Gastroenterology and Hepatology From Bed to Bench最新文献

Functional gastrointestinal disorders (FGID) are prevalent illnesses associated with diminished quality of life and increased healthcare utilization. These conditions influence gut sensitivity, motility, microbiota, immunological function, and nervous processing in the brain. Chronic symptoms, including pain and dyspepsia, are exacerbated by maladaptive patient behaviors, stress, and co-morbidity. Studies of functional neuroimaging reveal increased brain responses in regions associated with gut sensory processing and salient cues, altered central regulation of endocrine and autonomic nerve responses, and aberrant connections in pain processing and the default mode network. This neuroimaging helps us understand the pathophysiology and outcomes of patients better. From the standpoint of brain connection, research in this area can further our understanding of the central pathophysiology of FGID and pave the way for the objective diagnosis and development of novel therapeutics for FGID. Prospective Neuroimaging research may change from brain mapping to clinical prognosis prediction due to technological advances in machine learning algorithms used in imaging. The usefulness and revelations of functional brain imaging are highlighted in this review, along with the areas that require development and, lastly, recommendations for future research.

Aim: To evaluate the prevalence of primary sclerosing cholangitis (PSC) among Iranian adult patients with inflammatory bowel disease (IBD) or liver disorders.

Background: PSC is a rare and chronic liver disease characterized by inflammation, fibrosis, and intra- and/or extrahepatic bile duct structure.

Methods: A systematic review and meta-analysis was conducted. The Web of Science, Scopus, Pubmed, Embase, Google Scholar, and local databases, including the IranDoc, IranMedex, SID, and MagIran databases, were searched for studies published before 6th February 2023 for the prevalence of PSC among Iranian adults.

Results: In total, 22 articles involving 19,747 Iranian participants were included in this meta-analysis. The overall pooled prevalence of PSC was 8% (95% CI: 5%-12%). Additionally, the prevalence of PSC stratified by gender was calculated based on four studies (n = 1402). The pooled prevalence of PSC was estimated to be 20% (95% CI: 11-31%) in males and 12% (95% CI: 3-38%) in females. The pooled prevalence of PSC was 6% (95% CI: 4-9%) in patients with IBD and 14% (95% CI: 8-23%) in patients with liver transplantation (LT).

Conclusion: The pooled prevalence of PSC was 8% in Iranian adults, and the prevalence was greater in males than in females.

Aim: This study aimed to assess the impact of a six-week gluten-free diet (GFD) on the iron profiles of patients with non-celiac gluten sensitivity (NCGS) and CD.

Background: Iron-deficiency anaemia (IDA) is a significant clinical feature of gluten-related disorders, especially Celiac disease (CD).

Methods: The study included 29 CD patients (mean age 40.28 ± 15.57 years) and 29 NCGS patients (mean age 30.31 ± 7.78 years) presenting with IDA who were enrolled in the study during 2023-2024. Haemoglobin, serum iron, serum ferritin, total iron-binding capacity (TIBC), and transferrin saturation (TSAT) levels were assessed at the beginning and after six weeks of GFD. HLA typing was conducted using the Real-time PCR-based SYBR Green method.

Results: Ferritin levels significantly increased in both CD and NCGS groups after the GFD, from 43.7807 to 50.5279 ng/mL and 23.0862 to 42.9910 ng/mL, respectively. Moreover, serum iron and TSAT levels significantly increased in the NCGS group, from 64.8034 to 81.3466 μg/dL and 19.29 ± 11.70 to 23.99 ± 9.05, respectively (p = 0.003).

Conclusion: The most frequent symptoms in CD and NCGS patients were bloating/bone disease (62.1%) and bone disease (37.9%), respectively. GFD was effective in improving IDA in both CD and NCGS patients. Further research is necessary to assess the therapeutic effect of GFD in patients with gastrointestinal symptoms and IDA.

Aim: This study aimed to analyze trends in the etiologies of liver transplants at Abu Ali Sina Hospital, Shiraz, Iran, from 2020 to 2024.

Background: Liver transplantation (LT) is a crucial treatment for end-stage liver disease (ESLD). Over time, the etiologies leading to LT have evolved due to changes in disease prevalence, advancements in medical treatments, and public health interventions.

Methods: Etiologies of LT were categorized into nine groups: acute liver failure, autoimmune disorders, alcoholic steatohepatitis, liver cancer, vascular, metabolic dysfunction-associated steatohepatitis (MASH), viral hepatitis, metabolic disorders, and others. Trend analysis was performed using Python 3.12 programming language with appropriate libraries.

Results: A total of 1579 patients, 59.9% male with a mean age of 45.12 years (SD: 13.52), were analyzed. Autoimmune disorders emerged as the leading cause of LT, increasing from 32.2% in 2020 to 40.6% in 2024 (p-trend = 0.039). Viral hepatitis cases decreased significantly from 18.1% to 3.0% (p-trend = 0.033). Liver cancer became the third leading cause in 2021, replacing viral hepatitis, while MASH consistently remained the second leading cause.

Conclusion: The significant shifts in LT etiologies underscore the success of public health interventions in reducing the burden of viral-related ESLD. Additionally, the findings highlight the need for ongoing research into the prevention, early diagnosis, and management of autoimmune liver diseases, MASH, and liver cancer. These findings provide critical insights for clinicians and policymakers to enhance liver disease management and allocate resources effectively.

Aim: Given the positive results of some research, this study aimed to explore the relationship between the presence of Helicobacter pylori (HP) in gastric histopathology and the location and grade of tumors in an institutional sample of patients diagnosed with colorectal cancer (CRC).

Background: Epidemiological studies have been conducted to investigate the association between HP infection and CRC.

Methods: This cross-sectional study retrieved data from the hospital database, considering inclusion criteria and medical record availability for patients who underwent both endoscopy and colonoscopy and were diagnosed with CRC. Patients were grouped based on tumor grade and location and compared regarding the presence or absence of HP pathogen in endoscopic biopsy direct smears.

Results: Data from 241 patients were available, 220 of whom had adenocarcinoma. A statistically significant relationship between tumor differentiation grade and HP positivity was observed (P= 0.001). Each 1-level increase in grade was associated with 2.2 times higher odds of HP positivity. No significant relationships existed in the analysis of tumor location related to HP positivity.

Conclusion: In colorectal cancer patients, the presence of the HP pathogen may be linked to a higher likelihood of high-grade colorectal cancers. This finding needs to be explored in screening cohorts.

Aim: This study aimed to evaluate the preventive and therapeutic effects of cepharanthine on APAP (N-acetyl-para-aminophenol )-induced liver and kidney injury in an experimental model.

Background: Acetaminophen (APAP) is widely used as an analgesic and antipyretic drug; however, its overdose can cause acute liver and kidney injury. Cepharanthine, a natural alkaloid with antioxidant properties, has been proposed as a potential protective agent.

Methods: In this experimental study 40 Male NMRI mice were divided into five groups: Control, Sham, APAP-treated, APAP + preventive cepharanthine, and APAP + therapeutic cepharanthine groups. Liver and kidney function markers, including ALT, AST, BUN, creatinine, total antioxidant capacity (TAC), and malondialdehyde (MDA), were measured. Histopathological analysis was performed to assess tissue damage. Statistical analysis was conducted using ANOVA with a significance threshold of p < 0.05.

Results: APAP administration significantly increased ALT, AST (p < 0.001), and MDA (p < 0.01) while reducing TAC levels (p < 0.01) in liver and kidney tissues. Cepharanthine, particularly in the therapeutic group, reduced ALT levels (p < 0.05) and improved liver histology but did not significantly alter AST or TAC in the prevention group. In contrast, cepharanthine failed to improve kidney function markers and worsened histological damage, leading to increased tubular casts and hemorrhagic areas.

Conclusion: Cepharanthine exhibited partial hepatoprotective effects against APAP-induced liver injury but did not improve kidney damage. So, this natural alkaloid does not confer a significant protective effect against acute kidney injury.

Aim: This study evaluated and compared the success rates of intussusception reduction in children younger under three years of age using colonoscopy versus ultrasound-guided saline enema.

Background: Intussusception involves telescoping one segment of the intestine into another.

Methods: This experimental study included 41 children under three years old who were diagnosed with intussusception via ultrasound and admitted for reduction treatment. Participants were randomly assigned to either the saline enema or colonoscopy intervention. Data analysis was conducted using Chi-square tests and independent T-tests, utilizing SPSS 23.

Results: Among the 41 children, 16 underwent reduction via colonoscopy, achieving a success rate of 81.25% (13 out of 16). In contrast, the saline enema method demonstrated a success rate of 84% (21 out of 25). The difference in success rates between the two methods was not statistically significant. Factors such as gender, age, the location of intussusception (ileocolic vs. colocolic), and the size of the intussusception did not significantly influence the success rates for either approach. Notably, intra-abdominal free fluid was significantly associated with reduced success rates for the saline enema method (P = 0.044). At the same time, no such association was found for the colonoscopy method (P = 0.142). Additionally, the presence of lymphadenopathy between the invaginated segments significantly impacted the success of the saline enema method (P = 0.036) but did not affect colonoscopy outcomes (P = 0.375).

Conclusion: The study concluded that there was no significant difference in the success rates of intussusception reductions between the colonoscopy and saline enema methods. Lymph nodes between invaginated loops and intraperitoneal fluid significantly decrease the success rate of saline enema reductions, suggesting that colonoscopy may be preferable in such cases.

Endoscopic retrograde cholangiopancreatography (ERCP) has become an essential treatment modality for managing biliary and pancreatic disorders. However, perforation remains one of the most concerning complications associated with ERCP and endoscopic sphincterotomy. While the incidence of perforation following ERCP is relatively low, the associated mortality rate can reach 7.8%. Diagnosis and management of perforations depend on the injury's mechanism, location, and extent, as clinical and radiographic findings suggest. This paper provides a detailed overview of the causes, classification, diagnosis, management, and prevention strategies for ERCP-related perforations.