Journal of Digestive Diseases最新文献_第10页

Primary sclerosing cholangitis with IgG4-positive plasma cells in bile duct biopsies ― Frequency and characterization 胆管活检中出现 IgG4 阳性浆细胞的原发性硬化性胆管炎--频率和特征。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-15 DOI: 10.1111/1751-2980.13295

Taotao Zhou, Florian Fronhoffs, Glen Kristiansen, Leona Dold, Dominik J. Kaczmarek, Christian P. Strassburg, Tobias J. Weismüller

Objectives

Patients diagnosed with primary sclerosing cholangitis (PSC) but with characteristics of immunoglobulin G4 (IgG4)-associated cholangitis (IAC) have been described. IAC often presents with biliary IgG4-positive plasma cell (IgG4+ PC) infiltration and responds to corticosteroids. In PSC, the frequencies or implications of biliary IgG4+ PC are unknown. We aimed to characterize the phenomenon of biliary IgG4+ PC in patients with an established PSC diagnosis.

Methods

Bile duct biopsies from 191 surveillance or therapeutic endoscopic retrograde cholangiography of 58 PSC patients were retrospectively analyzed for IgG4+ PC infiltration. Patients with ≥10 IgG4+ PC per high-power field (HPF) were identified and characterized by clinical parameters, including serum IgG4 and cholangiographic presentations.

Results

Altogether 39.7% of the PSC patients showed ≥10 IgG4+ PC/HPF in bile duct biopsies. Patients with biliary IgG4+ PC infiltration were significantly younger at diagnosis of PSC (P = 0.023). There was no association between biliary IgG4+ PC infiltration and transplant-free survival (P = 0.618). Patients with IgG4+ PC infiltration in bile duct biopsies showed significantly higher baseline (P = 0.002) and maximum (P = 0.001) serum IgG4 compared to those without. Biliary IgG4+ PC infiltration was associated with high-grade bile duct strictures (P = 0.05). IgG4-positive plasma cell infiltrations were found multifocally in 72.7% of this subgroup of PSC patients.

Conclusions

IgG4+ PC ≥10/HPF can be found abundantly in bile duct biopsies in PSC. Histological findings correlated with serum IgG4, age, and high-grade bile duct strictures. IgG4+ PC was located multifocally, hinting at a systemic biliary phenotype.

目的：有患者被诊断为原发性硬化性胆管炎（PSC），但却具有免疫球蛋白 G4（IgG4）相关性胆管炎（IAC）的特征。IAC 通常表现为胆道 IgG4 阳性浆细胞（IgG4+ PC）浸润，并对皮质类固醇有反应。在 PSC 中，胆汁 IgG4+ PC 的频率或影响尚不清楚。我们的目的是描述已确诊为 PSC 患者的胆道 IgG4+ PC 现象：我们对 58 例 PSC 患者的 191 例监测性或治疗性内镜逆行胆管造影的胆管活检进行了回顾性分析，以确定是否存在 IgG4+ PC 浸润。对每个高倍视野（HPF）IgG4+ PC ≥10 例的患者进行鉴定，并根据临床参数（包括血清 IgG4 和胆管造影表现）对其进行特征描述：结果：总共有 39.7% 的 PSC 患者在胆管活检中发现 IgG4+ PC≥10 个/HPF。有胆道 IgG4+ PC 浸润的患者在确诊为 PSC 时明显更年轻（P = 0.023）。胆道 IgG4+ PC 浸润与无移植生存率之间没有关联（P = 0.618）。胆管活检中出现 IgG4+ PC 浸润的患者的血清 IgG4 基线（P = 0.002）和最高值（P = 0.001）均明显高于未出现 IgG4 浸润的患者。胆道 IgG4+ PC 浸润与高级别胆管狭窄有关（P = 0.05）。在这一亚组PSC患者中，72.7%的患者发现IgG4阳性浆细胞多灶性浸润：结论：在 PSC 患者的胆管活检中可发现大量 IgG4+ PC ≥10/HPF。组织学发现与血清 IgG4、年龄和高级别胆管狭窄相关。IgG4+ PC分布在多个部位，提示存在系统性胆道表型。

{"title":"Primary sclerosing cholangitis with IgG4-positive plasma cells in bile duct biopsies ― Frequency and characterization","authors":"Taotao Zhou, Florian Fronhoffs, Glen Kristiansen, Leona Dold, Dominik J. Kaczmarek, Christian P. Strassburg, Tobias J. Weismüller","doi":"10.1111/1751-2980.13295","DOIUrl":"10.1111/1751-2980.13295","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Patients diagnosed with primary sclerosing cholangitis (PSC) but with characteristics of immunoglobulin G4 (IgG4)-associated cholangitis (IAC) have been described. IAC often presents with biliary IgG4-positive plasma cell (IgG4+ PC) infiltration and responds to corticosteroids. In PSC, the frequencies or implications of biliary IgG4+ PC are unknown. We aimed to characterize the phenomenon of biliary IgG4+ PC in patients with an established PSC diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Bile duct biopsies from 191 surveillance or therapeutic endoscopic retrograde cholangiography of 58 PSC patients were retrospectively analyzed for IgG4+ PC infiltration. Patients with ≥10 IgG4+ PC per high-power field (HPF) were identified and characterized by clinical parameters, including serum IgG4 and cholangiographic presentations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 39.7% of the PSC patients showed ≥10 IgG4+ PC/HPF in bile duct biopsies. Patients with biliary IgG4+ PC infiltration were significantly younger at diagnosis of PSC (<i>P</i> = 0.023). There was no association between biliary IgG4+ PC infiltration and transplant-free survival (<i>P</i> = 0.618). Patients with IgG4+ PC infiltration in bile duct biopsies showed significantly higher baseline (<i>P</i> = 0.002) and maximum (<i>P</i> = 0.001) serum IgG4 compared to those without. Biliary IgG4+ PC infiltration was associated with high-grade bile duct strictures (<i>P</i> = 0.05). IgG4-positive plasma cell infiltrations were found multifocally in 72.7% of this subgroup of PSC patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>IgG4+ PC ≥10/HPF can be found abundantly in bile duct biopsies in PSC. Histological findings correlated with serum IgG4, age, and high-grade bile duct strictures. IgG4+ PC was located multifocally, hinting at a systemic biliary phenotype.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 6","pages":"394-403"},"PeriodicalIF":2.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Goblet cell adenocarcinoma of the gallbladder: Report of two cases and a review 胆囊腺癌：两个病例的报告和综述。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-15 DOI: 10.1111/1751-2980.13298

Fatma Khanchel, Imen Helal, Amira Hmidi, Maissa Ben Thayer, Haithem Zaafouri, Dhafer Hadded, Raweh Hedhli, Ehsen Ben Brahim, Raja Jouini, Aschraf Chadli-Debbiche

引用次数: 0

Reassessment of EUS features in preoperative diagnosis of pancreatic serous cystic neoplasm: Lessons to avoid misdiagnosis 重新评估胰腺浆液性囊性瘤术前诊断中的 EUS 特征：避免误诊的经验。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-14 DOI: 10.1111/1751-2980.13299

Xiao Lan Zhang, Ke Chen, Yi Ping He, Xiu Jiang Yang, Jian Qiang Liu

Objectives

Pancreatic serous cystic neoplasm (SCN) is a benign cystic neoplasm that is likely to be surgically resected due to preoperative misdiagnosis or tentative diagnosis even using endoscopic ultrasonography (EUS). We aimed to analyze EUS findings of SCN associated with misdiagnosis.

Methods

Between January 2012 and September 2023, histologically confirmed pancreatic SCN were included and EUS features were reviewed.

Results

Overall, 294 patients with 300 surgically resected SCNs were included. The median age of the patients was 51 years and 75.9% were females. The lesions were predominantly located in the body/neck/tail of the pancreas (63.0%). The overall preoperative diagnostic rate of SCN was 36.3%, with the most common misdiagnosis being intraductal papillary mucinous neoplasm (IPMN) (31.3%), while 16.3% remained undefined. The preoperative diagnostic rate of SCN varied across different endosonographic morphologies, with oligocystic, macrocystic, microcystic, and solid patterns yielding rates of 12.8%, 37.9%, 76.5%, and 19.2%, respectively. Notably, the presence of central scar and vascularity improved the diagnostic accuracy and correctly identified 41.4% and 52.3% of the lesions. While mucus or pancreatic duct (PD) communication significantly increased the likelihood of misdiagnosis, particularly as IPMN. Multivariate analysis revealed a morphological pattern, mucin-producing signs, wall thickening, vascularity, and PD communication were independent factors related to preoperative misdiagnosis, with an overall accuracy of 82.3%.

Conclusions

Preoperative diagnosis of SCN remains challenging. The microcystic pattern emerged as a reliable feature, while mucin-producing signs, including mural nodules, mucus, and PD communication, pose diagnostic pitfalls despite the presence of typical central scar or vascularity commonly in SCN.

目的：胰腺浆液性囊性肿瘤（SCN）是一种良性囊性肿瘤，很可能因术前误诊或即使使用内镜超声检查（EUS）也无法做出初步诊断而被手术切除。我们旨在分析与误诊相关的 SCN 的 EUS 结果：方法：纳入2012年1月至2023年9月期间经组织学确诊的胰腺SCN患者，并回顾性分析其EUS特征：结果：共纳入 294 例患者，300 例经手术切除的 SCN。患者的中位年龄为 51 岁，75.9% 为女性。病变主要位于胰体/胰颈/胰尾（63.0%）。SCN的总体术前诊断率为36.3%，最常见的误诊为导管内乳头状粘液瘤（IPMN）（31.3%），16.3%仍未确定。不同内镜形态的 SCN 术前诊断率各不相同，少囊型、大囊型、小囊型和实变型的诊断率分别为 12.8%、37.9%、76.5% 和 19.2%。值得注意的是，中央疤痕和血管的存在提高了诊断的准确性，分别正确识别了 41.4% 和 52.3% 的病变。而粘液或胰管（PD）沟通则大大增加了误诊的可能性，尤其是误诊为 IPMN。多变量分析显示，形态模式、粘液分泌征象、壁增厚、血管和胰管沟通是导致术前误诊的独立因素，总体准确率为82.3%：结论：SCN的术前诊断仍具有挑战性。微囊型是一个可靠的特征，而粘液分泌征象，包括壁层结节、粘液和PD沟通，尽管存在SCN常见的典型中央瘢痕或血管，但仍会造成诊断误区。

{"title":"Reassessment of EUS features in preoperative diagnosis of pancreatic serous cystic neoplasm: Lessons to avoid misdiagnosis","authors":"Xiao Lan Zhang, Ke Chen, Yi Ping He, Xiu Jiang Yang, Jian Qiang Liu","doi":"10.1111/1751-2980.13299","DOIUrl":"10.1111/1751-2980.13299","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Pancreatic serous cystic neoplasm (SCN) is a benign cystic neoplasm that is likely to be surgically resected due to preoperative misdiagnosis or tentative diagnosis even using endoscopic ultrasonography (EUS). We aimed to analyze EUS findings of SCN associated with misdiagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2012 and September 2023, histologically confirmed pancreatic SCN were included and EUS features were reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 294 patients with 300 surgically resected SCNs were included. The median age of the patients was 51 years and 75.9% were females. The lesions were predominantly located in the body/neck/tail of the pancreas (63.0%). The overall preoperative diagnostic rate of SCN was 36.3%, with the most common misdiagnosis being intraductal papillary mucinous neoplasm (IPMN) (31.3%), while 16.3% remained undefined. The preoperative diagnostic rate of SCN varied across different endosonographic morphologies, with oligocystic, macrocystic, microcystic, and solid patterns yielding rates of 12.8%, 37.9%, 76.5%, and 19.2%, respectively. Notably, the presence of central scar and vascularity improved the diagnostic accuracy and correctly identified 41.4% and 52.3% of the lesions. While mucus or pancreatic duct (PD) communication significantly increased the likelihood of misdiagnosis, particularly as IPMN. Multivariate analysis revealed a morphological pattern, mucin-producing signs, wall thickening, vascularity, and PD communication were independent factors related to preoperative misdiagnosis, with an overall accuracy of 82.3%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preoperative diagnosis of SCN remains challenging. The microcystic pattern emerged as a reliable feature, while mucin-producing signs, including mural nodules, mucus, and PD communication, pose diagnostic pitfalls despite the presence of typical central scar or vascularity commonly in SCN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 7","pages":"463-469"},"PeriodicalIF":2.3,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Survey of physicians' knowledge about pediatric nonalcoholic fatty liver disease in China 中国医生对小儿非酒精性脂肪肝知识的调查。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-11 DOI: 10.1111/1751-2980.13297

Xiang Yang Gao, Yi Fan Yang, Li Li, Yun Fei Xing, You Xin Wang, Xue Ying Li, Shu Han Yang, Ming Yue Wang, Jian Gao Fan, Hui Wang

Objectives

To evaluate physicians’ awareness and knowledge towards pediatric nonalcoholic fatty liver disease (NAFLD) and their attitude toward change in nomenclature from NAFLD to metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) in China.

Methods

The questionnaire survey contained five parts (characteristics of the participants, epidemiology, diagnosis, management of NAFLD, and attitudes toward the nomenclature of MAFLD/MASLD). The participants included 53 hepatologists, 88 gastroenterologists (GEs), 74 endocrinologists (ENDOs), 61 primary care physicians (PCPs), and 157 pediatricians across 31 municipalities, provinces and autonomous regions of China's mainland.

Results

Hepatologists saw the largest number of pediatric NAFLD patients annually (median 9 [range 1–20]), with the lowest number by PCPs (even notwithstanding one patient annually). The primary sources of pediatric NAFLD knowledge were acquired via guidelines. Hepatologists had the highest total knowledge score among all five types of physicians. Approximately one-third of nonspecialists (ENDOs and PCPs) considered liver biopsy necessary for pediatric NAFLD patients, and this percentage increased to half in specialists (hepatologists and GEs). For nonspecialists, the major barriers to the management of pediatric NAFLD were poor patient adherence to lifestyle modifications and lacking confidence in managing NAFLD. Above 90% physicians agreed to change the nomenclature NAFLD to MAFLD; however, they were not sure whether it could reduce the economic burden.

Conclusions

Despite the epidemic of pediatric NAFLD in China, a significant knowledge gap remains in the identification, diagnosis, and treatment of pediatric NAFLD, particularly among frontline workers such as pediatricians and PCPs. More education programs should be carried out in the future.

目的评估中国医生对小儿非酒精性脂肪肝（NAFLD）的认识和知识，以及他们对将NAFLD命名为代谢功能障碍相关性脂肪肝（MAFLD）或代谢功能障碍相关性脂肪肝（MASLD）的态度：问卷调查包括五个部分（参与者特征、流行病学、诊断、非酒精性脂肪肝的管理以及对MAFLD/MASLD命名的态度）。调查对象包括中国大陆31个省、市、自治区的53名肝病医生、88名消化科医生、74名内分泌科医生、61名全科医生和157名儿科医生：肝病医生每年接诊的小儿非酒精性脂肪肝患者最多（中位数为9例[1-20例]），而初级保健医生接诊的患者最少（即使每年接诊一名患者）。儿科非酒精性脂肪肝知识的主要来源是通过指南获得的。在所有五类医生中，肝病专家的知识总分最高。大约三分之一的非专科医生（ENDO和初级保健医生）认为小儿非酒精性脂肪肝患者有必要进行肝脏活检，而在专科医生（肝病专家和普通医师）中，这一比例增加到一半。对于非专科医生来说，治疗小儿非酒精性脂肪肝的主要障碍是患者对生活方式调整的依从性差，以及对治疗非酒精性脂肪肝缺乏信心。90%以上的医生同意将非酒精性脂肪肝更名为酒精性非酒精性脂肪肝，但他们不确定这样做能否减轻经济负担：尽管小儿非酒精性脂肪肝在中国呈流行趋势，但在识别、诊断和治疗小儿非酒精性脂肪肝方面仍存在巨大的知识差距，尤其是在儿科医生和初级保健医生等一线工作者中。今后应开展更多的教育项目。

{"title":"Survey of physicians' knowledge about pediatric nonalcoholic fatty liver disease in China","authors":"Xiang Yang Gao, Yi Fan Yang, Li Li, Yun Fei Xing, You Xin Wang, Xue Ying Li, Shu Han Yang, Ming Yue Wang, Jian Gao Fan, Hui Wang","doi":"10.1111/1751-2980.13297","DOIUrl":"10.1111/1751-2980.13297","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate physicians’ awareness and knowledge towards pediatric nonalcoholic fatty liver disease (NAFLD) and their attitude toward change in nomenclature from NAFLD to metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The questionnaire survey contained five parts (characteristics of the participants, epidemiology, diagnosis, management of NAFLD, and attitudes toward the nomenclature of MAFLD/MASLD). The participants included 53 hepatologists, 88 gastroenterologists (GEs), 74 endocrinologists (ENDOs), 61 primary care physicians (PCPs), and 157 pediatricians across 31 municipalities, provinces and autonomous regions of China's mainland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Hepatologists saw the largest number of pediatric NAFLD patients annually (median 9 [range 1–20]), with the lowest number by PCPs (even notwithstanding one patient annually). The primary sources of pediatric NAFLD knowledge were acquired via guidelines. Hepatologists had the highest total knowledge score among all five types of physicians. Approximately one-third of nonspecialists (ENDOs and PCPs) considered liver biopsy necessary for pediatric NAFLD patients, and this percentage increased to half in specialists (hepatologists and GEs). For nonspecialists, the major barriers to the management of pediatric NAFLD were poor patient adherence to lifestyle modifications and lacking confidence in managing NAFLD. Above 90% physicians agreed to change the nomenclature NAFLD to MAFLD; however, they were not sure whether it could reduce the economic burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the epidemic of pediatric NAFLD in China, a significant knowledge gap remains in the identification, diagnosis, and treatment of pediatric NAFLD, particularly among frontline workers such as pediatricians and PCPs. More education programs should be carried out in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 6","pages":"380-393"},"PeriodicalIF":2.3,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of the extended Japan NBI expert team classification of subtype 2B in laterally spreading colorectal tumors based on blue laser imaging 根据蓝色激光成像评估日本 NBI 专家小组对横向扩散结直肠肿瘤 2B 亚型的扩展分类。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-10 DOI: 10.1111/1751-2980.13296

Lin Fu Zheng, Long Ping Chen, Lin Xin Zhou, Jin Zheng, Chuan Shen Jiang, Shi Rui Peng, Da Zhou Li, Wen Wang

Objectives

The Japan NBI Expert Team (JNET) classification has good diagnostic potential for colorectal diseases. We aimed to explore the diagnostic value of the JNET classification type 2B (JNET2B) criteria for colorectal laterally spreading tumors (LSTs) based on magnifying endoscopy with blue laser imaging (ME-BLI) examination.

Methods

Between January 2017 and June 2023, 218 patients who were diagnosed as having JNET2B-type LSTs using ME-BLI were included retrospectively. Endoscopic images were reinterpreted to categorize the LSTs as JNET2B-low (n = 178) and JNET2B-high (n = 53) LSTs. The JNET2B-low and JNET2B-high LSTs were compared based on their histopathological and morphological classifications.

Results

Among the 178 JNET2B-low LSTs, 86 (48.3%) were histopathologically classified as low-grade intraepithelial neoplasia, 54 (30.3%) as high-grade intraepithelial neoplasia (HGIN), 37 (20.8%) as intramucosal carcinoma (IMC), and one (0.6%) as superficial invasive submucosal carcinoma (SMC1). Among the 53 JNET2B-high LSTs, five (9.4%) were classified as HGIN, 28 (52.9%) as IMC, 15 (28.3%) as SMC1, and 5 (9.4%) as deep invasive submucosal carcinoma. There were significant differences in this histopathological classification between the two groups (P < 0.001). However, there was no significant difference between JNET2B-low and JNET2B-high LSTs based on their morphological classification (granular vs nongranular) or size (<20 mm vs ≥20 mm). Besides, the κ value for JNET2B subtyping was 0.698 (95% confidence interval 0.592–0.804) between the two endoscopists who reassessed the endoscopic images.

Conclusion

The JNET2B subtyping of LSTs has a diagnostic potential in the preoperative setting, and may be valuable for treatment decision-making.

目的：日本 NBI 专家组（JNET）分类对结直肠疾病具有良好的诊断潜力。我们旨在探讨基于放大内镜与蓝激光成像（ME-BLI）检查的 JNET 分类 2B 型（JNET2B）标准对结直肠侧向扩散肿瘤（LST）的诊断价值：回顾性纳入2017年1月至2023年6月期间使用ME-BLI诊断为JNET2B型LST的218例患者。对内窥镜图像进行重新解读，将LST分为JNET2B-低（n = 178）和JNET2B-高（n = 53）LST。根据组织病理学和形态学分类，对JNET2B-low和JNET2B-high LST进行比较：在 178 例 JNET2B 低的 LST 中，86 例（48.3%）组织病理学分类为低级别上皮内瘤变、54 例（30.3%）为高级别上皮内瘤变、37 例（20.8%）为粘膜内癌（IMC）、1 例（0.6%）为浅表浸润性粘膜下癌（SMC1）。在 53 例 JNET2B 高的 LST 中，5 例（9.4%）被归类为 HGIN，28 例（52.9%）被归类为 IMC，15 例（28.3%）被归类为 SMC1，5 例（9.4%）被归类为深部浸润性粘膜下癌。两组患者在组织病理学分类上存在明显差异（P 结论：JNET2B 亚型与 SMC1 亚型之间存在明显差异：LST 的 JNET2B 亚型具有术前诊断潜力，可能对治疗决策很有价值。

{"title":"Evaluation of the extended Japan NBI expert team classification of subtype 2B in laterally spreading colorectal tumors based on blue laser imaging","authors":"Lin Fu Zheng, Long Ping Chen, Lin Xin Zhou, Jin Zheng, Chuan Shen Jiang, Shi Rui Peng, Da Zhou Li, Wen Wang","doi":"10.1111/1751-2980.13296","DOIUrl":"10.1111/1751-2980.13296","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The Japan NBI Expert Team (JNET) classification has good diagnostic potential for colorectal diseases. We aimed to explore the diagnostic value of the JNET classification type 2B (JNET2B) criteria for colorectal laterally spreading tumors (LSTs) based on magnifying endoscopy with blue laser imaging (ME-BLI) examination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2017 and June 2023, 218 patients who were diagnosed as having JNET2B-type LSTs using ME-BLI were included retrospectively. Endoscopic images were reinterpreted to categorize the LSTs as JNET2B-low (n = 178) and JNET2B-high (n = 53) LSTs. The JNET2B-low and JNET2B-high LSTs were compared based on their histopathological and morphological classifications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 178 JNET2B-low LSTs, 86 (48.3%) were histopathologically classified as low-grade intraepithelial neoplasia, 54 (30.3%) as high-grade intraepithelial neoplasia (HGIN), 37 (20.8%) as intramucosal carcinoma (IMC), and one (0.6%) as superficial invasive submucosal carcinoma (SMC1). Among the 53 JNET2B-high LSTs, five (9.4%) were classified as HGIN, 28 (52.9%) as IMC, 15 (28.3%) as SMC1, and 5 (9.4%) as deep invasive submucosal carcinoma. There were significant differences in this histopathological classification between the two groups (<i>P</i> < 0.001). However, there was no significant difference between JNET2B-low and JNET2B-high LSTs based on their morphological classification (granular vs nongranular) or size (<20 mm vs ≥20 mm). Besides, the κ value for JNET2B subtyping was 0.698 (95% confidence interval 0.592–0.804) between the two endoscopists who reassessed the endoscopic images.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The JNET2B subtyping of LSTs has a diagnostic potential in the preoperative setting, and may be valuable for treatment decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 6","pages":"361-367"},"PeriodicalIF":2.3,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Potential mediation effect of insulin resistance on the association between iron metabolism indicators and non-alcoholic fatty liver disease 胰岛素抵抗对铁代谢指标与非酒精性脂肪肝之间关联的潜在中介效应。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-01 DOI: 10.1111/1751-2980.13292

Xin Zhang, Xin Yu Han, Hong Fan, Cheng Nan Guo, Yi Li, Hai Li Wang, Zhen Qiu Liu, Tie Jun Zhang

Objectives

Iron metabolism and insulin resistance (IR) are closely related to non-alcoholic fatty liver disease (NAFLD). However, the interplay between them on the occurrence and progression of NAFLD is not fully understood. We aimed to disentangle the crosstalk between iron metabolism and IR and explore its impact on NAFLD.

Methods

We analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017–2018 to evaluate the association between serum iron metabolism indicators (ferritin, serum iron, unsaturated iron-binding capacity [UIBC], total iron-binding capacity [TIBC], transferrin saturation, and transferrin receptor) and NAFLD/non-alcoholic steatohepatitis (NASH). Mediation analysis was conducted to explore the role of IR played in these relationship.

Results

A total of 4812 participants were included, among whom 43.7% were diagnosed with NAFLD and 13.2% were further diagnosed with NASH. After adjusting the covariates, the risk of NAFLD increases with increasing serum ferritin (adjusted odds ratio [aOR] 1.71, 95% confidence interval [CI] 1.37–2.14), UIBC (aOR 1.45, 95% CI 1.17–1.79), and TIBC (aOR 1.36, 95% CI 1.11–1.68). Higher levels of serum ferritin (aOR 3.70, 95% CI 2.25–6.19) and TIBC (aOR 1.69, 95% CI 1.13–2.56) were also positively associated with NASH. Participants with IR were more likely to have NAFLD/NASH. Moreover, IR-mediated efficacy accounted for 85.85% and 64.51% between ferritin and NAFLD and NASH, respectively.

Conclusion

Higher levels of serum ferritin and TIBC are closely associated with the occurrence of NAFLD and NASH. IR may be considered a possible link between NAFLD or NASH and increased serum ferritin levels.

目的：铁代谢和胰岛素抵抗（IR）与非酒精性脂肪肝（NAFLD）密切相关。然而，它们之间的相互作用对非酒精性脂肪肝的发生和发展的影响尚未完全明了。我们旨在厘清铁代谢与 IR 之间的相互关系，并探讨其对非酒精性脂肪肝的影响：我们分析了2017-2018年美国国家健康与营养调查（NHANES）的数据，以评估血清铁代谢指标（铁蛋白、血清铁、不饱和铁结合能力[UIBC]、总铁结合能力[TIBC]、转铁蛋白饱和度和转铁蛋白受体）与非酒精性脂肪肝/非酒精性脂肪性肝炎（NASH）之间的关联。研究人员进行了中介分析，以探讨 IR 在这些关系中的作用：共纳入 4812 名参与者，其中 43.7% 被诊断为非酒精性脂肪肝，13.2% 被进一步诊断为非酒精性脂肪性肝炎。调整协变量后，非酒精性脂肪肝的风险随着血清铁蛋白（调整后的几率比 [aOR] 1.71，95% 置信区间 [CI] 1.37-2.14）、UIBC（aOR 1.45，95% CI 1.17-1.79）和 TIBC（aOR 1.36，95% CI 1.11-1.68）的增加而增加。较高水平的血清铁蛋白（aOR 3.70，95% CI 2.25-6.19）和TIBC（aOR 1.69，95% CI 1.13-2.56）也与NASH呈正相关。患有 IR 的参与者更有可能患有 NAFLD/NASH。此外，铁蛋白与非酒精性脂肪肝和NASH之间的IR介导效应分别占85.85%和64.51%：结论：较高水平的血清铁蛋白和TIBC与非酒精性脂肪肝和NASH的发生密切相关。IR可被视为非酒精性脂肪肝或NASH与血清铁蛋白水平升高之间的可能联系。

{"title":"Potential mediation effect of insulin resistance on the association between iron metabolism indicators and non-alcoholic fatty liver disease","authors":"Xin Zhang, Xin Yu Han, Hong Fan, Cheng Nan Guo, Yi Li, Hai Li Wang, Zhen Qiu Liu, Tie Jun Zhang","doi":"10.1111/1751-2980.13292","DOIUrl":"10.1111/1751-2980.13292","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Iron metabolism and insulin resistance (IR) are closely related to non-alcoholic fatty liver disease (NAFLD). However, the interplay between them on the occurrence and progression of NAFLD is not fully understood. We aimed to disentangle the crosstalk between iron metabolism and IR and explore its impact on NAFLD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017–2018 to evaluate the association between serum iron metabolism indicators (ferritin, serum iron, unsaturated iron-binding capacity [UIBC], total iron-binding capacity [TIBC], transferrin saturation, and transferrin receptor) and NAFLD/non-alcoholic steatohepatitis (NASH). Mediation analysis was conducted to explore the role of IR played in these relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4812 participants were included, among whom 43.7% were diagnosed with NAFLD and 13.2% were further diagnosed with NASH. After adjusting the covariates, the risk of NAFLD increases with increasing serum ferritin (adjusted odds ratio [aOR] 1.71, 95% confidence interval [CI] 1.37–2.14), UIBC (aOR 1.45, 95% CI 1.17–1.79), and TIBC (aOR 1.36, 95% CI 1.11–1.68). Higher levels of serum ferritin (aOR 3.70, 95% CI 2.25–6.19) and TIBC (aOR 1.69, 95% CI 1.13–2.56) were also positively associated with NASH. Participants with IR were more likely to have NAFLD/NASH. Moreover, IR-mediated efficacy accounted for 85.85% and 64.51% between ferritin and NAFLD and NASH, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher levels of serum ferritin and TIBC are closely associated with the occurrence of NAFLD and NASH. IR may be considered a possible link between NAFLD or NASH and increased serum ferritin levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 5","pages":"285-297"},"PeriodicalIF":2.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

KDM4C represses liver fibrosis by regulating H3K9me3 methylation of ALKBH5 and m6A methylation of snail1 mRNA KDM4C通过调节ALKBH5的H3K9me3甲基化和蜗牛1 mRNA的m6A甲基化抑制肝纤维化。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-06-27 DOI: 10.1111/1751-2980.13291

Hua Ying Zhou, Bing Qing Wang, Meng Xuan Chen, Yi Fan Wang, Yong Fang Jiang, Jing Ma

Objective

We aimed to disclose the molecular mechanism of snail1 in liver fibrosis.

Methods

Carbon tetrachloride (CCl₄) was used to induce a liver fibrosis model in mice whereby serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were evaluated, and liver pathological alternations were assessed. Rat hepatic stellate cells (HSC-T6) were irritated with transforming growth factor (TGF)-β1, followed by assessment of cell viability and migration. The levels of snail1, ALKBH5, and lysine specific demethylase 4C (KDM4C) were quantified by immunohistochemistry, western blot, or reverse transcription-quantitative polymerase chain reaction, in addition to α-smooth muscle actin (SMA), anti-collagen type I α1 (COL1A1), vimentin, and E-cadherin. Photoactivatable ribonucleoside-enhanced crosslinking and immunoprecipitation and RNA stability were evaluated to determine the relationship between ALKBH5 and snail1. Changes in KDM4C-bound ALKBH5 promoter and enrichment of histone H3 lysine 9 trimethylation (H3K9me3) at the ALKBH5 promoter were determined using chromatin immunoprecipitation.

Results

In fibrosis mice, snail1 was upregulated while ALKBH5 and KDM4C were downregulated. KDM4C overexpression reduced serum ALT and AST levels, liver injury, and α-SMA, COL1A1 and VIMENTIN expressions but increased E-cadherin expression. However, the aforementioned trends were reversed by concurrent overexpression of snail1. In HSC-T6 cells exposed to TGF-β1, ALKBH5 overexpression weakened cell viability and migration, downregulated α-SMA, COL1A1 and VIMENTIN, upregulated E-CADHERIN, and decreased m6A modification of snail1 and its mRNA stability. KDM4C increased ALKBH5 expression by lowering H3K9me3 level, but inhibited HSC-T6 cell activation by regulating the ALKBH5/snail1 axis.

Conclusion

KDM4C decreases H3K9me3 methylation to upregulate ALKBH5 and subsequently inhibits snail1, ultimately impeding liver fibrosis.

目的：揭示蜗牛1在肝纤维化中的分子机制：旨在揭示蜗牛1在肝纤维化中的分子机制：用四氯化碳（CCl4）诱导小鼠肝纤维化模型，评估血清丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）水平，并评估肝脏病理变化。用转化生长因子（TGF）-β1刺激大鼠肝星状细胞（HSC-T6），然后评估细胞活力和迁移。除了α-平滑肌肌动蛋白（SMA）、抗Ⅰ型胶原α1（COL1A1）、波形蛋白和E-粘连蛋白外，还通过免疫组化、Western印迹或逆转录定量聚合酶链反应对蜗牛1、ALKBH5和赖氨酸特异性去甲基化酶4C（KDM4C）的水平进行了量化。对光活化核糖核苷增强交联和免疫沉淀以及 RNA 稳定性进行了评估，以确定 ALKBH5 与蜗牛 1 之间的关系。使用染色质免疫沉淀法测定了KDM4C结合的ALKBH5启动子的变化以及组蛋白H3赖氨酸9三甲基化（H3K9me3）在ALKBH5启动子处的富集：结果：在纤维化小鼠中，蜗牛1上调，而ALKBH5和KDM4C下调。KDM4C的过表达降低了血清ALT和AST水平、肝损伤以及α-SMA、COL1A1和VIMENTIN的表达，但增加了E-cadherin的表达。然而，同时过表达蜗牛1会逆转上述趋势。在暴露于 TGF-β1 的 HSC-T6 细胞中，ALKBH5 的过表达削弱了细胞的活力和迁移，下调了 α-SMA、COL1A1 和 VIMENTIN，上调了 E-CADHERIN，并降低了蜗牛 1 的 m6A 修饰及其 mRNA 的稳定性。KDM4C通过降低H3K9me3水平增加了ALKBH5的表达，但通过调节ALKBH5/蜗牛1轴抑制了HSC-T6细胞的活化：结论：KDM4C通过降低H3K9me3甲基化来上调ALKBH5，进而抑制蜗牛1，最终阻碍肝纤维化。

{"title":"KDM4C represses liver fibrosis by regulating H3K9me3 methylation of ALKBH5 and m6A methylation of snail1 mRNA","authors":"Hua Ying Zhou, Bing Qing Wang, Meng Xuan Chen, Yi Fan Wang, Yong Fang Jiang, Jing Ma","doi":"10.1111/1751-2980.13291","DOIUrl":"10.1111/1751-2980.13291","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to disclose the molecular mechanism of snail1 in liver fibrosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Carbon tetrachloride (CCl<sub>4</sub>) was used to induce a liver fibrosis model in mice whereby serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were evaluated, and liver pathological alternations were assessed. Rat hepatic stellate cells (HSC-T6) were irritated with transforming growth factor (TGF)-β1, followed by assessment of cell viability and migration. The levels of snail1, ALKBH5, and lysine specific demethylase 4C (KDM4C) were quantified by immunohistochemistry, western blot, or reverse transcription-quantitative polymerase chain reaction, in addition to α-smooth muscle actin (SMA), anti-collagen type I α1 (COL1A1), vimentin, and E-cadherin. Photoactivatable ribonucleoside-enhanced crosslinking and immunoprecipitation and RNA stability were evaluated to determine the relationship between ALKBH5 and snail1. Changes in KDM4C-bound ALKBH5 promoter and enrichment of histone H3 lysine 9 trimethylation (H3K9me3) at the ALKBH5 promoter were determined using chromatin immunoprecipitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In fibrosis mice, snail1 was upregulated while ALKBH5 and KDM4C were downregulated. KDM4C overexpression reduced serum ALT and AST levels, liver injury, and α-SMA, COL1A1 and VIMENTIN expressions but increased E-cadherin expression. However, the aforementioned trends were reversed by concurrent overexpression of snail1. In HSC-T6 cells exposed to TGF-β1, ALKBH5 overexpression weakened cell viability and migration, downregulated α-SMA, COL1A1 and VIMENTIN, upregulated E-CADHERIN, and decreased m6A modification of snail1 and its mRNA stability. KDM4C increased ALKBH5 expression by lowering H3K9me3 level, but inhibited HSC-T6 cell activation by regulating the ALKBH5/snail1 axis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>KDM4C decreases H3K9me3 methylation to upregulate ALKBH5 and subsequently inhibits snail1, ultimately impeding liver fibrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 5","pages":"298-309"},"PeriodicalIF":2.3,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nature of histopathology in atypical lipomatous tumor/well-differentiated liposarcoma diagnosis 非典型脂肪瘤/分化良好的脂肪肉瘤诊断的组织病理学性质

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-06-21 DOI: 10.1111/1751-2980.13293

Jiro Ichikawa, Tomoaki Tashima, Tomonori Kawasaki

引用次数: 0

Comparison between SeHCAT test and clinical response to cholestyramine in patients with chronic diarrhea and high suspicion of bile acid malabsorption: A single-center prospective study 高度怀疑胆汁酸吸收不良的慢性腹泻患者的 SeHCAT 试验与胆汁淤积症临床反应的比较：单中心前瞻性研究

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-06-20 DOI: 10.1111/1751-2980.13289

Annalisa Schiepatti, Irene Bossert, Marta Cincotta, Carolina Arianna Zanini, Stiliano Maimaris, Daniela D'Ambrosio, Giuseppe Trifirò, Federico Biagi

Objectives

We aimed to evaluate the clinical response to cholestyramine in patients with functional chronic diarrhea and a high clinical suspicion of bile-acid diarrhea (BAD) investigated with 75-selenium homocholic acid taurine (SeHCAT) test.

Methods

Adult patients attending our outpatient clinic between January and December 2021 for chronic diarrhea with suspicion of BAD were proposed SeHCAT testing and a therapeutic trial of cholestyramine 4–8 g daily. Clinical response to cholestyramine was evaluated at 1, 3, 6, and 12 months. Clinical and demographic data were analyzed according to SeHCAT test results.

Results

Among the 50 patients with chronic diarrhea and clinical suspicion of BAD, 13 (26.0%) refused either SeHCAT testing or cholestyramine therapy. Finally, 37 patients (31 females, age 44 ± 14 years) agreed to undergo SeHCAT and were started on cholestyramine (median follow-up 14 months [interquartile range 6–16 months]). Initial response to cholestyramine was similar in patients with positive and negative SeHCAT test results, but improved over time in those with a positive test result. Long-term response (100% vs 65.2%, P = 0.02) and necessity of maintenance therapy for symptom control were more common in those with positive SeHCAT test result (71.4% vs 26.1%, P = 0.02). However, response to cholestyramine was also frequent in patients with a negative test result.

Conclusions

The SeHCAT test accurately identifies patients with BAD who benefit from long-term cholestyramine treatment. Nevertheless, cholestyramine may be also effective in patients with chronic diarrhea but negative SeHCAT test result.

方法2021年1月至12月期间，因慢性腹泻到我院门诊就诊并怀疑患有胆汁酸腹泻（BAD）的成人患者，建议进行SeHCAT测试和每天4-8克胆汁酸腹泻治疗试验。在 1、3、6 和 12 个月时对胆色素的临床反应进行评估。根据 SeHCAT 检测结果对临床和人口统计学数据进行了分析。结果在 50 名慢性腹泻且临床怀疑为 BAD 的患者中，有 13 人（26.0%）拒绝 SeHCAT 检测或胆碱酯酶治疗。最后，37 名患者（31 名女性，年龄为 44 ± 14 岁）同意接受 SeHCAT 检测，并开始服用胆司他明（中位随访时间为 14 个月（四分位间范围为 6-16 个月））。SeHCAT 检测结果呈阳性和阴性的患者对胆色素的初始反应相似，但检测结果呈阳性的患者的反应随时间推移有所改善。SeHCAT检测结果呈阳性的患者中，长期应答率（100% vs 65.2%，P = 0.02）和为控制症状而进行维持治疗的必要性更高（71.4% vs 26.1%，P = 0.02）。结论 SeHCAT 检测能准确识别出从长期胆司他敏治疗中获益的 BAD 患者。尽管如此，胆司他敏对SeHCAT检测结果阴性的慢性腹泻患者也可能有效。

{"title":"Comparison between SeHCAT test and clinical response to cholestyramine in patients with chronic diarrhea and high suspicion of bile acid malabsorption: A single-center prospective study","authors":"Annalisa Schiepatti, Irene Bossert, Marta Cincotta, Carolina Arianna Zanini, Stiliano Maimaris, Daniela D'Ambrosio, Giuseppe Trifirò, Federico Biagi","doi":"10.1111/1751-2980.13289","DOIUrl":"10.1111/1751-2980.13289","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to evaluate the clinical response to cholestyramine in patients with functional chronic diarrhea and a high clinical suspicion of bile-acid diarrhea (BAD) investigated with 75-selenium homocholic acid taurine (SeHCAT) test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients attending our outpatient clinic between January and December 2021 for chronic diarrhea with suspicion of BAD were proposed SeHCAT testing and a therapeutic trial of cholestyramine 4–8 g daily. Clinical response to cholestyramine was evaluated at 1, 3, 6, and 12 months. Clinical and demographic data were analyzed according to SeHCAT test results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 50 patients with chronic diarrhea and clinical suspicion of BAD, 13 (26.0%) refused either SeHCAT testing or cholestyramine therapy. Finally, 37 patients (31 females, age 44 ± 14 years) agreed to undergo SeHCAT and were started on cholestyramine (median follow-up 14 months [interquartile range 6–16 months]). Initial response to cholestyramine was similar in patients with positive and negative SeHCAT test results, but improved over time in those with a positive test result. Long-term response (100% vs 65.2%, <i>P</i> = 0.02) and necessity of maintenance therapy for symptom control were more common in those with positive SeHCAT test result (71.4% vs 26.1%, <i>P</i> = 0.02). However, response to cholestyramine was also frequent in patients with a negative test result.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The SeHCAT test accurately identifies patients with BAD who benefit from long-term cholestyramine treatment. Nevertheless, cholestyramine may be also effective in patients with chronic diarrhea but negative SeHCAT test result.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 5","pages":"279-284"},"PeriodicalIF":2.3,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141508059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring the potential causal effects of food preferences on irritable bowel syndrome risk: A two-sample Mendelian randomization study 探索食物偏好对肠易激综合征风险的潜在因果效应：双样本孟德尔随机研究

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-06-20 DOI: 10.1111/1751-2980.13290

Tao Zhang, Xiao Ang Li, Li Ping Duan

Objectives

Irritable bowel syndrome (IBS) is a common disorder in gut–brain interaction. Diet plays an important role in the pathophysiology of IBS. Therefore, we aimed to explore the potential causal effects of food-liking on IBS to provide better diet advice for patients.

Methods

Single-nucleotide polymorphisms associated with food-liking were selected as instrumental variables, which were obtained from the latest genome-wide association study (GWAS) conducted on 161 625 participants. The summary data of genetic associations with IBS were obtained from a recent GWAS with 433 201 European controls and 53 400 cases. We used inverse variance weighting as the main analysis. Sensitivity analyses were conducted to detect horizontal pleiotropy and heterogeneity.

Results

Significant evidence revealed the protective effects of a vegetarian diet-liking on IBS, including asparagus, avocadoes, globe artichoke, aubergine, and black olives, while onion-liking showed potential deleterious effects. For meat and fish, preference for sardines and fried fish was marginally associated with IBS risk, but salami and salmon were potential protective factors. In terms of desserts and dairy products, preferences for cake icing, ketchup, and cheesecake were suggestively associated with higher IBS risk, while goat cheese-liking was marginally correlated with lower IBS risk. Additionally and suggestively, significant causal effects of IBS on increased preferences for globe artichoke and salami were also found in a reverse Mendelian randomization (MR) study.

Conclusion

Our study revealed potential causal associations between food preference and IBS from a genetic perspective, which provides a dietary reference for such patients.

目的肠易激综合征（IBS）是肠道与大脑相互作用的一种常见疾病。饮食在肠易激综合征的病理生理学中起着重要作用。因此，我们旨在探讨喜食对肠易激综合征的潜在因果效应，从而为患者提供更好的饮食建议。方法选择与喜食相关的单核苷酸多态性作为工具变量，这些单核苷酸多态性来自最新的全基因组关联研究（GWAS），研究对象为 161 625 名参与者。与肠易激综合征有关的遗传关联的汇总数据来自最近的一项全基因组关联研究，该研究的对象包括 433 201 名欧洲对照者和 53 400 名病例。我们采用反方差加权法进行主要分析。结果有显著证据表明，偏好素食（包括芦笋、鳄梨、朝鲜蓟、茄子和黑橄榄）对肠易激综合征有保护作用，而偏好洋葱则有潜在的有害作用。在肉类和鱼类方面，对沙丁鱼和炸鱼的偏好与肠易激综合征的风险略有关联，但萨拉米香肠和三文鱼则是潜在的保护因素。在甜点和乳制品方面，偏爱蛋糕糖衣、番茄酱和芝士蛋糕与肠易激综合征的高风险有提示性关联，而偏爱山羊奶酪则与肠易激综合征的低风险略有关联。此外，在一项反向孟德尔随机化（MR）研究中还发现，IBS 对朝鲜蓟和萨拉米香肠的偏好增加具有显著的因果效应，这也是一种提示性结果。

{"title":"Exploring the potential causal effects of food preferences on irritable bowel syndrome risk: A two-sample Mendelian randomization study","authors":"Tao Zhang, Xiao Ang Li, Li Ping Duan","doi":"10.1111/1751-2980.13290","DOIUrl":"10.1111/1751-2980.13290","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Irritable bowel syndrome (IBS) is a common disorder in gut–brain interaction. Diet plays an important role in the pathophysiology of IBS. Therefore, we aimed to explore the potential causal effects of food-liking on IBS to provide better diet advice for patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-nucleotide polymorphisms associated with food-liking were selected as instrumental variables, which were obtained from the latest genome-wide association study (GWAS) conducted on 161 625 participants. The summary data of genetic associations with IBS were obtained from a recent GWAS with 433 201 European controls and 53 400 cases. We used inverse variance weighting as the main analysis. Sensitivity analyses were conducted to detect horizontal pleiotropy and heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant evidence revealed the protective effects of a vegetarian diet-liking on IBS, including asparagus, avocadoes, globe artichoke, aubergine, and black olives, while onion-liking showed potential deleterious effects. For meat and fish, preference for sardines and fried fish was marginally associated with IBS risk, but salami and salmon were potential protective factors. In terms of desserts and dairy products, preferences for cake icing, ketchup, and cheesecake were suggestively associated with higher IBS risk, while goat cheese-liking was marginally correlated with lower IBS risk. Additionally and suggestively, significant causal effects of IBS on increased preferences for globe artichoke and salami were also found in a reverse Mendelian randomization (MR) study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study revealed potential causal associations between food preference and IBS from a genetic perspective, which provides a dietary reference for such patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 5","pages":"270-278"},"PeriodicalIF":2.3,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141526096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0