Journal of Gastroenterology and Hepatology最新文献

Background and aim: Computer-aided detection (CADe) facilitates colorectal lesion detection, but it remains unclear whether CADe affects endoscopist's eye strain by altering gaze patterns. This study aimed to determine whether CADe-assisted colonoscopy is superior to conventional colonoscopy in reducing endoscopists' gaze-shift distance.

Methods: This single-center randomized controlled trial enrolled participants and randomly assigned them to two groups: first observation with CADe, then second observation without CADe (CADe-first group) in the ascending colon, or observations in the reverse order (conventional-first group). The endoscopist's gaze positions were recorded via a dedicated eye-tracking system. The primary endpoint was the endoscopist's gaze-shift distance within the first allocated group. The secondary endpoints were the gaze-shift distance based on CADe experience and eye strain, ascertained using a visual analog scale (VAS) score.

Results: Among 59 patients that were assigned to two groups (CADe-first, n = 30; conventional-first, n = 29), there was no intergroup difference in the gaze-shift distance (30.7 ± 10.7 pixels/30 ms vs. 32.7 ± 8.7 pixels/30 ms, p = 0.450). Among CADe-experienced endoscopists, the distance was significantly shorter in the CADe-first than in the conventional-first group (25.9 ± 3.4 pixels/30 ms vs. 29.4 ± 3.6 pixels/30 ms, p < 0.01), whereas no difference was observed among CADe-inexperienced endoscopists (40.3 ± 13.8 pixels/30 ms vs. 45.4 ± 11.1 pixels/30 ms, p = 0.463). The VAS score was significantly lower in the CADe-first than in the conventional-first group (3.2 ± 1.2 vs. 4.6 ± 1.5, p < 0.05).

Conclusions: CADe assistance did not significantly change the gaze-shift distance overall, but it reduced gaze-shift distance among CADe-experienced endoscopists. Thus, CADe may be associated with reduced eye strain, depending on the endoscopist's CADe experience.

Background: High antibiotic resistance and limited tetracycline accessibility severely restrict the clinical application of classic bismuth quadruple therapy (BQT), creating an urgent demand for alternative regimens.

Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science up to June 3, 2025, for trials comparing Helicobacter pylori eradication rates and adverse events between semisynthetic tetracycline-containing quadruple therapies and non-semisynthetic tetracycline controls. Statistical analysis was performed using RevMan 5.4.

Results: This meta-analysis included 11 randomized controlled trials (RCTs) and two retrospective studies (3667 participants). Semisynthetic tetracycline-containing regimens yielded significantly higher Hp eradication rates (per-protocol [PP] analysis: 91.8% vs. 85.6%; OR = 1.47, 95% CI: 1.08-2.00; p = 0.01) and fewer adverse events (32% vs. 39.2%; OR = 0.73, 95% CI: 0.56-0.94; p = 0.02). Minocycline-containing regimens were associated with a higher incidence of dizziness/headache (18.9% vs. 10.5%; OR = 2.22, 95% CI: 1.74-2.84; p < 0.00001). Subgroup PP analysis showed doxycycline-containing regimens outperformed controls (82.6% vs. 71.8%; OR = 1.56, 95% CI: 1.03-2.35; p = 0.04), and a 14-day course improved eradication rates (92.3% vs. 88.5%).

Conclusions: Semisynthetic tetracycline-containing regimens exhibit favorable efficacy and safety for H. pylori eradication, representing promising alternatives to traditional tetracyclines in clinical practice.

Gastrointestinal (GI) cancers remain a leading cause of cancer-related death worldwide, and many patients with advanced disease still respond poorly to standard treatments such as surgery, chemotherapy, and radiotherapy. Immune checkpoint inhibitors have changed the management of several solid tumors, but their benefit in most GI malignancies is limited by low tumor mutational burden, microsatellite stability, and "cold" tumor immune microenvironments. This has created interest in safe adjuvant agents that can boost antitumor immunity and improve responses to immunotherapy. Ginseng, a traditional medicinal herb, contains ginsenosides and polysaccharides with documented antitumor and immunomodulatory activities. Experimental studies in liver, colorectal, gastric, and esophageal cancer models show that selected ginsenosides can promote apoptosis, modulate DNA damage responses, inhibit angiogenesis, reshape inflammatory signaling, and downregulate PD-L1 or other resistance pathways. Ginseng-derived nanoparticles and liposomal formulations further suggest a role in drug delivery and microenvironment remodeling. At the same time, clinical experience from traditional Chinese medicine indicates that ginseng-based preparations may alleviate cancer-related fatigue, support host immunity, and enhance tolerance to chemoradiotherapy. However, the pharmacological targets, optimal combinations, and predictive biomarkers for ginsenoside-based adjuvant therapy remain poorly defined. Integration of systems pharmacology, single-cell technologies, and modern clinical trial design will be essential to clarify the role of ginsenosides as partners in immunotherapy for GI cancers.

Background and aim: Intestinal injury is a common complication following burn injury, increasing patient adverse outcomes. Hk2, a key glycolysis gene, promotes lactylation by raising intracellular lactate levels. While pyroptosis is crucial for intestinal homeostasis, its mediation by Hk2-induced lactylation remains unclear. This study elucidates how Hk2 regulates postburn intestinal injury via pyroptosis modulation.

Methods: BALB/c mice were exposed to a boiling water bath to induce a mouse burn model. Mouse intestinal epithelial cells were treated with lipopolysaccharide (LPS) to simulate intestinal injury in vitro. The role of Hk2 on LPS-induced mouse intestinal epithelial cells was evaluated by detecting cell viability, lactate dehydrogenase release, levels of inflammation, and pyroptosis factors and pyroptosis rate. The underlying mechanism was determined by quantitative real-time PCR, coimmunoprecipitation, and IP. Intestinal injury was evaluated by hematoxylin and eosin staining and measurements of inflammation factors.

Results: LPS promoted glycolysis and upregulated Hk2 in both models. Increased inflammation, pyroptosis, glycolysis, and histone lactylation caused by LPS were inhibited by Hk2 knockdown but enhanced by Hk2 overexpression. Exogenous addition of lactate reversed the inhibition of Hk2 knockdown on pyroptosis and inflammation in LPS-induced mouse intestinal epithelial cells. Mechanistically, Hk2 knockdown reduced the stability of the Gsdmc2 protein by decreasing its lactylation. Moreover, Hk2 knockdown improved survival rate, pathological changes, and inflammation of the intestine and downregulated Gsdmc2 in the mouse burn model.

Conclusion: Hk2 knockdown mitigated postburn intestinal injury by inhibiting pyroptosis through decreased Gsdmc2 lactylation, providing a theoretical basis for developing clinical treatment strategies for this condition.

Background and aim: Transcolonic endoscopic appendectomy is an emerging minimally invasive alternative to traditional appendectomy, offering potential benefits such as reduced postoperative pain, faster recovery, and avoidance of external incisions. The variable anatomical location of the appendix, however, influences both the surgical approach and technical difficulty. The appendiceal stump-defined as the residual portion of the appendix after prior appendectomy-poses a unique challenge, as the main body of the appendix has already been removed. This study aimed to evaluate the feasibility, safety, and efficacy of transcolonic endoscopic appendectomy for the removal of appendiceal stump lesions.

Methods: This retrospective study included patients who underwent the procedure between December 2020 and December 2024 after prior appendectomy for appendiceal remnant lesions. The primary outcome was technical success; secondary outcomes included postoperative complications, hospital stay, and recurrence.

Results: Nine patients (mean age 60.7 years; 4 males, 5 females) were included. Lesion size averaged 1.34 cm. Complete en bloc resection was achieved in all cases. Mean operative time was 70 min, with fasting and hospitalization durations of 3.4 and 5.8 days, respectively. No postoperative complications occurred, and 3-month colonoscopy showed no residual lesions or recurrence.

Conclusions: Transcolonic endoscopic appendectomy for appendiceal stump lesions is a safe and effective minimally invasive treatment option within experienced endoscopic centers. Due to their anatomical simplicity, these lesions represent a straightforward indication, making the procedure suitable as an entry-level application for endoscopists. Further investigation and structured training programs are warranted to assess long-term outcomes and broaden the generalizability of this technique.