Journal of Gastroenterology and Hepatology最新文献

Background: Functional dyspepsia (FD) is a common gastrointestinal disorder that significantly impacts patients' quality of life. Over a decade ago, the Asian Neurogastroenterology and Motility Association (ANMA) and the Asian Pacific Association of Gastroenterology (APAGE) jointly developed the first Asian consensus report on FD. In this consensus report, members of ANMA and APAGE provide updated recommendations on the definition, diagnosis, epidemiology, pathophysiology, and management of FD, focusing on Asian populations.

Methods: The task force members conducted a systematic literature review and used a modified Delphi process to develop updated consensus statements. Based on members' feedback, statements that failed to reach at least 80% consensus in the first round of voting were revised. Revisions included rephrasing for clarity, incorporating additional evidence, and subgroup voting during a second round of discussion at a hybrid meeting.

Results: The task force developed 32 statements covering key aspects of FD. Major updates include new insights into the pathophysiology and emerging treatment options. The task force acknowledged that the limited scope and heterogeneity of available studies limit definitive conclusions about the utility of some emerging therapies such as probiotics and potassium-competitive acid blockers in FD management.

Conclusions: The second Asian Consensus Report on FD provides updated evidence-based recommendations to improve the diagnosis and management of FD in clinical practice, particularly in the Asian setting.

Background: Gastrointestinal (GI) cancers contribute significantly to the global disease burden, yet their impact on adolescents and young adults (AYAs; ages 15-39) remains understudied. This study aimed to quantify the global burden of GI cancers in AYAs and assess associated risk factors.

Methods: Data on GI cancers, including esophageal, stomach, colorectal, gallbladder and biliary tract, pancreatic, and liver cancers, were retrieved from the Global Burden of Disease (GBD) Study 2021. Socio-demographic index (SDI)-related disparities in incidence and death were analyzed using Spearman correlation and health inequality assessments. Temporal trends were assessed using average annual percentage changes, with future projections by 2045 made using Nordpred models. Risk factors contributing to GI cancer prevalence were evaluated.

Results: In 2021, GI cancers accounted for 156 033 new cases and 84 623 deaths among AYAs, with the highest burden observed in East Asia. Age-standardized incidence rate (ASIR) increased, whereas age-standardized death rate (ASDR) decreased with rising SDI levels. Males and individuals aged 35-39 experienced a heavier GI cancer burden. From 1990 to 2021, both ASIR and ASDR for GI cancers declined, with projections indicating further decreases by 2045. The prevalence rate of GI cancers was positively associated with risk factors, including elevated cholesterol, obesity, physical inactivity, tobacco use, and alcohol consumption.

Conclusion: Despite a global decline in GI cancer burden, substantial disparities remain across regions, sexes, and age groups. Risk factors continue to drive the GI cancer burden. Targeted policies and prevention strategies for high-risk groups are crucial to effectively reduce this burden.

Hepatocellular carcinoma (HCC) remains one of the most prevalent and lethal malignancies worldwide, characterized by late diagnosis, limited therapeutic options, and poor prognosis. Conventional systemic therapies such as sorafenib and its successors provide only modest survival benefits and are frequently complicated by toxicity and drug resistance. In recent years, immunotherapy has emerged as a promising avenue, yet its efficacy is often restricted by the profoundly immunosuppressive tumor microenvironment (TME). Within this landscape, exosomes-nanoscale extracellular vesicles secreted by tumor, stromal, and immune cells-have gained increasing attention for their central role in intercellular communication. They influence immune modulation, metabolic reprogramming, and therapeutic resistance, while also serving as potential biomarkers, nanocarriers, and vaccine platforms. Tumor-derived exosomes (TEXs) contribute to immune evasion by suppressing CD8⁺ T cells, polarizing macrophages toward protumoral phenotypes, and enhancing immune checkpoint resistance. Conversely, engineered exosomes demonstrate significant therapeutic potential by reprogramming TAMs, improving drug delivery, and acting as cancer vaccines. Despite these advances, challenges remain in exosome biogenesis, heterogeneity, large-scale production, and off-target effects, which hinder clinical translation. Furthermore, interactions between exosomes and gut microbiota in modulating hepatic immunity represent an emerging frontier with unexplored therapeutic implications. Continued advances in bioengineering, nanotechnology, and systems biology are expected to refine exosome-based therapies, offering novel, personalized strategies to improve outcomes for HCC patients.