Gut and Liver最新文献

The gut microbiota has emerged as a key factor in the pathophysiology of inflammatory bowel disease (IBD), providing novel opportunities for diagnostic innovation. Traditional biomarkers, such as C-reactive protein and fecal calprotectin, are widely used in clinical practice; however, their ability to reflect disease complexity and microbial dysregulation remains limited. Recent advances in metagenomics and multi-omics integration have enabled high-resolution profiling of microbial communities and their functional capacities and associated metabolites. Differential abundance analysis and machine learning models have been used to identify microbial biomarkers that can distinguish patients with IBD from healthy individuals. Multicohort studies integrating microbiome and metabolomic data have further improved diagnostic accuracy and generalizability. Transcriptomic and proteomic analyses provide complementary insights into host-microbe interactions and disease mechanisms. In this review, we explored the potential of metagenomic biodata as diagnostic markers for IBD, with an emphasis on a multidimensional analytical approach. We highlight the recent developments in sequencing technologies, computational pipelines for microbial feature selection, and machine learning strategies applied to biomarker discovery. The integration of multi-omics data deepens our understanding of host-microbe interactions and facilitates the development of microbiota-informed diagnostic tools. As multidimensional microbial profiling evolves, its clinical utility for the diagnosis and stratification of IBD requires further investigation.

Background/aims: Intestinal Behçet's disease (BD) is a rare, chronic intestinal vascular disorder often refractory to conventional therapy. We aimed to assess the effectiveness and tolerability of anti-tumor necrosis factor alpha (anti-TNF-α) therapy in patients with moderate to severe refractory intestinal BD.

Methods: Clinical remission, clinical response, and biological response rates at 4, 12, and 24 months, as well as the adverse effects of anti-TNF-α therapy were investigated at the Inflammatory Bowel Disease Center of Severance Hospital, Seoul, Korea. We also examined the relapse rates and predictive factors for disease relapse.

Results: Of the 119 patients, 15 (12.6%) were bio-exposed, 68 (57.1%) received concomitant immunomodulators, and 56 (47.1%) received concomitant corticosteroids at anti-TNF-α treatment induction. At 4, 12, and 24 months, clinical remission rates were 23.5%, 40.3%, and 42.0%; clinical response rates were 84.0%, 62.2%, and 62.2%; and biological response rates were 61.3%, 68.9%, and 58.8%, respectively. Sixty-three patients (52.9%) relapsed, with a mean relapse time of 2.8 years. Higher initial C-reactive protein levels (hazards ratio [HR], 1.013; 95% confidence interval [CI], 1.008 to 1.018; p<0.001), history of previous intestinal surgery (HR, 4.282; 95% CI, 2.379 to 7.709; p<0.001), concomitant immunomodulator use (HR, 0.455; 95% CI, 0.267 to 0.775; p=0.004), and clinical response at 4 months (HR, 0.353; 95% CI, 0.181 to 0.687; p=0.002) were independent factors associated with the disease relapse. No mortality was observed during the study period; 26 (21.8%) and three patients (2.5%) experienced mild infection and infusion reactions, respectively.

Conclusions: Anti-TNF-α therapy could be an effective and tolerable option for refractory intestinal BD.

Background/aims: Early-onset inflammatory bowel disease (EO-IBD) poses a global health challenge with its distinct clinical manifestations and complex progression.

Methods: In this study, IBD cases occurring before age 20 were defined as EO-IBD. Data were extracted from the Global Burden of Disease 2021 database. Temporal trends were assessed using Joinpoint regression analysis, and future epidemiological trends were projected using the Bayesian age-period-cohort (BAPC) model. Health disparities across various sociodemographic index (SDI) regions were quantified using the slope index of inequality and concentration index.

Results: From 1990 to 2021, the global number of EO-IBD cases increased, while the incidence rates showed minimal change. Mortality and disability-adjusted life years (DALYs) rates briefly increased before a rapid decline after 1992. In 2021, males had higher mortality and DALYs rates due to EO-IBD than females. The highest mortality and DALYs rates were observed in the <5 years and 15 to 19 years age groups. Geographically, high SDI regions had the highest incidence, prevalence, and DALYs rates, while low SDI regions had the highest mortality rates. BAPC projections indicate that by 2036, the age-standardized incidence rate and prevalence rate will increase, whereas the age-standardized mortality rate and DALYs rates will continue to decline.

Conclusions: The incidence of EO-IBD is projected to exhibit an increasing trend in the future. Although the global mortality and DALYs rates of EO-IBD have decreased, significant disparities persist across age groups and regions. Targeted prevention and control strategies are needed to address the needs of high-risk populations and regions.

Background/aims: Ampullary adenomas are precancerous lesions requiring accurate diagnosis and timely intervention to prevent malignant transformation. Endoscopic papillectomy (EP) has emerged as a less invasive alternative to surgery; however, technical variations in practice remain. This study evaluated contemporary real-world approaches to the diagnosis, treatment, and surveillance of ampullary adenomas among pancreatobiliary endoscopists.

Methods: A nationwide cross-sectional survey was conducted among pancreatobiliary endoscopists certified by the Korean Pancreatobiliary Association between January 19 and March 2, 2025. A 29-item questionnaire assessed diagnostic methods, procedural techniques, and follow-up strategies. Of 231 invitations sent, 85 responses (36.8%) were analyzed. Respondents were stratified by EP experience: ≤10 years (n=40) and >10 years (n=45).

Results: Diagnostic and procedural strategies were largely comparable across the two experience groups. No significant differences were observed in the histologic reassessment, endoscopic ultrasound test, or cross-sectional images. Single pigtail plastic stents were the most preferred type for prophylactic pancreatic stenting, with a significantly higher preference among endoscopists with ≤10 years of experience compared to those with >10 years (92.5% vs 66.7%, p=0.008). For post-procedural bleeding management, fully covered self-expandable metal stents were more frequently used by endoscopists with ≤10 years of experience (47.5% vs 11.1%, p=0.001). Surveillance intervals, follow-up modalities, and timing of stent removal showed substantial heterogeneity, with no standardized patterns.

Conclusions: Although general clinical practices appear standardized, significant variability remains in specific procedural and post-procedural approaches. These findings highlight the need for refined guidelines to support a more consistent and comprehensive approach to EP.

Background/aims: Although atezolizumab plus bevacizumab has significantly improved the life expectancy of patients with unresectable hepatocellular carcinoma (HCC), it also increases bleeding risks. This study aimed to identify factors associated with bleeding events and evaluate their impact on prognosis.

Methods: Patients treated with atezolizumab plus bevacizumab as first-line therapy for unresectable HCC were retrospectively reviewed. Patients with high-risk varices were treated before therapy initiation. The primary endpoint was the incidence of bleeding events and secondary endpoints were overall survival (OS) and disease control rate (DCR).

Results: Among 123 patients, 81 had varices detected via esophagogastroduodenoscopy or computed tomography (varices group) while 42 did not (non-varices group). During a median follow-up of 11.1 months, bleeding events occurred in 15 patients, with 14 of occurring in the varices group. The cumulative incidence of bleeding in the varices group was 7.7%, 21.3%, or 32.6% at 6, 12, or 18 months, respectively, significantly higher than that (0.0%) in the non-varices group (p=0.001). No significant difference in OS was observed between the groups after inverse probability of treatment weighting (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.49 to 1.46; p=0.54). Bleeding events were not significantly associated with OS after inverse probability of treatment weighting (HR, 0.68; 95% CI, 0.35 to 1.33; p=0.26). However, the DCR was significantly higher in the varices group than in the non-varices group (80.2% vs 54.8%; p=0.006).

Conclusions: In unresectable HCC patients treated with atezolizumab plus bevacizumab, varices increase bleeding risk. However, proactive management and careful monitoring could mitigate their impact on OS and help increase the DCR.

Background/aims: Conventional oral sulfate tablets (OSTs) and mini-OSTs have gained popularity for bowel preparation in South Korea. This study aimed to evaluate the efficacy, tolerability, and safety of mini S-OSTs, which have fewer tablets and include simethicone compared to the mini-OSTs.

Methods: This was a prospective, randomized, investigator-blinded, multicenter, and noninferior phase 3 trial conducted between August 2023 and January 2024. The efficacy, safety, and tolerability were compared among a mini S-OST split dose group, mini S-OST non-split dose group and conventional OST group. To evaluate the occurrence of gastric mucosal lesions, gastroscopy was also performed.

Results: High-quality preparation was achieved in the mini S-OST split dose group and conventional OST group according to both the full analysis set and per-protocol set analyses, without significant differences. Tolerability metrics were more favorable in the mini-OST group. The hematin content tended to decrease and the number of erosions was reduced in the mini S-OST split dose group compared with the conventional OST group according to the gastroscopy results. Adverse events were comparable between the conventional OST and mini S-OST split dose groups. The mini S-OST non-split dose group showed no difference in overall successful cleaning, but the proportion of high-quality cleaning in the ascending colon was lower than that in the mini S-OST split dose group and conventional OST group.

Conclusions: Compared with conventional OST, the mini S-OST split dose showed excellent efficacy, comparable safety and tolerability, with less gastric injury (ClinicalTrial.gov identifier NCT06287606).

Background/aims: Patient-derived organoids (PDOs) are promising preclinical models that replicate critical tumor features. However, intratumoral heterogeneity challenges the clinical utility of PDOs, especially in capturing diverse tumor cell subpopulations.

Methods: Single-cell transcriptomics was used to analyze PDOs from distinct sites within a single gastric cancer tumor, aiming to assess their ability to reflect intratumoral heterogeneity.

Results: The PDOs displayed similarities in gene expression but also exhibited distinct profiles. Single-cell analysis of PDOs revealed upregulation of markers for neuroendocrine tumors, which was validated via immunohistochemistry staining of neuron-specific enolase in the primary tumor. Notably, heat shock proteins showed significant variability among the PDOs, impacting immune responses. Tumors with abundant heat shock proteins are reported to have increased cytotoxic T cell activity.

Conclusions: Intratumoral heterogeneity poses challenges for PDO-based models, highlighting the need for comprehensive assessment. Despite their limitations, PDOs offer valuable insights into precision medicine for patients with gastric cancer, aiding in the development of therapeutic strategies.