Gastroenterology Research and Practice最新文献

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.

Objective: To evaluate the efficacy and safety of vonoprazan therapy as compared to conventional proton pump inhibitors (PPIs) or no vonoprazan for nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers.

Methods: A literature search was conducted across databases (PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov). The primary outcome was the risk of ulcer recurrence. Secondary outcomes comprised the risk of gastrointestinal (gastric/duodenal) bleeding; serum gastrin, pepsinogen I, and pepsinogen II levels; and safety. Pooled relative risks (RRs) and mean differences with a 95% confidence interval (CI) were determined, as appropriate, utilizing random effects models.

Results: A total of 744 articles were screened and three of them were included. The overall proportion of ulcer recurrence with vonoprazan therapy was 1.88% (95% CI: 0.98, 3.6) and the overall proportion of gastrointestinal (gastric/duodenal) bleeding with vonoprazan therapy was 1.03 (95% CI: 0.64, 1.64). As compared to PPI (lansoprazole), vonoprazan treatment led to a significant reduction in the risks of ulcer recurrence (RR: 0.55 (95% CI: 0.31, 0.97), p = 0.04, i ² = 0%) and gastrointestinal bleeding (RR: 0.40 (95% CI: 0.16, 0.97), p = 0.04, i ² = 0%). Vonoprazan treatment led to a dose-dependent significant increase in serum gastrin, serum pepsinogen I, and serum pepsinogen II levels. There was no significant difference in the risk of any adverse event (RR: 0.99 (95% CI: 0.94, 1.04), p = 0.64, i ² = 36%) following vonoprazan therapy as compared to lansoprazole. The GRADE of evidence was moderate.

Conclusion: Vonoprazan could significantly reduce the risk of ulcer recurrence and gastrointestinal bleeding as compared to lansoprazole in patients with NSAID-induced ulcers.

Introduction: The aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratio has been widely recognized as an indicator of disease severity, complications, and prognosis in various clinical conditions. However, its relevance in acute pancreatitis (AP) has not yet been clearly established. This study is aimed at systematically evaluating the association between the AST/ALT ratio and AP, with a focus on disease severity, complication rates, and clinical outcomes.

Methods: A retrospective analysis was conducted on patients diagnosed with AP at the First Affiliated Hospital of Guangdong Pharmaceutical University between July 2014 and December 2020. Multivariate logistic regression and linear regression were used to examine the relationship between the AST/ALT ratio and AP severity, complications, and prognosis.

Results: A total of 207 patients were enrolled. Based on the optimal AST/ALT cut-off value determined by receiver operating characteristic curve analysis, patients were categorized into high and low AST/ALT groups. Elevated AST/ALT ratios were independently associated with severe AP, higher incidences of complications such as pleural effusion, acute heart failure, acute kidney failure, and systemic inflammatory response syndrome, as well as worse clinical outcomes, including greater vasopressor use. Linear regression further demonstrated a significant correlation between the AST/ALT ratio and severity scoring systems, including MODS, APACHE II, and Ranson scores.

Conclusion: An elevated AST/ALT ratio is a strong predictor of increased disease severity, higher complication risk, and poorer prognosis in patients with AP. The AST/ALT ratio may serve as a simple, cost-effective, and sensitive biomarker for early assessment of AP progression and outcomes.

Background: There has been very limited investigation regarding reduced interventional therapy-related adverse events in patients with hepatocellular carcinoma (HCC). This study was aimed at evaluating the effect of ozone therapy as an adjunctive treatment on inflammation markers and adverse events in patients with HCC receiving interventional therapy.

Methods: Three hundred and forty-two patients with HCC undergoing interventional therapy were enrolled from December 2020 to June 2023, of which 221 patients received rectal ozone insufflation therapy (ozone cohort), and the other 121 patients did not receive ozone therapy (control cohort). The information on treatment-related adverse events (TRAEs) was retrieved and analyzed.

Results: In the study, most clinical characteristics between the ozone and control cohorts showed no significant differences. In the ozone cohort, 122 patients (55.2%) reported TRAEs of any grade, compared with 67 (55.4%) patients in the control cohort (p > 0.05). In terms of specific TRAE incidence, no distinctiveness was found in incidence of other TRAEs. Furthermore, multivariate logistic regression revealed that higher levels of AFP (OR, 1.82; 95% CI, 1.13-2.94; p = 0.014) and ALT/AST ratio (OR, 2.02; 95% CI, 1.04-3.91; p = 0.037) were independently correlated with increased risk of total TRAEs. Based on similar levels of laboratory parameters with patients with HCC before treatment, there were no significant differences in these biomarker levels posttreatment between the ozone and control cohorts.

Conclusion: Ozone therapy did not significantly decrease the incidence of adverse events or mitigate the increase in inflammatory markers. Further research with a larger sample size is warranted.

Background: Adaptation of the small intestine and/or colon significantly impacts the prognosis of short bowel syndrome. This study investigated colonic adaptation in a mouse model of ileal resection, with a focus on bile acid absorption.

Methods: The ileal resection mouse model (ileal resection group, 8-10-week-old male C57BL/6J mice) was created by resecting 15 cm of the ileum, corresponding to approximately 50% of the small intestine, while preserving the cecum. The sham group underwent intestinal transection and reanastomosis at a site matched in distance from the ligament of Treitz to that used for the resection group. Postoperatively, between Days 1-7 and 7-14, mice received the elemental diet ELENTAL® (0.5 kcal/mL) and a standard solid diet ad libitum, respectively. The mice were euthanized on Day 14. We assessed postoperative body weight; histopathological characteristics of the colon; bile acid metabolism-related gene expression, including Asbt for luminal bile acid uptake, Fabp6 for cytosolic transport, Ostb for bile acid excretion into the circulation, and Fxr, the primary intracellular bile acid receptor regulating the genes; and fecal and serum bile acid concentrations.

Results: Significantly lower changes in body weight and longer colon length were observed in the ileal resection group than in the sham group; however, no histological differences were observed in colonic mucosal height. Furthermore, a significantly increased Asbt expression was detected in the ileal resection group. No significant differences were observed in bile acid concentrations in the feces and serum in both groups.

Conclusion: Our results suggest a colonic adaptation to prevent impairment of bile acid absorption following ileal resection.

Background: Irritable bowel syndrome (IBS), a gastrointestinal motility disorder affecting millions of patients worldwide, has a substantial impact on healthcare economics and patient quality of life. However, fully satisfactory therapeutic options remain lacking. The identification of pathogenic proteins supported by causal genetic evidence enables the exploration of potential therapeutic targets for IBS.

Methods: A Mendelian randomization (MR) study was performed to discover potential treatment targets linked to IBS. Summary data for IBS (outcome) were acquired from the two largest independent cohorts: sample sizes of 486,601 (53,400 cases and 433,201 controls) and 101,884 (24,735 cases and 77,149 controls), respectively. Instrumental variables were derived from cis-expression quantitative trait loci (cis-eQTL) data of druggable genes, obtained through the eQTLGen Consortium database. Colocalization analysis was employed to assess whether IBS risk and gene expression were influenced by shared SNPs. An IBS mouse model was additionally utilized to confirm the therapeutic potential of drug targets.

Results: Four drug targets (P2RY14, SLC5A6, ATRAID, and IL1RL1) displayed notable MR findings in two separate datasets. Purinergic receptor P2Y14 (P2RY14) and all-trans retinoic acid-induced differentiation factor (ATRAID) exhibited robust evidence of colocalization with IBS. We further showed an abnormal increase in expression of P2RY14 and a significant decrease in ATRAID level in the colon tissue of IBS mice.

Conclusion: This study proposes two potential therapeutic targets for IBS: P2RY14 and ATRAID. Drugs aimed at targeting these two genes have a greater chance of success in clinical trials, potentially facilitating the prioritization of IBS drug development and lowering associated costs.

Objective: This research was performed to determine the risk factors for gallbladder gangrene in acute acalculous cholecystitis patients and to assess the predictive ability of inflammatory markers.

Methods: The study included 226 acute acalculous cholecystitis patients who underwent laparoscopic cholecystectomy within 72 h of onset. The receiver operating characteristic curves were employed to determine the optimal cut-off, specificity, and sensitivity of inflammatory markers in predicting gangrenous cholecystitis. Logistic regression analysis was conducted to ascertain the independent risk factors associated with gallbladder gangrene.

Results: The incidence rate of gallbladder gangrene in acute acalculous cholecystitis was 45.1% (102/226). Compared with other inflammatory markers, the systemic immune-inflammation index (SII) demonstrated superior predictive validity (vs. CRP, p = 0.021; vs. WBC, p < 0.001; vs. PCT, p = 0.004; vs. NLR, p < 0.001; vs. PLR, p < 0.001). The results of the logistic regression analysis revealed that platelet, PCT, SII, D-dimer, CA19-9, gallbladder enlargement, and gallbladder effusion were independent risk factors.

Conclusion: This study found that platelet, PCT, SII, D-dimer, CA19-9, gallbladder enlargement, and gallbladder effusion were independent risk factors for gallbladder gangrene in acute acalculous cholecystitis. SII could serve as a novel, straightforward, and potent predictive indicator for gallbladder gangrene in acute acalculous cholecystitis.

Background and aims: To develop a noninvasive clinical diagnostic model based on serological markers for nonalcoholic steatohepatitis (NASH) and to verify its predictive efficacy.

Methods: A total of 82 biopsy-proven patients with nonalcoholic fatty liver disease (NAFLD) were included in the study. Patients were classified into nonalcoholic fatty liver (NAFL) and NASH groups based on the results of liver biopsies. The study utilized the LASSO regression model for variable selection, followed by logistic regression analysis to create a prediction model. A nomogram was then developed to illustrate this model. To validate the model, bootstrapping was applied for internal validation, and the accuracy, consistency, and clinical utility of the prediction model were evaluated.

Results: The NASH group had significantly higher levels of red blood cell count, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT), while levels of high-density lipoprotein (HDL) cholesterol were significantly lower in the NASH group (p < 0.05). Logistic regression analysis indicated that AST and ceruloplasmin were independent risk factors associated with NASH. A nomogram based on serological markers, including ceruloplasmin, HDL, AST, red blood cell count, thyroid-stimulating hormone (TSH), and total bile acid (TBA), was established to predict NASH with excellent discrimination (AUROC 0.813).

Conclusions: AST and ceruloplasmin are independent risk factors associated with NASH. The CHART2 prediction model based on serological markers demonstrates good accuracy, consistency, and clinical utility. The model could serve as a noninvasive approach to identifying patients with NASH, which might reduce the need for liver biopsy.

Background: Nonalcoholic fatty liver disease (NAFLD) progression may be associated with dysbiosis of gut microbiota. Therefore, probiotics that can modulate gut dysbiosis are a potential strategy to reverse NAFLD. The aim of this study was to evaluate the protective effect of Lactobacillus rhamnosus TCELL (TCELL), a strain of probiotics Lactobacillus rhamnosus, on a rat model fed a high-fat diet (HFD).

Materials and methods: We used a rat model fed an HFD for 3 weeks. TCELL (10⁹ colony-forming units/day) were administered orally at the end of the third week for another 3 weeks. Body weights were measured, and serum, stool, and liver tissues were collected and analyzed after the animals were euthanized at the end of the sixth week. Serum samples were examined for lipid and metabolome profiles. Stool samples were examined for changes in the gut microbiota composition. Liver samples were examined to assess the lipid content.

Results: After TCELL supplementation, the body weight and serum cholesterol levels decreased (p = 0.0088 and p = 0.0286, respectively). Additionally, the serum high-density lipoprotein/low-density lipoprotein ratio increased (p = 0.0177), and triglyceride lipid droplets decreased in the liver tissue (p = 0.0054). At the phylum level, TCELL supplementation increased the abundance of Firmicutes and the Firmicutes/Bacteroides ratio. At the species level, TCELL supplementation increased the abundance of Allobaculum stercoricanis, Blautia glucerasea, Erysipelatoclostridium ramosum, Lactobacillus johnsonii, Blautia schinkii, and Anaerostipes caccae. Based on the metabolome assay, the levels of acetic, propionic, butyric, and pentanoic acids decreased after feeding with HFD, and supplementation of TCELL significantly increased the level of isovaleric acid compared with that in the HFD group (p = 0.0418).

Conclusions: TCELL supplementation decreased body weight gain, reversed serum lipid profiles, and lowered triglyceride lipid droplets in the liver tissue in a rat model. The beneficial effects of TCELL may be associated with the modulation of the gut microbiota composition and SCFA profiles.