted quantitative metabolomics.<h3>Results</h3>Consecutive patients: 271 (52% males, average age- 31±12 years, B1 phenotype- 75%). FFQ collected: 636 (range 1-5 FFQ per patient). Adherence to MED was associated with a non-complicated CD course, and inversely correlated with CDAI, fecal calprotectin, CRP and microbial dysbiosis index (all <em>P</em> < .05). Increasing adherence to MED over time correlated with reduced CDAI and inflammatory markers (<em>P</em> < .05). Adherence to MED correlated with a microbial cluster of commensals and short-chain fatty acid producers including <em>Faecalibacterium</em>, and with plant metabolites, vitamin derivatives and amino acids. Conversely, adherence to MED inversely correlated with a cluster of oral genera, <em>Escherichia coli</em> and <em>Ruminococcus gnavus</em>, known CD-associated species, and with tryptophan metabolites, ceramides and primary bile acids (FDR < .2).<h3>Conclusion</h3>Adherence to MED is associated with beneficial clinical outcomes and decreased inflammatory markers. These may be driven by lower levels of primary bile-acids and microbial dysbiosis and a beneficial microbial and metabolite composition. Randomized controlled trials are needed to evaluate the role of MED in CD management.","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"51 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11DOI: 10.1053/j.gastro.2024.12.032
Daniel Karpati, Maartje Nielsen, Anja Wagner, Sanne W. Bajwa-ten Broeke, Fonnet E. Bleeker, Monique E. van Leerdam
No Abstract
没有抽象的
{"title":"Individuals with Lynch syndrome have similar survival as the general population, but lower than family members without Lynch syndrome","authors":"Daniel Karpati, Maartje Nielsen, Anja Wagner, Sanne W. Bajwa-ten Broeke, Fonnet E. Bleeker, Monique E. van Leerdam","doi":"10.1053/j.gastro.2024.12.032","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.032","url":null,"abstract":"No Abstract","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"16 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to evaluate the association of frequency of polyp diagnosis in relatives with the risk of overall and early-onset colorectal cancer (CRC).
Methods
We leveraged data from nationwide Swedish family cancer datasets (1964-2018) to calculate standardized incidence ratios (SIRs) for individuals with a family history of polyp by frequency of polyp diagnosis in family members.
Results
We followed up 11,676,043 individuals for up to 54 years. Compared with the risk in individuals without a family history of colorectal tumor (N=142,234), the risk of overall CRC was 1.4-fold in those with 1 FDR with one-time polyp diagnosis [95%CI=1.3-1.4, N=11,035; early-onset SIR: 1.4 (1.3-1.5), N=742]. The risk was significantly higher in individuals with 1 FDR with ≥2 times (frequent) polyp diagnoses [overall CRC: 1.8 (1.8-1.9); early-onset CRC=2.3 (2.0-2.6)]. A rather similar risk was observed for individuals with ≥2 FDRs with one-time polyp diagnosis [overall CRC: 1.9 (1.7-2.1); early-onset CRC: 2.2 (1.5-2.9)]. Individuals with ≥2 FDRs with frequent polyp diagnoses had a 2.4-fold overall risk (2.2-2.7) and a 3.9-fold early-onset risk (2.8-5.3). Younger age at polyp diagnosis in FDRs was associated with an increased risk of CRC. A family history of polyp in second-degree relatives was important only when there were frequent diagnoses of polyp.
Conclusions
A higher frequency of colorectal polyp diagnosis in relatives is associated with a greater risk of CRC, especially early-onset CRC. This risk is independent of number of affected relatives or youngest age at polyp diagnosis. These findings underscore the need for more personalized CRC screening strategies that are tailored to individuals with a family history of polyp.
{"title":"Risk of colorectal cancer associated with frequency of colorectal polyp diagnosis in relatives","authors":"Yuqing Hu, Elham Kharazmi, Qunfeng Liang, Kristina Sundquist, Jan Sundquist, Mahdi Fallah","doi":"10.1053/j.gastro.2024.12.030","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.030","url":null,"abstract":"<h3>Background & Aims</h3>We aimed to evaluate the association of frequency of polyp diagnosis in relatives with the risk of overall and early-onset colorectal cancer (CRC).<h3>Methods</h3>We leveraged data from nationwide Swedish family cancer datasets (1964-2018) to calculate standardized incidence ratios (SIRs) for individuals with a family history of polyp by frequency of polyp diagnosis in family members.<h3>Results</h3>We followed up 11,676,043 individuals for up to 54 years. Compared with the risk in individuals without a family history of colorectal tumor (N=142,234), the risk of overall CRC was 1.4-fold in those with 1 FDR with one-time polyp diagnosis [95%CI=1.3-1.4, N=11,035; early-onset SIR: 1.4 (1.3-1.5), N=742]. The risk was significantly higher in individuals with 1 FDR with ≥2 times (frequent) polyp diagnoses [overall CRC: 1.8 (1.8-1.9); early-onset CRC=2.3 (2.0-2.6)]. A rather similar risk was observed for individuals with ≥2 FDRs with one-time polyp diagnosis [overall CRC: 1.9 (1.7-2.1); early-onset CRC: 2.2 (1.5-2.9)]. Individuals with ≥2 FDRs with frequent polyp diagnoses had a 2.4-fold overall risk (2.2-2.7) and a 3.9-fold early-onset risk (2.8-5.3). Younger age at polyp diagnosis in FDRs was associated with an increased risk of CRC. A family history of polyp in second-degree relatives was important only when there were frequent diagnoses of polyp.<h3>Conclusions</h3>A higher frequency of colorectal polyp diagnosis in relatives is associated with a greater risk of CRC, especially early-onset CRC. This risk is independent of number of affected relatives or youngest age at polyp diagnosis. These findings underscore the need for more personalized CRC screening strategies that are tailored to individuals with a family history of polyp.","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"19 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-09DOI: 10.1053/j.gastro.2024.12.028
Ming Duan, Wei Liu, John Calvin Coffey, Jia Ke, Wei Zhou, Yi Li
No Abstract
没有抽象的
{"title":"Postoperative Endoscopic Outcomes in the MESOCOLIC Trial Investigating Mesenteric-based surgery for Crohn's Disease","authors":"Ming Duan, Wei Liu, John Calvin Coffey, Jia Ke, Wei Zhou, Yi Li","doi":"10.1053/j.gastro.2024.12.028","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.028","url":null,"abstract":"No Abstract","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"101 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-07DOI: 10.1053/j.gastro.2024.12.027
Romy Walker, Jihoon E. Joo, Khalid Mahmood, Peter Georgeson, Ingrid M. Winship, Daniel D. Buchanan
No Abstract
没有抽象的
{"title":"DNA mismatch repair (MMR) gene mosaicism is rare in people with MMR-deficient cancers","authors":"Romy Walker, Jihoon E. Joo, Khalid Mahmood, Peter Georgeson, Ingrid M. Winship, Daniel D. Buchanan","doi":"10.1053/j.gastro.2024.12.027","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.027","url":null,"abstract":"No Abstract","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-07DOI: 10.1053/j.gastro.2024.12.026
Brian D. Gulbransen, Robert O. Heuckeroth
No Abstract
没有抽象的
{"title":"Canonical and Schwann-like enteric glia “seq” diversity","authors":"Brian D. Gulbransen, Robert O. Heuckeroth","doi":"10.1053/j.gastro.2024.12.026","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.026","url":null,"abstract":"No Abstract","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"48 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-04DOI: 10.1053/j.gastro.2024.12.021
Yiting Li, Xing Jia, Caiyu Li, Li Liu
No Abstract
没有抽象的
{"title":"Reply to Liu et al","authors":"Yiting Li, Xing Jia, Caiyu Li, Li Liu","doi":"10.1053/j.gastro.2024.12.021","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.021","url":null,"abstract":"No Abstract","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"27 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-04DOI: 10.1053/j.gastro.2024.12.020
Yuan Chen, Chengcheng Wang, Yupei Zhao
No Abstract
没有抽象的
{"title":"Reply to Lin et al","authors":"Yuan Chen, Chengcheng Wang, Yupei Zhao","doi":"10.1053/j.gastro.2024.12.020","DOIUrl":"https://doi.org/10.1053/j.gastro.2024.12.020","url":null,"abstract":"No Abstract","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":"32 1","pages":""},"PeriodicalIF":29.4,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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