Indian Journal of Gastroenterology最新文献

Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is characterized by chronic gastrointestinal inflammation, leading to unpredictable flares and substantial morbidity. Gastrointestinal polymerase chain reaction (GI-PCR) testing has emerged as a widely used diagnostic tool to identify enteric pathogens during IBD exacerbations. It is a novel, quick and sensitive diagnostic test to detect Clostridioides difficile infection (CDI), as well as other enteric pathogens. However, the clinical significance of non-C. difficile pathogens detected by GI-PCR remains uncertain, raising concerns about the over-interpretation of positive results and the potential for unnecessary antimicrobial therapy. While traditional stool culture and microscopy offered limited sensitivity, GI-PCR has dramatically improved pathogen detection rates, identifying infections in up to 26% of IBD patients compared to 5% with conventional methods. Beyond C. difficile, pathogens such as Escherichia coli (especially adherent-invasive strains), Campylobacter, Salmonella, Norovirus and Yersinia enterocolitica are frequently detected in IBD flares. However, whether these microbes actively drive disease exacerbations or merely reflect inflammation-associated dysbiosis remains unclear. Enterobacteriaceae, in particular, bloom in inflamed intestines, raising critical questions regarding their pathogenic role vs. colonization. The high sensitivity of GI-PCR further complicates clinical decision-making, as distinguishing active infection from harmless microbial presence is challenging. This review explores the current literature on GI-PCR in IBD, emphasizing its benefits and limitations. While GI-PCR provides rapid, comprehensive pathogen detection, its indiscriminate application may lead to unnecessary antibiotic use and therapeutic missteps. Understanding the ecological shifts in IBD-associated dysbiosis and refining clinical interpretation of GI-PCR results are essential to optimizing patient management. Future research should aim to delineate the pathogenic significance of non-C. difficile microbes and establish evidence-based protocols for the appropriate use of GI-PCR in IBD care.

Background: Hyperspectral imaging (HSI), a high-throughput, three-dimensional technology initially developed for remote sensing, has recently garnered increasing interest in applications in gastroenterology and hepatology. We focus on the aspects of HSI clinical research in gastroenterology and hepatology from a more clinically oriented perspective, discussing its prospective trajectories in this field and delving into the current challenges encountered with HSI.

Methods: A comprehensive systematic search was carried out in PubMed, Embase and Web of Science, encompassing studies published up to June 30, 2024. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic review was then conducted to evaluate the identified studies. Two independent reviewers screened the retrieved articles based on pre-defined inclusion and exclusion criteria, followed by an independent data extraction process to ensure accuracy and reliability.

Results: Total 63 studies met the inclusion criteria. Among the 63 included studies, HSI demonstrated significant potential in cancer diagnosis (65.1%), intra-operative monitoring (33.3%) and H. pylori detection (1.6%), with most studies integrating artificial intelligence (AI) for enhanced data analysis. Most studies integrated HSI with AI, enabling efficient analysis and processing of complex hyperspectral data. Additionally, advancements in medical devices, including hyperspectral endoscopes and hyperspectral microscopes, have enhanced the practicality and clinical utility of HSI in gastroenterology and hepatology.

Discussion: HSI shows promising performance and significant potential in gastroenterology and hepatology by enhancing the detection of gastrointestinal cancers, improving intra-operative decision-making through real-time tissue characterization, and facilitating tissue assessment during surgery. HSI offers non-invasive, real-time tissue analysis, but its clinical adoption is hindered by high costs, technical complexity and lack of standardized protocols.

Obesity is a highly prevalent, chronic disease driven by food addiction and associated with increased premature mortality. Obesogenic environments promote unhealthy behavior, making weight management challenging. Until recently, effective pharmacological treatments were lacking. The introduction of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represents a major breakthrough in obesity care, with the potential to transform treatment strategies. Despite their efficacy, high costs (as of 2025) limit accessibility, particularly in low and middle-income regions, where parallel, unregulated use is emerging. Obesity remains under-recognized as a primary medical condition, especially in populations prone to metabolic complications, including metabolic dysfunction-associated steatotic liver disease (MASLD). Gastroenterology has historically underestimated the role of GLP-1 RAs in the past. Moving forward, the choice between GLP-1 therapy and bariatric endoscopy/surgery will become a central research focus, with treatment failures in one modality already leading to crossover. GLP-1 RAs are expected to significantly impact obesity-related comorbidities, including hypertension, dyslipidaemia, type-2 diabetes, sleep apnea, MASLD and inflammatory bowel disease (IBD). An "Obesity First" approach may reshape healthcare by addressing obesity as the primary topic cause for chronic disease. By 2035, the role of GLP-1 RAs as potential lifelong treatment will become clearer, with generic market expansion anticipated following patent expirations (China 2026; Europe 2031).

Background and objectives: Microplastics are pervasive environmental pollutants, attracting significant concern due to their potential adverse effects on ecosystems and human health. This study hypothesizes that microplastics may significantly impact gastrointestinal (GI) health through various mechanisms. The objective of this systematic review is to explore the effects of microplastics on GI health, focusing on animal models such as mice, fish and earthworms.

Methods: A systematic review approach was employed, analyzing studies that investigate the impact of microplastics on the gut microbiota, gut barrier integrity and GI inflammation. The review includes a synthesis of findings from multiple animal models.

Results: The review reveals consistent evidence that microplastics can disrupt the gut microbiota, impair the gut barrier, and induce inflammatory responses in the GI tract. Statistical analysis shows a significant correlation between microplastic exposure and GI health deterioration across various animal models.

Conclusions: The findings underscore the harmful effects of microplastics on GI health, emphasizing the urgent need for policy interventions to reduce plastic pollution. Implementing measures to limit the production and usage of disposable plastics is crucial for mitigating the risks posed by microplastic contamination to promote environmental sustainability and safeguard human well-being.