Gastroenterology Research and Practice最新文献

Background: Pyogenic liver abscess (PLA) is a critical infectious disease with varying incidence across global regions. There is a growing body of large-scale, population-based studies that offer a comprehensive understanding of the disease. Objective: To allow clinicians to gain a more comprehensive and systematic understanding of PLA, this review of the published literature was conducted to summarize the incidence of PLA and identify comprehensive risk factors and subsequent health outcomes. Methods: To obtain more reliable and convincing data, we searched through the electronic databases PubMed, Web of Science, and the China National Knowledge Infrastructure (CNKI), using the following search terms: pyogenic liver abscess and population-based study. The initial search was executed on 26 December 2022 and subsequently updated on 30 May 2025. Results: The search identified 43 eligible studies for the final analyses. Among the 43 studies, 11 included the incidence of PLA, 21 included information on the risk factors, and 11 included the prognosis of PLA. According to the distribution of study locations, most of the studies were from Taiwan, China, which had the highest incidence in the world, reaching 17.59 per 100,000. The results highlight that the risk factors for PLA encompass liver cirrhosis, hepatobiliary malignancy, liver transplantation, biliary disease, and diabetes mellitus. Furthermore, we observed that PLA increased the risk of subsequent health complications, including gastrointestinal tumors and infection. Conclusion: The increasing prevalence and multifaceted implications of PLA underscore the imperative for medical professionals to remain updated on its epidemiology, risk factors, and subsequent health outcomes. Such awareness is pivotal for effective community prevention, clinical intervention, and long-term patient management.

Background: Small intestinal bacterial overgrowth (SIBO) is suggested in irritable bowel syndrome (IBS). Our primary aim was to define a discriminating threshold for a positive lactulose hydrogen breath test (LHBT) in SIBO. As a secondary aim, IBS was subdivided into SIBO and non-SIBO groups. Methods: LHBT performed in 206 subjects, 74 healthy subjects, 39 SIBO patients with intestinal lesions, 77 IBS patients, and 16 nonhydrogen producers. Using scintigraphy and LHBT, orocecal transit time was set to 80 min. Peak hydrogen levels were compared between the groups. Values are mean and 95% confidence interval. Results: Using an 80-min orocecal cutoff time, LHBT in healthy subjects had peak values of 8 (6-9) ppm and SIBO 38 (31-45) ppm (p < 0.0001). The diagnostic cutoff 20 ppm verified a sensitivity of 77% and specificity of 88% and positive and negative predictions of 77% and 88%. With the same cutoff for IBS, the mean peak value was 21 (16-26) ppm (p < 0.0001 vs. healthy) with a sensitivity of 39% and a specificity of 78% and positive and negative predictions of 77% and 84%. Separating IBS at 20 ppm, the low-hydrogen group had a peak value of 6 (5-7) ppm (ns vs. healthy), and the high-hydrogen group had a peak of 44 (38-49) ppm (p < 0.0001 vs. healthy). After antibiotics, IBS with low hydrogen remained unchanged, whereas those with high hydrogen were reduced to control (p < 0.01). Conclusion: With cutoff at 20 ppm, LHBT differentiates SIBO in patients with early high breath hydrogen peaks, subdividing IBS into non-SIBO and SIBO groups; the latter may benefit from antibiotic treatment.

Gastroesophageal reflux disease (GERD) is primarily managed with acid suppressors, while laparoscopic fundoplication is considered the gold-standard surgical treatment for patients who have a suboptimal response to medical therapy, despite its limited acceptance. However, there have been alternative endoscopic treatment techniques available, including radiofrequency therapy, transoral fundoplication, and mucosal resection or mucosal ablation for this subgroup of patients, among which antireflux mucosectomy (ARMS) stands out as a relatively novel and minimally invasive option. The objective of this article is to provide gastroenterologists with a more comprehensive understanding of the technical features, current application status, clinical outcomes, and future perspectives regarding ARMS in the management of GERD. It is expected that ARMS will have a place in the standard endoscopic treatment of GERD. In the meantime, long-term multicenter, large-sample studies are required to provide a more convincing evaluation.

Background: Diarrhea-predominant irritable bowel syndrome (D-IBS) is a clinically common functional intestinal disease, classified into "diarrhea," "abdominal pain," and "depression syndrome" categories according to traditional Chinese medicine (TCM). The exact pathogenesis of D-IBS is still not fully understood. Gut microbiota regulates gastrointestinal nerve, endocrine, and immune functions and maintains gastrointestinal homeostasis through interaction with the brain-gut axis. In this study, we assessed the changes in gut microbiota in a D-IBS rat model with liver depression, spleen deficiency, and liver depression and spleen deficiency syndrome. We also discussed the biological basis of liver depression and spleen deficiency syndrome and the associations among the three syndromes from the perspective of gut microbiota. Methods: Ninety rats were divided into nine groups randomly: normal group (ZC), spleen deficiency syndrome groups (four PX groups), liver depression syndrome groups (two GY groups), and liver depression and spleen deficiency syndrome groups (two GYPX groups). The abdominal wall withdrawal reflex (AWR) test detected visceral sensitivity, while changes in gut microbiota were analyzed using 16S rRNA sequencing. Results: The visceral sensitivity of rats in the model group was significantly higher than that in the ZC group, and the visceral sensitivity of the GYPX groups was significantly higher compared to the PX and GY groups. 16S rRNA sequencing analysis showed that the D-IBS model gut microbiota's species number, alpha diversity, and beta diversity were changed; the Bacteroidota increased, and the Firmicutes decreased in the model group. The abundance of pathogenic bacteria, such as Bacteroidales, significantly increased in the GYPX groups compared to other groups. Conclusion: Oral administration of senna combined with restraint stress had different effects on visceral hypersensitivity, gut microbiota composition, and metabolic pathways in rats with D-IBS liver depression and spleen deficiency syndrome, and the liver depression factors play an important role in the pathogenesis of liver depression and spleen deficiency syndrome in D-IBS.

Background: Inflammatory bowel disease (IBD) is an immune-mediated disorder characterized by intestinal inflammation and includes two subtypes: Crohn's disease (CD) and ulcerative colitis (UC). The computed tomography manifestations of colonic CD (cCD) and UC are similar, and differential diagnosis is challenging. Our study aimed to investigate the feasibility of using a modified YOLOv5 algorithm for differentiating between cCD and UC on computed tomography enterography (CTE) images. Methods: This multicenter retrospective study analyzed data from a total of 29 cCD patients and 29 UC patients. Five submodels (YOLOv5n, YOLOv5s, YOLOv5m, YOLOv5l, and YOLOv5x) of YOLOv5 were trained and evaluated on the datasets. The CTE images of the cCD group and UC group were divided into a training set, validation set, and test set at a ratio of 8:1:1. Finally, the precision (Pr), recall rate (Rc), and mean average precision (mAP_{_0.5} and mAP_{_0.5:0.95}) of the models were compared. Results: The YOLOv5x model showed the best performance among the five submodels, with mAP_{_0.5} of 0.97 and mAP_{_0.5:0.95} of 0.97 and 0.84 in the validation set and mAP_{_0.5} and mAP_{_0.5:0.95} of 0.97 and 0.83 in the test set, respectively. These results demonstrated similar diagnostic accuracy to the two radiologists (84.5%). Conclusion: The modified YOLOv5 algorithm is a feasible approach to distinguish between cCD and UC on CTE images. These findings may facilitate the early detection and differential diagnosis of IBD.

Background and Aim: Colorectal carcinogenesis involves two distinct pathways, the serrated neoplasia pathway and adenoma (AD)-carcinoma sequence, whose precursors are sessile serrated lesion (SSL) and traditional AD, respectively. MicroRNAs (miRNAs) regulate gene expression and play a crucial role in colorectal tumorigenesis. This study investigated miRNA expression in the precursors and early invasive carcinomas of the two pathways. Methods: Using real-time reverse transcription polymerase chain reaction, we quantified the expression of miR-20a, miR-21, miR-93, and miR-181b in 127 lesions, including 25 SSLs, 19 SSLs with high-grade dysplasia (SSL-HD), 13 SSLs with submucosal invasive carcinoma (SSL-SC), 19 ADs, 26 ADs with HD (AD-HD), and 25 ADs with SC (AD-SC). Results: In the SSL series, miR-93 (SSL vs. SSL-SC, p = 0.038) and miR-181b (SSL vs. SSL-HD/SSL-SC, p = 0.013/p < 0.001, respectively) levels decreased with tumor progression. In the AD lineage, the expression of miR-20a (AD vs. AD-SC and AD-HD vs. AD-SC, p < 0.001), miR-21 (AD vs. AD-HD/AD-SC and AD-HD vs. AD-SC, p < 0.001), and miR-181b (AD-HD vs. AD-SC, p = 0.020) increased during carcinogenesis. Compared with normal mucosa (baseline), miR-93 expression showed a stepwise increase with tumor progression in the AD lineage, whereas the values did not change during SSL carcinogenesis. In the AD lineage, miR-20a expression increased in early invasive carcinoma but decreased in this phase of the SSL series. Overall, miR-20a, miR-93, and miR-181b levels were significantly lower in SSL-SC than in AD-SC (all p < 0.001). Conclusions: These findings indicate that the SSL and AD pathways exhibit distinct miRNA expression dynamics during colorectal tumorigenesis, with the AD lineage showing a progressive increase in oncogenic miRNAs and the SSL series exhibiting selective downregulation or plateauing, particularly in invasive lesions. The differential expression of miR-20a, miR-21, miR-93, and miR-181b was presumed to be related to (epi)genetic alterations among serrated neoplasia and AD-carcinoma routes.

Objective: Crohn's disease (CD) is a chronic systemic inflammatory disease that mainly affects the intestine, accompanied by extraintestinal symptoms and immune problems. The progression of the disease may cause permanent damage to the structure and function of the intestine. Due to unclear early symptoms and lack of precise detection methods, early diagnosis of CD is difficult. Many patients were diagnosis at late stage, which may lead to delayed treatment and increased risk of complications. Identifying hub genes related to CD and using them to predict CD is of great significance. Methods: DEG and WGCNA were employed to identify key genes associated with CD and to detect modules significantly linked to the disease. GO and KEGG analyses were conducted to explore the functions of these identified genes. Additionally, MR method was utilized to assess the causal relationships between the most significant gene and CD. Results: WCGNA identified 3240 differentially expressed genes, with the magenta module being the most significant among the nine clustered modules. The enrichment of GO and KEGG pathways indicates that the hub genes in the magenta module are related to the positive regulation of heme binding, tetrapyrrole binding, carboxylic acid binding, organic acid binding, IL-17 signaling pathway, and amoebiasis pathway. The Top 5 hub genes are CXCL1, LCN2, NOS2, S100A8, and DUOX2. Mendelian randomization analysis found a significant correlation between CXCL1 and CD. Conclusions: The study screened five potential biomarker genes in CD patients using a bioinformatics approach and Mendelian randomization study. Our results provided insights into CXCL1, LCN2, NOS2, S100A8, and DUOX2 in CD and suggested that CXCL1 may potentially be the optimal biomarker that could be a relatively easy path to clinical translation.

Background and Aim: Superficial nonampullary duodenal epithelial tumors (SNADETs) that are pathologically classified as gastric-type might manifest a more aggressive behavior than the intestinal type. However, the details of their histologic and genetic features remain unclear because of their rarity. This study was aimed at identifying clinicopathological findings and early genomic events in gastric-type SNADETs treated with endoscopic resection. Methods: We retrospectively analyzed 204 patients with SNADETs between January 2011 and September 2020. Immunohistochemical analysis for β-catenin and targeted exome sequence analysis of 50 cancer-related genes using next-generation sequencing were performed for the representative cases. Results: Among the 204 SNADETs cases, only nine (4.4%) were gastric type; the remaining 195 cases were intestinal type. Among the gastric-type tumors, seven were adenomas and two were adenocarcinomas, whereas only three of the 195 intestinal-type tumors were adenocarcinomas. Nuclear expression of β-catenin was observed in three of the nine (33%) gastric-type tumors and in eight of the 10 (80%) intestinal-type tumors. The most prevalent abnormality among the 50 genes tested in gastric-type tumors was GNAS mutation (89%), whereas that in intestinal-type tumors was APC mutation (67%). All gastric-type adenocarcinomas had GNAS mutations as well as adenomas, while APC mutations were absent in intestinal-type adenocarcinomas and present in most adenomas. Conclusions: GNAS mutations are more common in gastric-type SNADETs than in the intestinal type. As GNAS mutations are continuously present from adenoma to adenocarcinoma, resection at the adenoma stage is desirable.

Background and Study Aim: Changrun Formula (CRF) is a representative traditional Chinese medicine prescription for functional constipation (FC). However, the mechanism by which CRF alleviates FC remains unclear. Therefore, this study aimed to investigate the therapeutic mechanism of CRF in an FC rat model. Material and Methods: A total of 72 healthy SD rats were selected and randomly divided into six groups: the blank group, model group, hemp seed pill (HSP) group, high-dose CRF group, medium-dose CRF group, and low-dose CRF group. Except for the blank group, all the other groups were administered compound diphenoxylate via oral gavage to establish the FC rat model with impaired intestinal motility. The expression of genes related to intestinal motility in the colon tissues of rats was analyzed using Western blotting and real-time PCR. The effect of CRF on isolated colonic smooth muscle was assessed through electrophysiological analysis. Results: Compared with the blank group, the other groups exhibited a longer time to expel the first black stool and a reduced number of fecal particles within 6 h, confirming the successful establishment of the FC rat model. Furthermore, the expressions of HCN1, c-kit, and SP in the colon tissue of the model group were significantly decreased, while the expression level of VIP was significantly increased. HCN1 was found to colocalize with c-kit, SP, and VIP. Treatment of CRF (high and medium doses) significantly increased the expressions of c-kit, SCF, HCN1, and HCN2, enhanced the contractile movement of colonic smooth muscle, and improved muscle tension. Conclusions: CRF likely improves intestinal motility by targeting HCN1 and HCN2 ion channels and the SCF/c-kit signaling pathway, thereby alleviating FC symptoms in rats.

Purpose: Fecal calprotectin (FC) is a Crohn's disease (CD) biomarker, although the impact of disease duration on its accuracy remains unclear. This study was aimed at investigating the effects of CD disease duration on FC. Methods: In this prospective, single-center, cross-sectional study, we performed 113 endoscopies and biomarker measurements. Endoscopy results were assessed using the simple endoscopic score for Crohn's disease (SES-CD), with an SES-CD ≤ 2 defined as endoscopic remission (ER). Cohort 1 was divided into short-term and long-term disease groups. The associations of the SES-CD with C-reactive protein and FC were analyzed. Results: The correlation coefficient of FC and the SES-CD was 0.670 for all cases. In Cohort 1, the correlation coefficient of FC and the SES-CD was > 0.670 for all subgroups of the short-term disease group (≤ 20 years). The correlation coefficient of FC and CD was < 0.670 for all subgroups of the long-term disease group (> 20 years). In Cohort 2, the correlation coefficients were > 0.670 (0.808) for the 0-4-year disease group and < 0.670 for the 5-14- and 15-40-year disease groups. The receiver-operating characteristic analysis performed to predict ER of all cases resulted in an area under the curve (AUC) of 0.8443, with large AUCs of 0.907, 0.816, and 0.770 observed for the 0-4-, 5-14-, and 15-40-year disease groups, respectively. Conclusions: FC was affected by CD duration, and it may be a useful biomarker of CD, especially in patients with a short disease duration.