Gastroenterology Research and Practice最新文献

Background: Compound sophorae decoction (CSD) has been extensively applied in clinic for the treatment of ulcerative colitis (UC). However, the effect and precise therapeutic mechanism have not been fully clarified. In this study, we systematically explored the protective efficacy and the underlying molecular mechanisms of CSD against UC.

Methods: The main constituents of CSD were analyzed by HPLC-MS/MS and TLC. H₂O₂-treated Caco-2 cells were employed to investigate the impact of CSD on ferroptosis and its underlying mechanism. The impacts of CSD on inflammation, oxidative stress, and ferroptosis in vitro were evaluated by ELISA, biochemical detection, or fluorescence probe. The UC model was established in rats by administering 5% DSS in the drinking water. The effects and safety of CSD on DSS-induced colitis were evaluated through daily body weight, DAI, colon length, and HE staining. In addition, cytokines (IL-1β, IL-6, TNF-α, and TGF-β) and ferroptosis-associated parameters (iNOS and PTGS2) were detected by ELISA. Antioxidant and oxidant enzyme activities (SOD, GSH, MDA, and NO) and lipid ROS in serum and colon tissue were measured by biochemical kit. Ferroptosis was determined by analysis of ferroptosis-associated proteins (Keap1, Nrf2, GPX4, and SLC7A11).

Results: Then, 10 main active components were identified in CSD. CSD significantly attenuated DSS-induced intestinal injury and inflammation. Moreover, CSD notably decreased oxidative stress and lipid peroxidation. Mechanistically, CSD suppressed ferroptosis in DSS-induced UC and upregulated GPX4 and SLC7A11 expression through the activation of Nrf2 signaling in DSS-induced rats.

Conclusions: Collectively, this study demonstrated that CSD ameliorates ferroptosis in DSS-induced UC rats, with its protective effects attributed to the activation of the Keap1/Nrf2/GPX4 signaling pathway.

Background: Transoral incisionless fundoplication (TIF) presents a minimally invasive, endoscopic treatment for the management of gastroesophageal reflux disease (GERD), known for its efficacy and safety in patients with normal esophageal motility. However, the use of TIF in ineffective esophageal motility (IEM) remains largely unexplored. This study examined the outcomes of TIF in IEM patients.

Methods: Retrospective data from 164 patients, including 29 with IEM and refractory GERD, were analyzed to obtain assessments of disease-specific quality of life through the Gastroesophageal Reflux Disease Health-Related Quality of Life Questionnaire (GERD-HRQL) and proton pump inhibitor usage.

Results: Statistically significant improvements were seen in total, heart burn, and regurgitation GERD-HRQL scores (p < 0.001, p < 0.001, p < 0.001) and reduction in PPI use (0 < 0.001) after TIF, with no significant difference in dysphagia risk (p < 0.2).

Conclusion: This study underscores durable improvements that TIF can provide in quality of life in patients with both GERD and IEM, without compromising the increased risk of dysphagia. Although some patients resume antisecretory medications within 3-6 months, most stopped taking PPI after the procedure.

Introduction: Changes in nomenclature and in the criteria for histological diagnosis of the serrated lesions have occurred over the years. Some of these lesions, the sessile serrated lesions (SSLs), progress to adenocarcinoma via suppression of the MLH1 gene, an important carcinogenic pathway.

Objective: Evaluate the frequency of reclassification in histological diagnosis from hyperplastic polyps (HPs) to SSL after reappraisal using the 2019 World Health Organization (WHO) classification, to determine the occurrence of previously undiagnosed dysplasia and to study the expression of the MLH1 protein in SSLs and SSLDs.

Methodology: Lesions with histological diagnosis of HP, SSL, and SSLD resected by colonoscopies performed between 2005 and 2015 located in the proximal colon were studied. All HPs were submitted for histological review by two pathologists (Examiners 1 and 2), and a third experienced pathologist (Examiner 3) made the final decision when the other examiners did not agree. Interobserver agreement was analyzed. MLH1 protein expression was assessed by immunohistochemistry in lesions diagnosed as SSL and SSLD before and after reappraisal. These lesions were reviewed again for missed dysplasia.

Results: A total of 308 lesions were assessed being 287 with the initial diagnosis of HP and 21 SSL. Thirty-eight (13.3%) lesions with an initial diagnosis of HP had their diagnosis reclassified to SSL. No dysplasia was found. There was a moderate agreement (Kappa 0.52) between Examiners 1 and 2 regarding the diagnosis of SSL. Between Examiners 1 and 3, there was no agreement (Kappa -0.19), and between Examiners 3 and 2, the agreement was poor (Kappa 0.13). All 38 lesions analyzed by immunohistochemistry had MLH1 expression.

Conclusion: Changes in diagnosis from HP to SSL occurred in 13.3%. No dysplasia or lack of MLH1 expression was observed.

[This corrects the article DOI: 10.1155/2021/8828326.].

Purpose: This study was aimed at investigating the influence of age on patients with autoimmune gastritis (AIG).

Methods: A total of 56 patients diagnosed with AIG at our hospital between January 2019 and December 2021 were included in this study. The participants were categorized into the elderly group (≥ 60 years old) and the nonelderly group. We analyzed the baseline characteristics, gastroscopy findings, and various laboratory examination parameters to see if age significantly influences the clinical manifestation of AIG patients.

Results: During the study period, 32 and 24 patients were included in the elderly and nonelderly groups. Regarding baseline characteristics and symptoms, the nonelderly group showed a higher prevalence of acid reflux (12.5% vs. 6.3%, p < 0.05), a higher proportion of asymptomatic patients (8.3% vs. 3.1%, p = 0.046), and a higher prevalence of iron deficiency anemia (37.5% vs. 12.5%). Regarding laboratory examinations, the nonelderly group had a lower mean corpuscular volume (78.8 ± 7.9 vs. 89.2 ± 8.1 fL, p = 0.024), decreased serum ferritin levels ((24.8 ± 10.9 vs. 48.4 ± 13.1 ng/mL, p = 0.024), elevated serum vitamin B12 (92.3 ± 18.2 vs. 76.8 ± 12.9 pmol/L, p = 0.037), and a higher incidence of positive thyroid peroxidase antibody (28.2% vs. 12.5%, p = 0.024). However, the gastroscopy findings, including the incidence of proliferative polyps, neuroendocrine tumors, gastric intraepithelial neoplasia, and cancers, showed no significant difference between the two groups (p > 0.05).

Conclusion: Nonelderly patients with AIG exhibit distinct clinical features compared to elderly patients. Large sample sizes with multiple centers involved in studies are required to verify our findings.

Background: While preoperative neoadjuvant chemotherapy (NT) followed by surgery has gained acceptance in the management of locally advanced gastric cancer (LAGC), there remains a paucity of studies examining the efficacy of total neoadjuvant chemotherapy (TNT) for LAGC. This study was aimed at addressing this gap by comparing the outcomes of patients with clinical stage T4a-bN + M0 proximal gastric cancer treated with TNT and NT. The investigation sought to provide valuable insights into the effectiveness of the TNT regimen in this specific clinical context.

Methods: Retrospective analysis was conducted on the clinical data of patients diagnosed with proximal LAGC who underwent perioperative docetaxel, oxaliplatin, and fluorouracil (FLOT) chemotherapy followed by laparoscopic radical gastrectomy at Longyan First Hospital affiliated with Fujian Medical University. The study, spanning from January 2017 to December 2019, included 26 patients in the TNT group and 32 patients in the NT group. Comparative assessments were made regarding the outcomes of chemotherapy and surgery, as well as the 3-year disease-free survival (DFS) and overall survival (OS) between the two groups.

Results: The TNT group demonstrated superiority over the NT group in terms of operation time and intraoperative blood loss. While no significant difference was observed in total postoperative complications between the two groups, the TNT group exhibited a more pronounced downstaging in T stage and a higher rate of pathological complete regression. The 3-year OS rate was notably higher in the TNT group at 61.5%, compared to 46.9% in the NT group. Similarly, the 3-year DFS rate favored the TNT group at 53.8%, surpassing the rate of 34.4% in the NT group.

Conclusions: The TNT approach for LAGC had the potential to enhance tumor regression and increase the completion rate of chemotherapy. This strategy demonstrated a positive trend in long-term outcomes and introduced a novel treatment model.

Background: Severe acute pancreatitis (SAP), one of the common causes of acute abdomen in clinical practice, is characterized by acute and rapid onset as well as the systemic inflammatory response syndrome, which often leads to intestinal injury and high mortality. Recent studies indicate that innate lymphoid cells (ILCs) play an important role in the connection of SAP and intestinal injury. TCM, including the QingXia HuaYu (QXHY) formula, is known to benefit gastrointestinal dysfunction in SAP, but its mechanisms, especially regarding ILCs, are unclear.

Methods: A mouse model of SAP was established by retrograde infusion of sodium taurocholate into the common bile duct of C57BL/6 mice. QXHY was orally administered three times postinfusion. Serum inflammatory markers, pancreatic myeloperoxidase, and histopathological changes in the mice with SAP with or without QXHY treatment were used to evaluate the pancreatic injury and the therapeutic effects of QXHY. Intestinal tight junctions, serum markers for mucosal injury, and inflammatory factors were used to analyze the effects of QXHY on intestinal injury in SAP mice. Flow cytometry and qRT-PCR were used to analyze ILC3s numbers and functions.

Results: QXHY significantly reduced serum amylase, pancreatic myeloperoxidase, and improved histopathological manifestations in SAP mice. In addition, QXHY reduced intestinal damage, improved tight junction integrity, and lowered proinflammatory cytokines. Mechanistically, QXHY restored the diminished RORγt⁺-ILC3s in SAP mice and upregulated the expression of IL-22 (interleukin-22) and IL-17 (interleukin-17) mRNA.

Conclusion: QXHY mitigates SAP-associated intestinal damage by enhancing ILC3 cells to regulate tissue injury and maintain homeostasis. Our data suggest that QXHY is a promising alternative and cost-friendly therapy for SAP-associated intestinal damage.

Background: Diet is a modifiable risk factor for gallstone formation and influence the risk of gallstone disease (GSD). The present study was designed with the aim of investigating the association between different dietary protein and the risk of GSD.

Methods: This case-control study was conducted on 189 patients diagnosed with GSD and 342 controls. Intake of total protein and its subgroups was measured based on food frequency questionnaire. Using multiple logistic regression models, crude and multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.

Results: Total protein intake can have protective effects against GSD and its beneficial effect was more in moderate consumption (OR_T2 vs.T1 = 0.2, 95% CI 0.1-0.4) than high consumption (OR_T3 vs.T1 = 0.39, 95% CI 0.23-0.66) (p for trend < 0.001). The relationship between dairy protein intake and the risk of GSD was U-shaped, so that moderate intake was associated with a reduced risk (OR_T2 vs.T1 = 0.76) and higher intake was associated with an increased risk of the disease (OR_T3 vs.T1 = 1.5) (p for trend = 0.027). Vegetable protein as a protective factor and animal protein as a risk factor showed a significant relationship with the risk of GSD.

Conclusion: Dietary protein intake, especially vegetable protein, may protect against GSD, while animal protein may be a predisposing factor. Dairy protein protects against GSD when consumed in moderation, but higher intakes may increase the risk of GSD.

Objectives: T staging is required before choosing the treatment modality for early gastric cancer (EGC). Ultrasound endoscopy (EUS) is a commonly used method for T staging of EGC. However, the results of studies on the accuracy of EUS in diagnosing the depth of EGC infiltration have been inconsistent. The purpose of this article is to investigate the overall accuracy of miniprobe EUS for diagnosing EGC infiltration depth and to explore the risk factors affecting the accuracy of miniprobe EUS.

Methods: We retrospectively analyzed the data of 136 patients with EGC, all of whom underwent preoperative EUS T staging and pathological specimens were obtained by endoscopic submucosal dissection (ESD) or radical surgery. The accuracy of miniprobe EUS in determining EGC was assessed by comparing the concordance between EGC EUS T staging and histopathological diagnosis and analyzing the lesion characterization factors affecting the accuracy of EUS.

Results: By analyzing the 136 EGC cases included, the overall accuracy of miniprobe EUS for EGC T stage was 77.2% (105/136); the accuracy of miniprobe EUS for diagnosing T1a and T1b EGC was 80.7% (92/114) and 59.1% (13/22), respectively. Lesions combined with ulcers (OR: 3.221; 95% CI: 1.084-9.570; p = 0.035) and lesions with depressed morphology (OR: 3.869; 95% CI: 1.208-12.389; p = 0.023) were independent risk factors for overdetermination of EGC infiltration depth by miniprobe EUS. Helicobacter pylori (HP) presenting infection was significantly associated with EGC combined with ulcers (OR: 19.725; 95% CI: 2.451-158.747; p = 0.005).

Conclusions: The accuracy of miniprobe EUS in diagnosing T1a EGC is high, and the accuracy in diagnosing T1b EGC is relatively low. Miniprobe EUS is less accurate in determining the depth of infiltration of EGCs combined with ulcers and with a depressed morphology. EGCs are more prone to be combined with ulcers in the setting of a presenting infection of HP, which led us to propose the hypothesis "is it possible to improve the accuracy of EUS by short-term eradication of HP to reduce the inflammation of EGC ulcers."

Background: Irritable bowel syndrome (IBS) can be dietary managed by applying restrictions in the diet of fermentable oligosaccharides, disaccharides, monosaccharides and polyols-the low FODMAP diet. However, many patients have major difficulties integrating the diet into their daily lives.

Objective: We aimed to investigate if the three carbohydrate groups eliminated in the traditional low FODMAP diet are equally important in relieving gastrointestinal symptoms in IBS.

Methods: Nine patients with IBS according to the Rome IV criteria and referred to specialised diet therapy in private clinics were randomised in a crossover design to three different carbohydrate-modified diets: (A) low polyol diet, (B) low FOS + GOS diet and (C) low standard FODMAP diet for 4 weeks on each diet. Symptoms were assessed by the Birmingham IBS questionnaire and adequate relief (IBS-AR) and quality of life by the IBS Quality of Life Scale questionnaire (IBS-QOL) at baseline and after every intervention period by a dietitian with assessment of the intake by weekly contact. Nonparametric statistical methods were used.

Results: Compared to baseline, the low polyol diet did not change the symptoms, but relief was significant on both the low FOS + GOS diet and the low FODMAP diet (p < 0.05) with no difference between these two diets. Clinically relevant symptom relief was experienced by 75% of patients on the low FOS + GOS diet and 62.5% on the low FODMAP diet, but none on the low polyol diet.

Conclusion: A carbohydrate-modified diet with the exclusion of fructooligosaccharides and galactooligosaccharides (low FOS + GOS diet) reduced gastrointestinal symptoms and improved quality of life equally to the standard low FODMAP diet in patients with IBS. Polyol restriction was of minor importance. The low FOS + GOS diet could be the starting diet in selected patients with IBS.

Trial registration: ClinicalTrials.gov identifier: NCT05618106.