Gastroenterology and Hepatology From Bed to Bench最新文献

Pancreatic cancer (PC) remains one of the most formidable malignancies, with survival rates showing minimal improvement over the years despite progress in chemotherapy, targeted treatments, and radiation therapy. The development of targeted agents and chemotherapy for cancer treatment has only moderately influenced clinical results and has not significantly altered 5-year survival rates. However, with the rapid discovery of the genetic and molecular functions underlying PC, new opportunities for targeted therapies are emerging. One promising approach is oncolytic viral therapy, which has shown potential as a targeted agent for the treatment of pancreatic cancer. Based on the available evidence, oncolytic viral therapy appears to be a viable treatment option for pancreatic cancer. In the present narrative review, we explore oncolytic viruses in detail, and their potential applications in cancer therapy as a future alternative treatment are investigated.

Aim: This review aims to summarize the characteristics of gut microbiota in celiac patients and assess its composition compared to healthy controls.

Background: The gut microbiota influences the regulation of host immunity. Accordingly, alterations in the intestinal microbiota, also known as dysbiosis, have been studied in various gastrointestinal disorders, including celiac disease.

Methods: We conducted a systematic review of available studies over the last decade (2013-2023). The comprehensive search was performed using various academic databases. The selected studies focused on the analysis of gut microbiota from duodenal and/or fecal samples and included both pediatric and adult populations.

Results: Twenty-two articles were included following PRISMA guidelines: nine on fecal microbiota, six on duodenal microbiota, and seven on both. The findings revealed significant differences in bacterial prevalence associated with celiac disease across 17 studies, with celiac patients showing altered microbial diversity characterized by an increase in pathogenic bacteria and a decrease in beneficial bacteria such as Bifidobacterium and Lactobacillus, compared to healthy controls. However, other studies showed no significant distinction between groups of children affected by celiac disease and control groups. Some articles also highlight the effect of a gluten-free diet on the composition of the gut microbiota.

Conclusion: Current data on the composition of the gut microbiome in patients with celiac disease is characterized by considerable heterogeneity and inconsistency. This highlights the need for a thorough and holistic approach to understand better these variations and their impact on the health of people with celiac disease.

Aim: In this study, we investigated the relationship between serum uric acid (SUA) and metabolic dysfunction-associated steatotic liver disease (MASLD) in patients detected through abdominal ultrasound. The second aim was to determine if there were any gender differences.

Background: High SUA levels may contribute to the mechanisms underlying various metabolic disorders, including MASLD.

Methods: We conducted a retrospective study among patients older than 18 who had been admitted to a tertiary hospital's gastroenterology outpatient clinic for over two years. A total of 200 patients diagnosed with either Grade 1, 2, or 3 hepatosteatosis by ultrasound screening and 200 patients without hepatosteatosis were included in the study. Patients' demographic features, laboratory parameters, and detailed medical history were extracted from the hospital's medical records.

Results: The mean age of the 400 patients enrolled in the study was 47.92±0.78 years, and 70.25% were men. SUA (5.34 mg/dL ± 1.52 vs. 4.64 mg/dL ± 1.28, p=0.001), alanine aminotransferase (ALT) (26.55 U/L ± 23.82 vs. 19.57 U/L ± 20.81, p=0.002), aspartate aminotransferase (AST) (22.68 U/L ± 20.35 vs. 18.07 U/L ± 9.89, p=0.005), and glycosylated hemoglobin (HbA1c) (6.45% ± 1.69 vs. 5.76% ± 1.23, p=0.001) levels were higher in the MASLD group. In the MASLD group, HbA1c, AST, and ALT were significantly higher in the Grade 2-3 group than in the Grade 1 (p=0.038, p=0.038, p=0.001, respectively).

Conclusion: Elevated SUA levels are strongly linked to MASLD, particularly in males. Ease of measurement and low cost suggest that SUA could serve as a non-invasive biomarker for MASLD detection in at-risk groups.

With the growing incidence of colorectal cancer worldwide, mainly due to increased early detection in screening programs, usage of endoscopic techniques for management of colorectal lesions have been gaining progressive attention. Each year, more advanced endoscopic techniques come to practice and old ones find technical enhancements. By reviewing guidelines, randomized controlled trials, meta-analyses, and original research, we aim to establish an evidence-based approach for selecting the optimal endoscopic method based on the polyp size, morphology, and classification. We critically analyze the advantages, limitations, and potential complications associated with each technique, providing a comprehensive overview for clinicians and suggest areas which may yet need further studies to be conducted. Our comprehensive review can provide a framework that will help clinicians choose an approach most suitable for their patients. This review attempts to contribute to the optimization of endoscopic management in colorectal polyps, with eventual improvement in patient outcomes.

Aim: In this study, global and regional trends between 1990 and 2021 were examined by sex, level of development, and geography, and projected to 2025.

Background: Diarrheal disease continues to be a leading cause of morbidity and mortality in children under the age of five (U5).

Methods: We assessed GBD 2021 data for U5 children in 204 countries, 21 regions, and 7 super-regions with joinpoint regression to analyze time trends, a hybrid ARIMA-ETS-ANN model to project prevalence and mortality until 2025, and longitudinal multilevel modeling to determine the effect of development level. Spatial clustering in 1990 and 2021 was assessed with Local Moran's I.

Results: In 2021, the global prevalence and mortality rates of diarrheal disease among children under five were 885.07 and 51.72 per 100,000 population, respectively. Between 1990 and 2021, global U5 mortality decreased by 80.4%, and prevalence by 71.8%. The heaviest burden remained in Sub-Saharan Africa (SSA) and South Asia (SA), though all super-regions experienced statistically significant decreases. Joinpoint regression across the entire interval (1990-2021) revealed significant overall reductions in mortality (AAPC -5.15; 95% CI: -5.19, -5.10) and prevalence (AAPC -3.98; 95% CI: -4.03, -3.94). Hybrid forecasts predict ongoing decreases through 2025, with prevalence reaching 631.3 and mortality 36.6 per 100,000 population worldwide. Multilevel models revealed steeper annual reductions in low- and medium-Human Development Index (HDI) nations, corroborated by significant time-HDI interaction terms (β=79.76 for prevalence; β=7.50 for mortality; both p<0.001), although such countries had a persisting higher absolute burden. Spatial analysis revealed enduring hotspots in SSA and SA in both 1990 and 2021, and the formation of new clusters in several high-income countries. Coldspots occurred primarily in high-income and island nations.

Conclusion: Significant global advancements have lessened the burden of diarrheal disease in U5 children; yet, ongoing disparities attributed to unsafe water, poor sanitation and hygiene, undernutrition, and low maternal education underscore the necessity for combined water, sanitation, and hygiene interventions, rotavirus immunization, and community-based health education in high-risk areas.

Aim: To evaluate the efficacy and safety of sphingosine-1-phosphate (S1P) receptor modulators in treating ulcerative colitis (UC) and Crohn's disease (CD).

Background: Inflammatory Bowel Disease (IBD) is a chronic immune-mediated condition that remains challenging to manage. S1P receptor modulators offer a novel therapeutic approach by targeting immune cell trafficking, potentially improving disease outcomes.

Methods: A systematic review and meta-analysis were conducted by searching PubMed, Scopus, and Cochrane Library major electronic databases for randomized controlled trials (RCTs) investigating S1P receptor modulators in IBD. Clinical outcomes assessed included clinical remission, clinical response, endoscopic improvement, histologic remission, and serious adverse events. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a fixed-effects model.

Results: Seven RCTs with a total of 2,597 patients were included. S1P receptor modulators significantly improved clinical remission (OR = 1.49, 95% CI: 1.21-1.84, p < 0.001), histologic remission (OR = 1.74, 95% CI: 1.31-2.31, p < 0.001), endoscopic improvement (OR = 1.58, 95% CI: 1.23-2.04, p < 0.001), and clinical response (OR = 1.27, 95% CI: 1.05-1.54, p = 0.01). The risk of serious adverse events did not significantly differ between treatment and placebo groups (OR = 1.28, 95% CI: 0.92-1.80, p = 0.14), suggesting a favorable safety profile.

Conclusion: This meta-analysis supports S1P receptor modulators, particularly ozanimod and etrasimod, as effective and safe treatments for UC. Further studies are needed to assess long-term safety and direct comparisons with existing biologic therapies.

Aim: The objective of this study was to develop a real-time PCR method to detect hepatitis C virus (HCV), human immunodeficiency virus-1 (HIV-1), and also recently discovered human hepegivirus-1 (HHpgV-1) through melting curve analysis using SYBR Green dye in a single reaction.

Background: It is estimated that chronic viral infections affect millions of people worldwide, and a significant number of these individuals are unaware of their infection. In addition, infection with newly discovered and emerging viruses may put public health at potential risks. Precise and early detection is a primary and important task for controlling infections and helping patients.

Methods: A set of specific primers were designed for detection of HCV, HIV-1, and HHpgV-1 in a single tube. The real-time polymerase chain reaction was performed and melt curves were analyzed. Specificity was assessed by cross-reaction tests with other common blood-borne pathogens. The established assay was evaluated for the detection of viruses in clinical samples.

Results: The three viruses were clearly distinguished by their respective melting temperature values. The detection limits of this assay were 10² copies/ml for each virus. The clinical evaluation of this assay was demonstrated by analyzing 134 patients' serum samples. The specificity of the developed assay considered as 100%.

Conclusion: The developed multiplex real-time PCR based on SYBR Green dye is a well-suited detection assay of single or co-infections of HCV, HIV, and HHpgV-1 in clinical and research laboratories. It can be used as a cost-effective, rapid tool for routine diagnostic in-house tests.

Aim: The aim of this study was to develop a simple and reliable scoring system for colorectal cancer risk assessment considering the effectiveness of different screening options.

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide. As a preventable disease, accurate risk assessment plays a critical role in early detection and prevention strategies.

Methods: This study analyzed data from 3,465 individuals, including patients, first-degree, second-degree, and third-degree relatives of patients, and volunteers participating in a national CRC screening program. The dataset reflects nine years of prevention efforts targeting at-risk populations. Machine learning algorithms-Logistic Regression, Naïve Bayes, Neural Networks, Random Forest, and Support Vector Machines (SVM)-were applied to the data. Model performance was evaluated using cross-validation, ROC curves, F1 score, classification accuracy (CA), and overall accuracy metrics.

Results: Of the 3,465 participants, 2,240 were diagnosed with colorectal cancer, 60 were relatives of affected patients, and 1,086 were non-patient relatives. Among CRC patients, 1,979 were over the age of 40. Logistic Regression and Naïve Bayes achieved the highest AUC values (0.910 and 0.907, respectively), with corresponding accuracies of 84.5% and 82.8%. Logistic Regression demonstrated the highest overall accuracy. The proposed scoring system incorporated variables such as age, sex, diabetes, inflammatory bowel disease (IBD), smoking, alcohol consumption, tobacco use, BMI, family history, and five key symptoms: rectal bleeding, abdominal pain, unintended weight loss, changes in bowel habits, and anemia. The highest score was assigned to individuals over 60 years of age, while a score of 2 was allocated for a family history involving more than two affected relatives.

Conclusion: A scoring system based on easily measurable variables offers a practical and efficient tool for widespread clinical use. Such systems can assist healthcare professionals in streamlining risk assessment and improving early identification of high-risk individuals.

Aim: This study examined the associations between psychosocial factors, Irritable bowel syndrome (IBS) diagnosis, and quality of life (QOL) in both control and IBS groups. Additionally, we explored the potential influence of psychosocial factors on the onset of IBS and developed a machine-learning model for IBS prediction.

Background: IBS is a prevalent gastrointestinal disorder, with various factors predicting its severity and associated symptoms.

Methods: Through convenience sampling, a cross-sectional study recruited participants diagnosed with IBS (n=134) and healthy controls (n=150) from Arak Gastroenterology Clinics. Linear regression assessed the impact of psychosocial factors on IBS symptom severity and QOL. Logistic regression analyzed the association of these factors with IBS onset. Machine learning algorithms were used to predict IBS based on psychosocial features. Instruments include IBS-SSS, IBS-QOL, Toronto Alexithymia Scale (TAS-20), Visceral Sensitivity Index (VSI), and Pain Catastrophe Scale (PCS).

Results: A total of 284 participants (61.27% females) were recruited in the study, with a mean age of 36.48±10.75 years. Compared to controls, IBS patients exhibited significantly higher scores on measures of pain catastrophizing scale (PCS, 40.95 vs. 27.73), somatization (13.91 vs. 6.49), and alexithymia (60.23 vs. 54.71) as well as lower VSI (40.54 vs. 72.10). For those with IBS, only difficulty identifying feelings and somatization remained associated with worse symptoms, while VSI presented an inverse correlation. Psychological factors were inversely related to QOL. Elevated levels of alexithymia (OR 1.06; 95% CI 0.48, 1.63), somatization (OR 1.80; 95%CI 1.12, 2.48), and PCS (OR 1.70; 95% CI 1.30, 2.10) were associated with a higher chance of developing IBS, while higher VSI (OR -1.65; 95% CI -1.89, -1.42) was protective. Among machine learning models, logistic regression based on these factors (excluding alexithymia) and age achieved good performance (AUC: 0.86, 95% CI: 0.78-0.94; Accuracy: 0.83, 95% CI: 0.73-0.90) in predicting IBS onset.

Conclusion: Psychological factors were linked to worse IBS symptoms and quality of life. A machine learning model for IBS prediction presented promising results.

Microvillus inclusion disease (MVD) is a rare autosomal recessive disease that was first discovered in 1978 by Davidson et al., with significant mortality and morbidity within the first year of life. It presents mainly with abdominal symptoms like diarrhoea, abdominal distension, vomiting electrolyte imbalance. Sometimes, depending on the genetic mutation involved, the phenotypic manifestation can vary. Certain genetic mutations are associated with cholestasis, dilated bowel loops, and metabolic acidosis, whereas some present with nystagmus and reduced visual acuity. Electron microscopy of the duodenal biopsy sample is used as a diagnostic tool. Absence or shortening of apical microvilli with microvillus inclusion bodies in mature enterocytes, which are pathognomonic to MVD alongside periodic acid Schiff (PAS)-positive granules or vesicles in the immature enterocytes.