Journal of Digestive Diseases最新文献_第8页

Efficacy and safety of probiotics, prebiotics, and synbiotics for the prevention of colorectal cancer and precancerous lesion in high-risk populations: A systematic review and meta-analysis of randomized controlled trials 益生菌、益生元和合成益生菌预防高危人群结直肠癌和癌前病变的有效性和安全性：随机对照试验的系统回顾和元分析

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-12-21 DOI: 10.1111/1751-2980.13247

Hao Xuan Kan, Yang Cao, Ye Ma, Yue Lun Zhang, Jing Wang, Ji Li, Jing Nan Li

Objectives

Colorectal cancer (CRC) is highly prevalent worldwide and is a leading cause of cancer-related death. Probiotics, prebiotics, and synbiotics have recently attracted attention as preventive measures against colorectal neoplasms. We aimed to analyze the findings of randomized controlled trials (RCTs) on the effects of probiotics, prebiotics, and synbiotics in patients at a high risk of CRC, outlining the challenges and future prospects of using probiotics to prevent colorectal tumors and providing evidence for clinical physicians in particular.

Methods

PubMed, EMBASE, and the Cochrane Library databases were searched for relevant studies published up to January 7, 2022. RCTs conducted on populations with a high risk of CRC who received probiotics, prebiotics or synbiotics in comparison with placebo, candidate agent or no treatment were included. The primary outcome was the incidence or recurrence of any colorectal neoplasms. Additional outcomes included their effects on the diversity of gut microbiota and relevant inflammatory biomarkers. Safety outcomes were also analyzed. Two authors independently screened and selected studies based on pre-specified eligible criteria, performed data extraction and risk-of-bias assessment independently.

Results

Nine RCTs were included in the systematic review and meta-analysis. Probiotic supplementation significantly reduced adenoma incidence, but no significant benefit was observed in CRC incidence. Additionally, probiotics modulated gut microbiota and inflammatory biomarkers.

Conclusion

Probiotics may have beneficial effects in the prevention of CRC. More RCTs with larger sample sizes are warranted to further confirm these findings.

大肠癌在全球范围内发病率很高，是导致癌症相关死亡的主要原因之一。最近，益生菌、益生元和合成益生菌作为预防结直肠肿瘤的措施备受关注。我们旨在分析和总结研究益生菌、益生元和合成益生菌对结直肠癌高危患者影响的随机对照试验结果，特别是概述使用益生菌预防结直肠肿瘤的挑战和未来前景，并为临床医生提供证据。

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引用次数: 0

Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures 内镜射频消融治疗恶性胆道狭窄的共识声明

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-12-21 DOI: 10.1111/1751-2980.13248

Digestive Endoscopology Branch of Chinese Medical Association, Digestive Endoscopy Professional Committee, Endoscopic Physicians Branch of Chinese Medical Doctor Association, National Clinical Research Center for Digestive Diseases (Shanghai)

Endoscopy-guided endobiliary radiofrequency ablation has emerged as a novel treatment for malignant biliary strictures in recent years. When combined with biliary stenting and systemic chemotherapy, it can effectively postpone local tumor progression, improve patient's quality of life, and prolong their survival, which is mainly indicated for patients with inoperable extrahepatic cholangiocarcinoma and ampullary cancer. Based on the existing clinical evidence, the Digestive Endoscopology Branch of Chinese Medical Association, the Digestive Endoscopy Professional Committee, Endoscopic Physicians Branch of Chinese Medical Doctor Association, and the National Clinical Research Center for Digestive Diseases (Shanghai) organized relevant experts to discuss the indications, contraindications, technical operation specifications, and prevention and treatment of the complications during endoscopy-guided endobiliary radiofrequency ablation. Consensus statements were established, trying to provide references for standard treatment of malignant biliary tumors in clinical practice.

内镜引导下胆道射频消融术是近年来治疗恶性胆道狭窄的新兴疗法。它能有效延缓肿瘤局部进展，改善生活质量，延长患者生存期，结合胆道支架置入术和全身化疗等，主要适用于无法手术的肝外胆管癌和膀胱癌患者。在现有临床证据的基础上，中国消化内镜学会、中国医师协会消化内镜专业委员会、国家消化疾病临床医学研究中心（上海）组织相关专家对内镜引导下胆道射频消融术的适应证、禁忌证、技术操作规范、并发症防治等进行了讨论。会议达成共识，为胆道恶性肿瘤的临床规范化治疗提供参考。

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引用次数: 0

Covert hepatic encephalopathy is associated with aggressive disease progression and poor survival in patients with cirrhosis 隐匿性肝性脑病与肝硬化患者病情恶化和生存率低下有关

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-12-18 DOI: 10.1111/1751-2980.13246

Jian Wang, Ming Jie Deng, Pei Mei Shi, Yu Peng, Xiao Hang Wang, Wei Tan, Pei Qin Wang, Yue Xiang Chen, Zong Li Yuan, Bei Fang Ning, Wei Fen Xie, Chuan Yin

Objectives

Covert hepatic encephalopathy (CHE) negatively affects the health-related quality of life and increases the risk of overt HE (OHE) in patients with liver cirrhosis. However, the impact of CHE on long-term patient outcomes remains controversial. This study aimed to explore the association between CHE and disease progression and survival among cirrhotic patients.

Methods

This was a single-center prospective study that enrolled 132 hospitalized patients with cirrhosis, with an average follow-up period of 45.02 ± 23.06 months. CHE was diagnosed using the validated Chinese standardized psychometric hepatic encephalopathy score.

Results

CHE was detected in 35.61% cirrhotic patients. During the follow-up, patients with CHE had a higher risk of developing OHE (log-rank 5.840, P = 0.016), exacerbation of ascites (log-rank 4.789, P = 0.029), and portal vein thrombosis (PVT) (log-rank 8.738, P = 0.003). Cox multivariate regression analyses revealed that CHE was independently associated with the occurrence of OHE, exacerbation of ascites, and PVT. Furthermore, patients with progression of cirrhosis were more likely to be diagnosed as CHE (log-rank 4.462, P = 0.035). At the end of the follow-up, patients with CHE had a lower survival rate compared to those without CHE (log-rank 8.151, P = 0.004). CHE diagnosis (hazard ratio 2.530, P = 0.008), together with elder age and higher Child–Pugh score, were risk factors for impaired survival in cirrhotic patients.

Conclusion

CHE is associated with disease progression and poor survival in patients with cirrhosis, indicating that CHE may serve as an independent predictor of poor prognosis among these patients.

隐匿性肝性脑病（CHE）会对健康相关的生活质量产生负面影响，并增加发生显性肝性脑病（OHE）的风险。然而，CHE 对肝硬化患者长期预后的影响仍存在争议。本研究探讨了CHE与肝硬化患者疾病进展和生存期之间的关系。

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引用次数: 0

Clinicopathological significance of intestinal metaplasia in endoscopically resected early gastric carcinoma 内镜下切除的早期胃癌中肠化生的临床病理意义

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-12-15 DOI: 10.1111/1751-2980.13245

Yu Qing Cheng, Xin Wen Zhang, Shao Hua Zhuang, Xiao Li Zhou, Qin Huang

Objective

To investigate the clinicopathological and prognostic significance of intestinal metaplasia (IM) in endoscopically resected early gastric carcinoma (EGC).

Methods

Altogether 136 consecutive cases with EGC resected by endoscopic submucosal dissection over 5 years were included and divided into the early gastric cardiac (EGCC; n = 60) and non-cardiac carcinoma (EGNCC; n = 76) groups. Goblet cell IM and subtypes were determined with histology and immunostaining. Recurrence-free survival (RFS) was compared among various IM groups.

Results

IM was identified in 128 (94.1%) EGC cases, including complete IM (n = 39), incomplete IM (n = 27), and mixed IM (n = 62). Incomplete IM was significantly more common in EGCC and exhibited a lower frequency of en bloc resection than the complete subtype. The frequency of synchronous or metachronous gastric tumor was significantly more common in EGCC with complete IM than in those with incomplete IM. Compared to EGC without IM, EGC with IM showed a significantly higher frequency of non-poorly cohesive carcinoma, en bloc resection, and non-eCuraC-1 grade. EGNCC with IM was significantly associated with negative resection margins and en bloc resection. The 5-year RFS was significantly lower in EGNCC patients with incomplete IM compared with those with mixed IM. The independent risk factors for RFS included tumor size >2 cm and eCuraC-1 grade.

Conclusions

Subtyping IM in EGC helped predict endoscopic resectability, prognosis, and risk of synchronous or metachronous gastric tumor. The significance of IM differed between EGCC and EGNCC. Large studies with longer follow-up are warranted to validate our findings.

研究内镜下切除的早期胃癌（EGC）中肠化生（IM）的临床病理和预后意义。

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引用次数: 0

Recent updates on pyroptosis in tumors of the digestive tract 消化道肿瘤焦亡的最新进展。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-12-07 DOI: 10.1111/1751-2980.13244

Ruo Han Wang, Bing Bing Shang, Shi Xi Wu, Liang Wang, Shao Guang Sui

Pyroptosis is an inflammasome-dependent form of programmed cell death that is mediated by caspases-1, -4, -5, and -11, and the gasdermin protein family. It is characterized by the rupture of cell membrane and the subsequent release of cell contents and interleukins, leading to inflammatory reaction and activation of the immune system. Recent studies have suggested that pyroptosis plays a role in the development of gastrointestinal tumors, impeding tumor generation and progression as well as providing a favorable microenvironment for tumor growth. In this review we outlined the current knowledge regarding the implications of pyroptosis in gastrointestinal cancers.

焦亡是一种炎性小体依赖性的程序性细胞死亡形式，由caspase-1、caspase-4/5/11和gasdermin蛋白家族介导。它的特点是细胞膜破裂，细胞内容物和白细胞介素释放，相关的炎症反应和免疫系统激活。近年来的研究表明，焦亡在消化道肿瘤的发生发展中起作用，既阻碍肿瘤的发生和发展，又为肿瘤生长提供了良好的微环境。这篇综述概述了目前关于焦亡在胃肠道癌症中的意义的知识，重点是提供对其发病机制和潜在治疗的见解。这篇文章受版权保护。版权所有。

引用次数: 0

Prognostic significance of organ failure and infected pancreatic necrosis in acute pancreatitis: An updated systematic review and meta-analysis 急性胰腺炎器官衰竭和感染性胰腺坏死的预后意义:最新的系统回顾和荟萃分析。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-11-30 DOI: 10.1111/1751-2980.13243

Wen Mo Hu, Tian Rui Hua, Yue Lun Zhang, Guo Rong Chen, Kai Song, Sayali Pendharkar, Dong Wu, John A. Windsor

Objectives

In patients with acute pancreatitis (AP), minimally invasive treatment and the step-up approach have been widely used to deal with infected pancreatic necrosis (IPN) in the last decade. It is unclear whether IPN has become a less important determinant of mortality relative to organ failure (OF). We aimed to statistically aggregate recent evidence from published studies to determine the relative importance of IPN and OF as determinants of mortality in patients with AP (PROSPERO: CRD42020176989).

Methods

Relevant studies were sourced from MEDLINE and EMBASE databases. Relative risk (RR) or weighted mean difference (WMD) was analyzed as outcomes. A two-sided P value of less than 0.05 was regarded as statistical significance.

Results

Forty-three studies comprising 11 601 patients with AP were included. The mortality was 28% for OF patients and 24% for those with IPN. Patients with OF without IPN had a significantly higher risk of mortality compared to those with IPN but without OF (RR 3.72, P < 0.0001). However, patients with both OF and IPN faced the highest risk of mortality. Additionally, IPN increased length of stay in hospital for OF patients (WMD 28.75, P = 0.032).

Conclusion

Though IPN remains a significant concern, which leads to increased morbidity and longer hospital stay, it is a less critical mortality determinant compared to OF in AP.

背景与目的:近十年来，在急性胰腺炎患者中，微创治疗和强化治疗已被引入并广泛用于治疗感染性胰腺坏死(IPN)。目前尚不清楚IPN是否已成为相对于器官衰竭(of)死亡率的一个不那么重要的决定因素。我们旨在统计汇总最近发表的研究证据，以确定IPN和of作为AP患者死亡率决定因素的相对重要性(PROSPERO: CRD42020176989)。方法:在MEDLINE和EMBASE中检索相关研究。这些估计值以基于结果类型的相对风险(RR)或平均差异(MD)表示。双侧P值小于0.05为有统计学意义。结果:13项研究包括11601例急性胰腺炎患者被荟萃分析。其中，28%的OF(2901例中814例)和24%的IPN(2108例中504例)死亡。四组患者的死亡率分别为:of +IPN+ 34.1%、of +IPN- 22.7%、of -IPN+ 5.2%、of -IPN- 0.9%。有OF且无IPN的患者的死亡风险明显高于有IPN且无OF的患者(RR = 3.72;95% ci: 2.02-6.84;结论:与of相比，IPN已成为死亡率的一个不那么重要的决定因素，但仍然是显著的发病率和住院时间延长的原因。这篇文章受版权保护。版权所有。

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引用次数: 0

Correction to “Autoimmune pancreatitis associated with inflammatory bowel diseases: A retrospectively bidirectional case–control study in China” 更正“与炎症性肠病相关的自身免疫性胰腺炎:中国回顾性双向病例对照研究”。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-11-28 DOI: 10.1111/1751-2980.13240

Yu ZQ, Bai XY, Ruan GC, et al. Autoimmune pancreatitis associated with inflammatory bowel diseases: a retrospectively bidirectional case–control study in China. J Dig Dis. 2023;24(8–9):452–460. doi:10.1111/1751-2980.13209.

In Funding information section, the funding number of National High-Level Hospital Clinical Research Funding should read as ‘2022-PUMCH-C-018’ instead of ‘PUMCH-C-018’.

We apologize for this error.

引用次数: 0

Diagnostic value of FibroTouch in identifying hepatic steatosis in NAFLD with MRI-PDFF as the reference standard 以MRI-PDFF为参考标准，纤维触摸技术对NAFLD肝脂肪变性的诊断价值。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-11-23 DOI: 10.1111/1751-2980.13242

Rong Mu, You Chen Xia, Kou Yun Zhu, Jing Yi Lu, Qian Luo, Lei Zhang, Ren Kun Lin, Xiao Bo Cai, Ying Qu, Lun Gen Lu

Objective

To estimate the performance of the FibroTouch-based ultrasound attenuation parameter (UAP) for assessing hepatic steatosis in nonalcoholic fatty liver disease (NAFLD), with magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference standard.

Methods

This prospective, cross-sectional study included 275 individuals in the training group and 110 individuals in the validation group, all of whom completed a standardized research visit, laboratory tests, MRI-PDFF, and UAP measurements over 1 month. Pearson correlation coefficient and Bland–Altman analysis were used to assess the agreement between UAP and MRI-PDFF for the detection of hepatic steatosis. The diagnostic value of UAP was evaluated by the area under the receiver operating characteristic (ROC) curve (AUROC). Confounding factors to UAP performance were identified by ROC curves and regression analyses.

Results

The AUROC of UAP for detecting MRI-PDFF at ≥5%, ≥10%, and ≥20% were 0.95 (95% confidence interval [CI] 0.92–0.97), 0.86 (95% CI 0.81–0.90), and 0.90 (95% CI 0.86–0.93), respectively, and their optimal thresholds were 259, 274, and 295 dB/m, respectively. The UAP measurements had higher diagnostic accuracy in participants with lower waist circumference (≤90 cm for men and ≤80 cm for women) compared to those with higher waist circumference (AUROC values: 0.97 vs 0.84, P < 0.05). Bland–Altman analysis showed good agreement between UAP and MRI-PDFF (bias 0.00021). According to established regression analyses, hepatic steatosis could be accurately diagnosed using UAP estimation.

Conclusions

FibroTouch-UAP has a high diagnostic potential for hepatic steatosis in NAFLD patients and helps clinical assessment and monitoring.

目的:以MRI质子密度脂肪分数(MRI- pdff)为参考标准，评价基于fibrotouch的超声衰减参数(UAP)对非酒精性脂肪性肝病(NAFLD)肝脏脂肪变性的评估效果。方法:这项前瞻性和横断面研究包括275名训练组和110名验证组，所有人在一个月的时间里完成了标准化的研究访问、实验室测试、MRI-PDFF和UAP测量。采用Pearson相关系数和Bland-Altman分析评估UAP与MRI-PDFF的一致性。通过受试者工作特征曲线下面积(AUROC)评价UAP的诊断价值。通过分析ROC曲线并完成回归分析，确定影响UAP性能的混杂因素。结果:在≥5%、≥10%和20%时检测MRI-PDFF的UAP AUROC值分别为0.95 (95%CI: 0.92 ~ 0.98)、0.86 (95%CI: 0.81 ~ 0.90)和0.90 (95%CI: 0.86 ~ 0.93)，其最佳阈值分别为259、274和295 dB/m。结论:FibroTouch-UAP对NAFLD患者具有较高的诊断潜力，有助于临床评估和监测。这篇文章受版权保护。版权所有。

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引用次数: 0

Development and validation of a scoring system to predict esophagogastroduodenoscopy necessity 预测食管胃十二指肠镜检查必要性的评分系统的开发和验证。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-11-16 DOI: 10.1111/1751-2980.13241

Jing Yang, Jing Shuang Yan, Cen Xi Xiong, Xiao Mei Zhang, Lei Shen, Jun Li Zhi, Shu Yun Ma, Hong Xia Dong, Yun Sheng Yang

Objective

This study aimed to develop and validate a scoring system for predicting the need for esophagogastroduodenoscopy (EGD) in clinical practice to enhance accuracy and reduce misapplications.

Methods

From February 2021 to April 2022, outpatients scheduled for EGD at the Department of Gastroenterology in our hospital were recruited. Patients completed the system evaluation by providing clinical symptoms, relevant medical history, and endoscopic findings. Patients were randomly divided into the training and validation cohorts (at 2:1 ratio). The optimal algorithm was selected from five alternatives including a parallel test. Six physicians participated in a human-computer comparative validation. Sensitivity and negative likelihood ratio (−LR) were used as the primary indicators.

Results

Altogether 865 patients were enrolled, with 578 in the training cohort and 287 in the validation cohort. The scoring system comprised 21 variables, including age, 13 typical clinical symptoms, and seven medical history variables. The parallel test was selected as the final algorithm. Positive EGD findings were reported in 54.5% of the training cohort and 62.7% of the validation cohort. The scoring system demonstrated a sensitivity of 79.0% in the training cohort and 83.9% in the validation cohort, with −LR being 0.627 and 0.615, respectively. Compared to physicians, the scoring system exhibited higher sensitivity (84.0% vs 68.7%, P = 0.02) and a lower −LR (1.11 vs 2.41, P = 0.439).

Conclusions

We developed a scoring system to predict the necessity of EGD using a parallel test algorithm, which was user-friendly and effective, as evidenced by single-center validation.

目的:本研究旨在开发并验证一种评分系统，用于预测进行食管胃十二指肠镜检查(ESD)的必要性，以提高准确性并减少误用。方法:在2021年2月至2022年4月期间，招募消化内科门诊预定进行EGD的患者。患者通过提供临床症状信息、相关病史和最终内镜检查结果来完成系统评估，这些被视为诊断的金标准。患者被随机分为训练组和验证组(2:1)。从包括并行测试在内的五个备选方案中选择最优算法。六名医生参与了人机控制的验证。敏感度和负似然比(-LR)作为主要指标。结果:共纳入865例患者，其中578例为训练队列，287例为验证队列。评分系统包括21个变量，包括年龄、13个典型临床症状和7个相关病史。选择并行测试作为最终算法。EGD阳性结果在训练组中为54.5%(315/578)，在验证组中为62.7%(180/287)。该评分系统在训练组和验证组的敏感性分别为79%和83.9%，相应的-LR值分别为0.627和0.615。与医生相比，评分系统表现出更高的敏感性(84% vs 68.7%， P=0.02)和更低的-LR (1.10 vs 2.41, P=0.439)。结论:我们开发并验证了一个评分系统，使用并行测试算法来预测EGD的必要性。单中心验证的结果表明，该系统是一种用户友好且有效的内镜前患者评估工具。这篇文章受版权保护。版权所有。

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引用次数: 0

Predicting the risk of variceal rehemorrhage in cirrhotic patients with portal vein thrombosis: A two-center retrospective study 预测肝硬化门静脉血栓形成患者静脉曲张再出血的风险：A Two-Center 艺术家作品回顾展学习

IF 3.5 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2023-11-11 DOI: 10.1111/1751-2980.13239

Shuo Zhang, Xuan Zhong, Hui Zhong, Lan Zhong, Jing Li, Feng Shang Zhu, Lu Xia, Chang Qing Yang

Objectives

Although portal vein thrombosis (PVT) was thought to deteriorate portal hypertension and contribute to poor prognosis, risk stratification remains unclear. This study aimed to evaluate its effect on the risk of variceal rehemorrhage and to develop a competitive risk model in cirrhotic patients with PVT.

Methods

Cirrhotic patients with and without PVT admitted for acute variceal hemorrhage were retrospectively included after matching (1:1) for age, gender and etiology of cirrhosis from two tertiary centers with 1-year follow-up. Those with PVT were subsequently divided into the training and validation cohorts. Cox regression analysis was performed to identify risk factors and develop a competitive risk model, of which the predictive performance and optimal decision threshold were evaluated by C-index, competitive risk curves, calibration curves and decision curve analysis.

Results

Among 398 patients, PVT significantly increased the variceal rehemorrhage risk. Multivariate Cox regression analysis identified that the Child–Turcotte–Pugh score (P = 0.013), chronic PVT (P = 0.025), C-reactive protein (P < 0.001), and aspartate aminotransferase (P = 0.039) were independently associated with variceal rehemorrhage, which were incorporated into the competitive risk model, with high C-index (0.804 and 0.742 of the training and validation cohorts, respectively), risk stratification ability, and consistency. The optimal decision range of the threshold probability was 0.2–1.0.

Conclusion

We confirmed the adverse effect of PVT on variceal rehemorrhage and developed a competitive risk model for variceal rehemorrhage in cirrhotic patients with PVT, which might be conveniently used for clinical decision-making.

背景和目的：尽管门静脉血栓形成（PVT）被认为会恶化门静脉高压并导致不良预后，但风险分层仍不清楚。本研究旨在评估其对静脉曲张再出血风险的影响，从而确定临床预测因素，并开发一个用于肝硬化PVT患者的竞争风险模型，来自两个三级中心的1年随访患者的年龄和病因，其中PVT患者被分为训练和验证队列。Cox回归分析用于识别风险因素，从而建立竞争风险模型，其中通过C指数、竞争风险曲线、校准曲线和决策曲线分析来评估预测性能和最佳决策阈值。结果：我们纳入398例患者，首次发现PVT可显著增加静脉曲张再出血的风险。然后，多元Cox回归分析发现CTP评分（P= 0.013）、PVT时间进程（P= 0.025），CRP（P结论：本研究不仅证实了PVT对静脉曲张再出血的有害影响，而且为PVT肝硬化患者建立了一个竞争风险模型，可方便地用于临床决策。本文受版权保护。保留所有权利。

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引用次数: 0